Mandible Angle Resection

Overview

The extent of the mandible's outward protrusion distinguishes it from the neck and delineates the lower face. The mandibular angle and the chin are significant demarcation structures. The mandibular angle is the protrusion of the lower jaw in front of the ear's lowest section. The lower jaw's prominence frames the lower face. A comparable and proportionately pronounced mandibular angle is likewise desirable, just as high prominent cheek bones are linked with attractiveness.

The majority of individuals who seek mandibuloplasty want a slimmer jaw. Mandibuloplasty is more than only resecting mandibular angles to slim down the face; it is also a technique for sculpting an aesthetically beautiful lower face that integrates nicely with the upper and midfacial areas. To accomplish this, the general contour of the mandible must be examined, as well as genioplasty to produce an aesthetically acceptable lower face.

 

What is Mandible Angle Resection Surgery?

Male jaws are typically larger and taller than female jaws, with a sharp corner at the back. In a treatment known as "mandibular angle reduction," the rear corner of the jaw can be rounded off; bone can also be shaved off along the lower border of the jaw to reduce breadth and height, and the chewing muscles (masseter muscles) can be lowered to make the jaw look smaller.

Males have higher chins than females, and male chins are square with a flat base and two corners, whereas female chins are rounder. The chin's height can be lowered via bone shaving or a treatment termed a "slide genioplasty" in which a portion of bone is removed. Square corners are frequently shaved down. Liposuction is often done to remove some of the fat that some people have behind their chin.

The angle of the mandibular plane, the breadth of the chin, and the ratio of the length and width of the mandible are all important factors in achieving a smaller lower face. These elements must be taken into account while developing the surgical strategy. A narrowing genioplasty with a T-shaped bone segment excision can be performed to minimize the width of the chin. A resected bone piece from the chin or mandibular angle can be grafted to enhance the height of the chin while decreasing the breadth. A slender lower face can be sculpted by raising the mandibular plane angle, decreasing the breadth of the chin, and increasing the ratio between the length and width of the mandible.

Patients can begin eating normal foods the day following their mandibuloplasty, and we recommend gargling for two weeks. After two weeks, patients must begin practicing opening their jaws. Swelling around the chin area might remain for a long period, and the slimming effect is usually seen after 3 months.

Reduction angleplasty, also known as mandibular angle reduction surgery, is a cosmetic surgical technique used to change the look of a square-shaped face to a more delicate and feminine one. This surgical technique is successful in lowering the width of the lower face and transforming a square face to an oval or "V" shaped face by addressing the prominent body and angle of the lower jaw. To achieve face equilibrium, mandible angle reduction surgery is sometimes paired with other facial contouring treatments such as zygoma reduction, messeter muscle reduction, or genioplasty. Because mandible angle reduction surgery is frequently performed by an intraoral method, there is no visible scar on the outside.

Patients seeking mandibular angle reduction surgery typically want to improve their look, but they should not try to emulate the appearance associated with Caucasian facial characteristics. The preservation of ethnicity is still the cornerstone of this surgery, and patients should have reasonable expectations of the procedure.

 

Surgical Anatomy

The masseter muscle arises from the zygomatic arch's inferior border and medial surface and inserts extensively onto the ramus of the mandible and the coronoid process. The medial pterygoid arises from the lateral pterygoid plate and attaches into the ramus' medial side.

Both the masseter and medial pterygoid muscles (PS) have strong tendinous insertions at the inferior border of the mandible that cling to the periosteum and are commonly referred to as the PS. Again, sling disruption might result in soft tissue damage. Subsequent masseter contraction raises the disinserted border of the muscle, increasing not only the skeletonized area but also exaggerating the deficit by generating a soft tissue protrusion above it.

In a number of surgical procedures that involve exposure of the inferior border and angle of the mandible, the PS and masseter insertion can be purposefully or accidentally interrupted. An extraoral approach to the angle of the mandible always necessitates the division of the PS. An intraoral technique, on the other hand, might result in sling disruption.

Standard intraoral procedures for mandibular exposure employ a number of devices designed to promote masseter retraction and release in order to achieve surgical access to the inferior border of the mandible. The exposure along the buccal side of the jaw during split ramus osteotomy for mandibular advancement in orthognathic surgery necessitates separation of at least a piece of the masseter muscle.

 

Best Candidates for Mandible Angle Resection Surgery

• You must be over the age of 18 and in excellent health.
• Aesthetic surgery can help you look better.
• One of the most crucial variables is emotional stability.
• To produce a more feminine appearance, smooth the jaw and chin.
• Increasing the Jaw and Chin Position.

