New Method for Removing Involuted Bony Fragment in Reduction Angleplasty of Mandible

Oriental women, in general, have prominent mandibular angles and short chins that are thought to be unattractive, square and muscular appearance. Therefore, mandibular ostectomy is one of the most common aesthetic facial bone contouring surgery in oriental and intraoral approach has been used commonly. After the angle ostectomy via intraoral approach, it is not easy for unexperienced surgeons to remove the involuted bony fragment due to the limited view and operation access. This report describes a new method for removal of involuted bony fragment in reduction mandibular angleplasty Thirty eights Case of reduction mandibular angleplasty has been operated from February 2003 to June 2005. We have experienced the involuted bony segment in 12 cases after angle ostectomy. We have adopted periosteal cottle elevator and 18 gauze spinal needle as new methods of extracting the involuted bony fragment. The institutes were used to push the involuted bone segment. We could easily extract the bony fragment with new methods involuted 12 patients mandibular angle within 5 minutes. No major complications were occurred.

Benign Mass after Reduction Mandibular Angleplasty

There have been various methods of reduction mandibular angleplasty. 21-year old woman with prominent mandibular angle and body was done curved angle ostectomy with tangential ostectomy. In operation, we had used bone wax for controlling of bone bleeding. After 1 year, the patient revisited to our clinic because she had a mass with tenderness on Lt. mandibular angle area. The mass had been gradually increasing in severity after reduction mandibular angleplasty. Computed tomography of the patient showed inflammatory lesion in Lt. mandibular angle area with focal cortical bony destruction and adjacent soft tissue thickening. After surgical removal of mass, clinical pathology revealed that the mass was chronic inflammatory fibrosis around foreign body(bone wax). The postoperative course was uneventful, the patient was satisfied for her shape. If possible we must avoid using a bone wax in reduction mandibular angleplasty, because bone wax can induce inflammatory reaction and fibrosis.

Clinical Experiences of Endoscopically Assisted Mandibular Angleplasty

The reduction mandibular angleplasty is one of the most common aesthetic facial bone contouring surgery in the Oriental and the intraoral approach has been used commonly. However this method has some disadvantages because of anatomical restriction of operation field. We performed therefore the reduction of mandibular angle with endoscopic assistance in 15 patients of mandibular angle protrusion. Thirty patients of mandibular angle protrusion were randomly divided into control group (n=15) who received classic ostectomy and study group (n=15) who received endoscopically assisted ostectomy. We compared two groups in operative times, size of incision, duration of postoperative accommodation and satisfactory rate of doctors and patients. Size of incision was assessed as smaller in study group who received endoscopically assisted ostectomy than that of control group who received classic ostectomy on student t-test (5.50 + /-0.65 versus 4.70+/- 0.56, p< or= 0.01). Duration of postoperative accommodation was also assessed as shorter in study group on student t-test (5.07+/- 0.80 versus 4.00+/-1.00, p< or =0.01). There was no specific difference between 2 groups for operative time on x(2)-test (97.33+/- 12.22 versus 97.33+/-12.80, p=1.00). Satisfactory rate of cosmetic appearances were similar according to patients and surgeons. The postoperative course was satisfactory with smaller size of incision, shorter duration of postoperative accommodation and similar operative time and satisfactory rate of cosmetic appearances according to both patients and surgeons.

Surgical Correction of Squared Mandibular Face

Many Oriental women have prominent mandibular angle and short chin, in other words, 'squared' mandibular face or 'boxy' face. That kind of face is considered to be unattractive and causes big cosmetic problems for those who want to have an ovoid or almond shaped face. A squared mandibular face often needs to be corrected by operative procedure. A reduction mandibular angleplasty by bony angle resection is one of the operative procedures, but it is not always an adequate method. The successful correction of squared mandibular face can be accomplished by horizontal facial reduction and/or vertical facial lengthening procedure. From March 1996 to March 2000, We had operated 117 patients. The patients were divided into 3 groups. Group I had prominent mandibular angle and/or massetric hypertrophy. Patients in this group were operated by reduction angleplasty with/without resection of masseter muscle. Group II had prominent mandibular angle, cheek and mandibular body. In this case, we applied reduction angleplasty, contouring of body, resection of buccal fat pad and/or masseter muscle. Group III had prominent mandibular angle with short face. We used methods used for group II and Le Fort I lengthening and genioplasty. Ancillary procedures were forehead lengthening and reduction maloplasty. Successful correction of squared mandibular face could be performed by accurate analysis of facial profile and reduction mandibular angleplasty with proper ancillary procedures for each group. The results were as follows: 1) We obtained successful correction of squared mandibular face with multiple horizontal facial reduction procedures, which reduced anterior and posterior facial plane. 2) In case of short face, we made better mid-low facial balance with vertical facial lengthening and horizontal facial reduction.