Combined Long-Curved Ostectomy in the Inferior Mandibular Border and Angle of the Mandible with Splitting Corticectomy for Reduction of the Lower Face

ArticleinAesthetic Plastic Surgery 35(3):382-9 · February 2011with10 Reads
DOI: 10.1007/s00266-011-9652-9 · Source: PubMed
In Asian countries, a square-shaped face is considered unattractive. Many operative techniques have been developed and reported for reduction of the lower face, including mandibular angle ostectomy and splitting corticectomy. Many surgeons have performed the operation in the angle region using one of the aforementioned techniques, which may not lead to effective results. This report mainly discusses the standard procedures of surgery. To overcome the drawbacks of conventional procedures and to perform ostectomy accurately, proper preoperative analysis and design were implemented for 159 patients with square-shaped faces. Based on a new type of classification and concepts for mandible reduction, long-curved ostectomy combined with splitting corticectomy was used for reduction of the lower face. A series of standard procedures was developed during the operative process. The majority of patients were satisfied with both their frontal and lateral appearances. The gonial angle and the mandibular plane angle were increased effectively. No major complications such as fracture or facial nerve damage occurred. Lip numbness occurred for 15% of the patients. The authors' series of standard procedures allows surgeons to perform accurate, safe, and reproducible ostectomy and to obtain reliable and stable effects.
    • "Therefore, several newly developed surgical techniques have been developed to overcome these limitations. In 2011, Shao et al. [11] used full-thickness, long, curved ostectomy from the mandibular border of the mandible below the mental foramen to correct the lateral profile, and mandible corticectomy to improve the frontal appearance. This surgical technique is not limited to the angle but extends to the mandible body and ramus. "
    [Show abstract] [Hide abstract] ABSTRACT: In Asian countries, patients with a square-shaped lower face want a narrow chin as well as improvements in the mandibular angle contour, which is called a "V-line shape." Currently, various surgical techniques have been developed for mandibuloplasty.
    Article · Jan 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Mandibular angle osteotomy is commonly used for prominent mandibular angle contouring. Because of difficult control of the line, shape, and amount of osteotomy, many complications such as asymmetry, undercorrection, overcorrection, and formation of a second mandibular angle after surgery occurred commonly. In addition, it is more difficult to implement osteotomy exactly the same as preoperative design in curved osteotomy owing to the arc-shaped osteotomy line. Therefore, further studies are needed to explore ways to make osteotomy accurately identical with preoperative design. In this report, a case of curved osteotomy guided by a stereolithographic template for unilateral prominent mandibular angle is described. We established the osteotomy line, the shape, and the volume with Mimics software for the right prominent mandibular angle; fabricated individual osteotomy template with computer-aided design/computer-aided manufacturing (CAD/CAM) technique; and performed curved osteotomy with the template. A secure fit of the template on the bone surface was found during the operation. Computed tomographic scan after the surgery revealed that bilateral mandibular angles were symmetric, that the right mandibular angle had a natural curve, and that the osteotomy line, shape, and amount were in accordance with the preoperative design. It is suggested that CAD/CAM template could guide curved osteotomy for prominent mandibular angle accurately, improve efficiency, and avoid complications in osteotomy.
    Article · May 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Background Various surgical options are reported to address the Asian 'squared face', characterized by a prominent mandibular angle (PMA) associated with an oversized chin deformity; but shortcomings lie in the requirement of multi-stage procedures with the risk of further revision surgery. We have developed a single-stage "Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG)" surgical technique to shorten the period of the surgical treatment and minimize the inherent surgical risks in the multi-staged procedures. Methods A retrospective study involving patients (n=36) presented with prominent mandibular angle and an oversized chin who underwent the operation described from 2010 to 2012 with at least 12 months of follow-up. The surgical and aesthetic outcomes were evaluated through clinical assessment, photography, imaging analysis including preoperative and postoperative patient satisfaction rates. Results All the patients were satisfied with the improvement in their appearance following surgery; specifically the 'smoothness' of the mandibular inferior border with no 'second mandibular angle'.The width of the mandible was reduced with G-G distance reduced from 119.9mm+/-3.9 to 109.7mm+/-3.5 (p<0.05). A significant preoperative and post-operative gonial angle (G-A) was found at the left (110.7°+/-9.6 vs 139.9°+/-11.5, p<0.05) and right side of mandible(111.3°+/-10.7 vs 140.7°+/-11.8, p<0.05). There was no iatrogenic inferior alveolar nerve or mental nerve injury and a stable aesthetic outcome beyond the first year. Conclusion We demonstrated favourable surgical and aesthetic outcomes with our single-stage en-bloc curved osteotomy surgical technique to reshape the prominent mandibular angle with a broad chin deformity with no increased in surgical risks but a high satisfaction rate and stable outcomes.
    Article · Oct 2014

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