 

Preoperative Evaluation

• No aspirin 2 weeks before surgery
• Stop using vitamin E oil one day before surgery. Stop smoking two days after surgery and for a month thereafter.
• Inform your doctor if you have any major medical conditions.
• Stop eating and drinking after midnight the night before surgery.
• Before the process, be sure to shower, shampoo, and clean your brows. Makeup should not be worn. 

 

Surgical techniques

The procedure was carried out under general anesthesia with nasotracheal intubation. After injecting a local anaesthetic solution containing epinephrine, an incision was made in the mucosal membrane on the labial side of the buccal sulcus. Subperiosteal dissection was used to expose the lateral surface of the mandibular corpus and angle, after which the operating field was enlarged utilizing two types of retractors. Following an evaluation of the thickness of the excised bone fragment, an ostectomy of the marginal area of the mandibular corpus-angle was done, followed by a corticectomy.

 

Postoperative Care

Postoperative care is the treatment you receive following a surgical operation. The sort of postoperative care you require is determined by the type of surgery you had as well as your medical history. Pain management and wound care are frequently included. Immediately following surgery, postoperative care begins.

• Follow the postoperative instructions given carefully
• Head elevation especially when sleeping for 3-4 weeks
• Take the prescribed medications as instructed
• Cold compressive dressing around the lower jaw might be used for 3-7 days
• Regular mouth wash or gargle after every meal if there is any oral wounds
• Soft diet for 2-3 weeks
• Avoid strenuous physical activities for 3-4 weeks

 

Postoperative Recovery

It is critical to keep the head elevated for many days after Mandibular Angle Resection surgery to reduce postoperative edema. Some numbness and transient discomfort may continue for several days around the incision, although this may be managed with pain medication. The bruising and swelling that does occur will normally go away within a week. The bandages will be removed a day or two following the Mandibular operation. The stitches from the procedure are removed during the first two weeks, however this varies by case.

Normal work can be resumed after 10 days of recuperation from a Mandibular surgery. After the bandages are removed, you should be able to shower and wash your hair. However, intense exercise, such as jogging, bending, sex, or any activity that raises your blood pressure, should be avoided for many weeks.

Most obvious indications of Mandibular surgery should fade within a few weeks, and minor swelling and bruises are typically concealable with cosmetics. Do not be concerned if you initially feel exhausted and let down; as your body recovers and you begin to look better, you will feel better as well.

Once the surgical site has healed fully, patients are typically quite pleased with their new appearance. Patients sometimes do not know how much their Mandibular contributed to an older appearance until they saw their new, revitalized appearance.

 

Treatment after surgery during the first 7 days of Mandibular Angle Resection:

1. Removing Incisions within 5-7 days after surgery.
2. No heavy exercise 2 weeks after surgery
3. Scars are usually well hidden and normally fade in time
4. Swelling and bruising can be minimized by keeping the head elevated as much as possible during the first few days of recovery.

 

Complications

Complications are uncommon and typically mild; nonetheless, people differ widely in their anatomy, bodily responses, and healing ability. Surgery's outcome is never totally predictable.

1. Mental nerve symptom: To avoid this symptom, careful dissection around the mental nerve is essential. Most individuals who complain of numbness and tingling improve without therapy between 6 months to 2 years.
2. Stepping deformity: Following the rearrangement of bone flaps, a residual bony fracture might develop a secondary angle due to size disparity. To avoid this, the conspicuous part is rasped intraoperatively.

 

Post Op Expectations

Drains (tubes used to remove excess blood) may be removed during the second postoperative day following mandibular angle reduction surgery. The patient may have discomfort, numbness, bruising, and swelling around the lower jaw during the first healing period. These symptoms often subside after 3-4 weeks. To lessen the risk of infection and postoperative pain, oral antibiotics and analgesics will be provided.

 

Conclusion 

A broad jaw line provides a masculine or square facial aspect, which may be unfavorable in Asian girls. A prominent jaw line throws off the equilibrium of midfacial features, notably the nose and chin, by overwhelming the mid face. Reducing the jaw line provides balance and harmony to the face. Patients with a prominent jaw line may have a substantial muscle component, a bone component, or both. This condition's genesis is uncertain. However, several of these disorders have been linked to ethnicity, such as masseter muscular hypertrophy (jaw muscle overgrowth) as a result of persistent jaw clenching, teeth grinding, or nutrition.