Clinical effects of platelet rich fibrin in prevention of bleeding and swelling after mandibular angle reduction / 中华医学美学美容杂志

Objective To observe the clinical effect of platelet-rich fibrin (PRF) on prevention of postoperative hemorrhage and facial traumatic swelling in patients with mandibular angle osteotomy.Methods Twenty-five patients with mandibular angle hypertrophy were included in this study from January 2014 to November 2015.Split face comparative study was carried out to use the left and right sides as the experimental side and the control side,respectively.The PRF in the experimental side was placed in the mandibular osteotomy,while the control side was placed in platelet-poor plasma (PPP).After operation,the drainage volume and facial swelling degree were measured.Results The drainage volume of the experimental group (PRF group) was (20.35 ±7.40) ml,the control group (PPP group) was (43.23±11.96) ml,and the difference was statistically significant (P＜0.05).There was no such case without swelling in postoperative third day.The facial swelling score on the experimental side was (1.19±0.40),the control side was (2.62±0.64),and two groups of postoperative facial swelling scores were significantly different (P＜0.05).Conclusions The PRF can reduce postoperative bleeding and facial swelling after mandibular angle osteotomy.

The postoperative trismus, nerve injury and secondary angle formation after partial masseter muscle resection combined with mandibular angle reduction: a case report

A patient, who underwent partial masseter muscle resection and mandibular angle reduction at a plastic surgery clinic, visited this hospital with major complaints of trismus and dysesthesia. A secondary angle formation due to a wrong surgical method was observed via clinical and radiological examinations, and the patient complained of trismus due to the postoperative scars and muscular atrophy caused by the masseter muscle resection. The need for a masseter muscle resection in square jaw patients must be approached with caution. In addition, surgical techniques must be carefully selected in order to prevent complications, and obtain effective and satisfactory surgery results.

THE CORRECTION OF CLASS III MANDIBULAR ASYMMETRY USING BILATERAL SAGITTAL SPLIT RAMUS OSTEOTOMY AND LATERAL ANGLE REDUCTION

The cephalometric study of korean mandibular angle

The contour of mandibular angle is important for facial esthetics in the oriental population, because the wide and square face is thought to have had an unhappy life. A prominent mandibular angle produces a characteristics quardrangle, coase, and muscular appearance. So, uni- or bi-lateral mandibular angle reduction is usually performed. However, there is little guideline for bi-lateral angle reduction. So, this study was to investigate the pattern of Korean mandibular angle for bi-lateral mandibular angle reduction as guideline. This study was included 66 adult men and women over 19 years old who are having the normal mandibular angle. We measured the posterior border, angle, and inferior border of mandible using cephalometric view. The results of study was as followed : 1. The ratio of posterior mandible was 96.6, 97.3% in male, and 103.0, 106.0% in female. 2. The ratio of mandibular angle(R1-Go/R1-R2) was 120.2% in male, and 117.3% in female. 3. The ratio of inferior mandible(D5, 6, 7, E, F, G/D4) was 97. 3, 90.9, 79.5, 65.2, 57.8, 46.9% in male, and 98.5, 91.2, 80.5, 67.6, 59.1, 50.2 % in female. The results of this study should be useful to decide accurate amount of reduction.

Mandibular Angle Reduction By Selective Extraoral Approach

For the aeshetic contouring of prominent mandibular angle, conventional resection of mandible angle through intraoral approach has been used commonly. And the sagittal resection of lateral cortex is being performed recently to reduce the lower width of square face in some cases. That is to say, the prominent mandibular angle is meant by not only posteroinferior projection as well as lateral bulging. But intraoral approach corrects the former more efficiently than the latter because of limited operation field. And sometimes, the conventional resection of the mandibular angle yields obtuse, unnatural angle. Still more, postoperative complications such as bleeding, swelling, pain are inescapable. Through extraoral approach, authors were simultaneously able to accomplish precise, sufficient resection of angle and sufficient burring of lateral cortical bone without difficulty and complication. With the incision along relaxed skin tension line and meticulous everted sutures, scars are acceptable. One patient needed scar revision afterward. And so it is reported with review of literatures.

Facial Rejuvenation Surgery Combined with Malarplasty or Angleplasty

In general, Oriental people have thicker facial skin with more subcutaneous adipose tissues than Caucacian people. These differences result in characteristic Oriental aging face combined with squared facial contours. Conventional face lift essentially consists of facial wrinklinges and reducing flaccidity of facial skin but squared facial contouring is not considered. Flat and squared face can be improved by reduction malarplasty and mandibular angleplasty, thoses are the common facial bone contouring surgeries performed in the Orient. If patients, who have aging face, also have flat and squared face, it is necessary to be performed face lift and facial bone contouring surgery simultaneously. We have experienced 18 cases of patients with aging face and squared face who were operated face lifting procedures combined with maloplasty or angleplasty(from Apr.1997 to Mar. 2001). And We have satisfactory results on most patients(16 cases of patients were satisfied with results).

Pitfalls and Management of Mandible Angle Reduction

In general, orientals have a round and broad facial contour. In case of females with prominent mandible angles, the facial contour may look very square-like and unnatural with a masculine image. Recently, due to western aesthetic standards, there tends to be an increase of mandible angle reductions for an oval shaped face. The two methods for mandible angle reduction are curved horizontal ostectomy and angle splitting ostectomy depending on the layer of bone excision. The curved horizontal method may improve the lateral view of the patient but limited improvement is shown on the frontal view due to the lack of reduction of the mandible bone width. The angle splitting ostectomy improves the frontal view by decreasing the mandible bone width but there is limited change on the lateral view due to minimal change of the mandible angle contour. Currently, there are no specific protocols to determine the ideal operation methods for patients with prominent mandible angles. The authors measured the degree of mandible angles of 35 patients with prominent mandible angles and divided them into 3 types; severe 125. Patients with severe type angles showed best results with both operations combined due to not just the prominence of the angle but the width of the mandible bone. Patients with mild type angles obtained satisfactory results only with angle splitting ostectomy because they could have a natural lateral view. In case of moderate type angles, patients with angles closer to 105 should undergo curved horizontal ostectomy and those with angles closer to 125 should be operated with angle splitting ostectomy for satisfactory results.

Gonial angle reduction during mandibular sagittal split ramus osteotomy

A prognathic mandible and prominent gonial angle are considered to be unattractive in the Orient because it gives the face a square and muscular appearance. Requests for contouring of the mandibular angle are rare in the other race but are much more common in Korea and, through out the Orient. So, we often encounter a patient with a prognathic mandible and squarish or broad face who wishes to have his or her facial size reduced minimally or to acquire a round or slender appearance. But, mandibular angle is located in the deepest part of the operative field and the strong tension of the lateral soft tissue makes retraction difficult. It is extremely difficult to reduce the gonial angle with sagittal split ramus osteotomy by intraoral approach at the same time. We apply the method of gonial angle reduction during SSRO and had satisfactory results. We will present our results and hope to give some useful information for management of mandibular deformity.