Jaw/Mandibular Angle Contouring Surgery
- Prominence of the lower jaw or mandibular angle, which makes the face square with masculine look, is considered to be unattractive for females as well as transsexuals.
- The shape of lower jaw in female tends to have a more gradual curve.
- The concept of surgery is to coutour the mandibular angle to be small, smooth and sloping.
- The cause of prominence of the mandibular angle comes mainly from the bony part rather than from the cheek muscle.
- I normally do not reduce the amount of cheek muscle as this will have an effect on your chewing ability and prolonged swelling.
Preoperative assessment
- The amount of the muscle is estimated through physical examination. The exact amount and line of bone resection is determined through clinical examination and specific X-ray views.
Surgical technique by intra-oral approach
- The procedure is done under general anesthesia.
- The incisions are made along the sulcus between gum and cheek mucosa to access the prominent areas of jaw bone.
- A template model from X-ray film is used to determine the line of bone resection, started from the most back area of the angle, down to the angle with a smooth natural curve, and forward to join with the chin area.
- The marked area of prominent bone is cut with surgical drill and micro-saw, curving down from back to front, to achieve the best rounded contour without stepping.
- Small surgical tube is placed inside the wound and comes out through the skin at the level of your previous jaw line and will leave some mini-scar (0.5cm), which will be nearly invisible soon.
This is very important to prevent any potential blood collection and shorten the period of postoperative swelling.
- All stitches are self-dissolving.
Possible complication
- Bleeding and prolonged swelling:
- Bleeding usually comes through the surface of resected bone and becomes hamatoma (large blood clot in the wound). However, the use of surgical drains and facial pressure garment will significantly reduce this risk.
- Infection:
- Infection is an uncommon risk. Prophylactic antibiotics is routinely administered pre and postoperatively. After the intra-oral surgery, you need to clean your mouth with a provided mouth wash solution. Nothing must be taken orally for at least 24 hours.
- Asymmetry or over-resection:
- A careful preoperative assessment, x-ray template and a complete set of fine surgical instruments can help prevent such problems.
- Injury to the sensory nerves and the nerves that control facial muscle
- The sensory nerve is well protected in the bone and rarely injured if the line of bone resection is not extended to the course of the main nerve. However, it is not unusual to get temporarily numbness along the incision line or around the lower lip.
If the nerve, which control the function of the expression muscle around the mouth is injured, facial palsy may happen either temporary or permanent. Since the nerve located underneath the skin, in my opinion, to access the bone from inside the mouth is more safe and can significantly reduce the chance of nerve injury.
Temporo-mandibular joint injury or fracture around the joint
If the line of resection is accidentally extended to the joint, it may cause limitation of open mouth or malposition of the teeth contact (occlusion) and the intermaxillary fixation would be needed to stabilize the fracture site or injured joint.
Fortunately, this injury is extremely rare when performed by experienced plastic surgeon.
