A modified intraoral and extraoral approach osteotomy for the prominent mandibular angle.

BACKGROUND: A prominent mandibular angle (PMA) is a relatively common condition in Asians, and surgeons typically use the intraoral approach to treat it. However, the approach can have many drawbacks due to the limited operative field and view. The procedures of osteotomy are not easily manipulated, and an exact resection is difficult. In addition, some major complications can easily occur. This article presents a modified osteotomy method for the PMA that avoids these disadvantages and makes the procedure easier to execute. METHODS: Four modifications of the procedures have been made: 1. The addition of a small extraoral incision in the auriculocephalic sulcus behind the earlobe; 2. A modest reduction in both the intraoral incision length and excessive mouth traction; 3. The use of a reciprocating saw through the extraoral incision tunnel to simplify the operative procedure; and 4. Extraction of sustained-suction drains from the extraoral incision. Postoperatively, all patients were followed up and administered the validated satisfaction questionnaire and the Patient Scar Assessment Questionnaire. RESULTS: From June 2010 to June 2015, 46 patients with a PMA underwent surgery using this method. All patients were satisfied with the esthetic results. The majority of patients could not feel an objectionable jaw line or bony step (86.9%), visible deformity (97.8%) or bony regrowth (95.6%). All patients noted a positive psychosocial influence. All patients perceived the overall appearance of their extraoral scar to be "good" or "excellent." Forty-five (97.8%) were "not at all" self-conscious of their scar. The overall complication rate was 6.5%, and no major complication was seen. CONCLUSION: The described method for the surgical treatment of PMA is a simple and safe procedure with fewer complications. The procedure is easy to perform, consumes less time, and can help resect the PMA accurately and easily.

Patients offered orthognathic surgery: why do many refrain from treatment?

AIM: To examine factors associated with patients' decision to decline surgery. MATERIAL/METHODS: Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires. RESULTS: Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p < 0.001). The most prevalent reasons for declining surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance. CONCLUSION: Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment.

Reduction genioplasty enhances quality of life in female patients with prognathism and maxillary hypoplasia undergoing bimaxillary osteotomy.

The structure of the chin determines facial attractiveness and is directly linked to quality of life (QoL). In patients with prognathism and maxillary hypoplasia, bimaxillary osteotomy (BIMAX) with mandibular setback does not always lead to a more slender chin or improved aesthetics. The aim of the present study was to evaluate whether QoL differed between females undergoing BIMAX alone (group I; n=30) and those undergoing BIMAX combined with reduction genioplasty (group II; n=30). Presurgical and postsurgical evaluations included cephalography, photogrammetry, and the Oral Health Impact Profile with one additional domain (aesthetics). Setback of the hard tissue pogonion was significantly greater (P=0.006) in group II (7.1mm) than in group I (2.7mm). Only in group II were soft tissue pogonion changes highly significant (P<0.001), amounting to a mean of 5mm. In both groups, the QoL domains 'social disability', 'psychological discomfort', and 'dissatisfied with aesthetics' changed significantly towards lower impact scores. Changes in the latter two domains were significantly greater in group II patients than in group I patients (P=0.021; P<0.001) and were correlated with changes in the soft tissue pogonion in the horizontal (P=0.024; P=0.022) and vertical directions (P=0.037; P=0.042). Genioplasty addresses both psychological and aesthetic concerns, and therefore significantly enhances postsurgical QoL.