Background: Jaw angle reduction is a well known surgery that is most commonly performed in Asian patients to narrow a wide lower face. The historic approach for this operation, and still one that is commonly performed, is that of an amputation technique of the jaw angle bone. By cutting off the jaw angle, the lower facial protrusion is eliminated and the lower face narrowed.
But jaw angle reduction surgery is not without its complications. Adverse aesthetic effects may develop such as overcorrection, asymmetry and loss of support of the jawline soft tissues. Patients may also develop surgical regret and wish to return to the original jaw angle shape.
Jaw angle implants would be the logical method to restore the bony anatomy from prior jaw angle reduction surgery. But standard jaw angle implants do not provide vertical jaw angle lengthening, a critical element in jaw angle restoration.
Case Study: This 40 year-old Asian male had his jaw angles removed over ten years ago. He tried to reverse the surgery six years later with standard Medpor jaw angle implants. They failed to create the effect he desired leaving his jaw angle still vertically and horiontally defiicient. Custom jaw angle implants were designed off of an original presurgical panorex x-ray where the jaw angle reduction surgeon had marked the lines of bone resection. A 3D CT scan was used to create the implant designs. The 3D CT scan can not visualize the Medpor material although the three metal screws used to secure the implant could be seen.
Under general anesthesia, his original intraoral incisions were reopened and his jaw angle implants exposed. The Medpor jaw angle implants were removed in pieces and the screws were chiseled out of the bone. The custom jaw angle implants were inserted after lower border capsulotomies to release the scar tissue. The new implants were secured with two 1.5 x 5mm screws placed with a percutaneous technique.
Jaw angle restoration from prior jaw angle reduction surgery is usually best done with custom made implants. This case illustrates that inadequate results are usually obtained using standard jaw angle implants. Vertical lengthening of the surgically altered jaw angles is the key to an adequate jaw angle restoration. New vertical jaw angle implants that will soon be available may work for some patients but it is hard to beat what custom jaw angle implants can do.
Highlights:
1) Jaw angle reduction surgery often amputates the jaw angles creating a vertical shortening and loss of soft tissue support.
2) Jaw angle restoration is frequently inadequate using standard jaw angle implants.
3) Custom jaw angle implants is the ideal method for jaw angle restoration after jaw angle reduction surgery.
Dr. Barry Eppley
Indianapolis, Indiana