Jaw angle augmentation has become an increasingly popular facial implant procedure. While done more in men to enhance an overall weak jawline, it is even done in females who have thin lower faces and lack of any jaw angle width. While historically jaw angle implants only added width to the back part of the jaw, it is now recognized that vertical lengthening of the jaw angles is often needed as well in many patients. This has led to two jaw angle implant types, width only and combined width and vertical lengthening styles.
Regardless of jaw angle implant type, they are usually placed as pairs and their positional symmetry becomes an important part of the aesthetic result. Because the implants are usually smooth (silicone), assuring their position on the bone (and often partly off it to length the angle) is important as any instability can lead to displacement. One simple technique to secure implant position, and the most common one that I use, is single screw fixation. Placed percutaneously, a single 1.5mm screw placed through the implant into just the outer cortex of jaw angle bone is usually sufficient to secure its position.
But in some jaw angle implant cases, particularly those which have suffered implant displacement, an even more secure form of fixation is needed. Jaw angle implant displacement is always superiorly, up and away from its lower desired position over the angle. With healing an enveloping capsule develops around the implant which must be opened or removed to permit it to be positioned in its lower desired position during a revisional procedure This leaves a large upper space into which an unsecured implant can become displaced back into it during the healing phase.
One absolute secure fixation method for jaw angle implant revision is the ‘flange’ technique using a matrix or grid type fixation plate. By securing the upper end of the metal plate just above the implant with 1.5mms screws, the lower end of the plate overlaps the jaw angle implant essentially pinching against the bone. The upper end of the plate prevents the implant from ever riding up again out of place.
Dr. Barry Eppley
Indianapolis, Indiana