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

Abstract

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. 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. 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. 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.