Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Jaw Angle Deformity after Sagittal Split Osteotomy


sagittal split mandibuar osteotomyThe sagittal split mandibular ramus osteotomy (SSRO) is the most commonly performed osteotomy of the mandible. It is done to either move the lower jaw and its attached teeth either forward or back to correct dentoalveolar deformities and bring the teeth into a better interdigitating relationship. It is a very cleverly designed osteotomy that splits the ramus of the mandible in a sagittal dimension into inner and outer cortical halves. One of the most important maneuvers during its execution is to avoid injuring the inferior alveolar nerve that runs through the bone.

In looking at diagrams of the bone put back together and even early after surgery x-rays, there is a smooth inferior border between the proximal and distal segments. One of the key elements during surgery is to ensure there is good alignment along the inferior border in most cases.

Jawline Irregularities after Sagittal Split Osteotomies Dr Barry Eppley IndianapolisDespite this bony alignment during surgery it is not rare that long-term healing leads to notching along the once smooth inferior border. Thus undoubtably occurs due to some bone resorption from partial devascularization to the outer half of the bone. The outer bone segment has had the masseter muscle stripped off during the procedure, and in conjunction it being split away from its inner half, it has become partially like a free bone graft near the anterior vertical bone cut.

Such notching along the inferior border can be an insignificant issue or can causeĀ  a visible external deformity. I have observed it numerous times in the creation of custom jawline implants and has often been a reason for the implant to recreate a visible and well defined jaw angle shape. Between creating better jaw angle shape and improving the notching the lies anterior to it, a custom implant design may be need in any cases.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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