A mandibular angle osteotomy is a cosmetic surgical procedure that alters the shape of the lower jaw. It involves the precise cutting and removal of bone at the angle of the mandible, where the jawbone turns upwards towards the ear. By modifying the bone structure, the operation creates a lasting change in the lower face’s appearance.
This surgery is a subspecialty of orthognathic surgery, which corrects jaw and face conditions. While many orthognathic procedures address functional issues like a misaligned bite, a mandibular angle osteotomy is performed for aesthetic purposes and is tailored to the patient’s facial structure.
Purpose of the Procedure
The primary reason for a mandibular angle osteotomy is aesthetic. Many patients feel their jaw is overly wide or “square,” and they desire a softer, more tapered appearance by addressing the bone at the posterior jawline.
A common goal is the creation of a “V-shaped” jawline, which is often perceived as more delicate. Removing bone from the mandibular angle narrows the lower face’s width when viewed from the front. It also reduces the sharpness of the angle seen in profile, creating a gentler slope from the ear to the chin.
The procedure is also an effective method for correcting facial asymmetry. If one side of the jaw is larger or lower than the other, a surgeon can remove different amounts of bone from each side to create better balance and harmony.
The Surgical Consultation and Preparation
The process begins with a consultation with a qualified plastic or maxillofacial surgeon where the patient discusses their aesthetic goals. The surgeon performs a physical examination of the face and jaw, assessing bone structure, masseter muscle size, and facial proportions. A complete medical history is also taken to ensure the patient is a safe candidate for surgery.
Advanced imaging is a standard part of preoperative planning. A three-dimensional computed tomography (CT) scan of the skull allows the surgeon to visualize the mandible’s shape, locate the inferior alveolar nerve, and determine the exact amount of bone to remove. Using specialized software, the surgeon can simulate the surgery and plan the osteotomy lines to achieve the desired contour safely.
Once the surgical plan is established, the patient receives instructions for the operation. Preparations include:
- Stopping certain medications and supplements, such as aspirin or anti-inflammatory drugs, that can increase bleeding.
- Ceasing smoking well in advance of the surgery, as nicotine can impair healing.
- Arranging for time off from work for recovery.
- Having someone available to assist during the initial post-operative period.
The Mandibular Angle Osteotomy Procedure
The surgery is performed under general anesthesia. The surgeon makes an incision inside the mouth, in the gum line near the back molars. This standard intraoral approach provides full access to the jawbone without creating any visible scars on the face.
Once the incision is made, the surgeon dissects through the soft tissues and lifts the periosteum, the membrane covering the bone, to expose the mandibular angle. Retractors are used to hold the cheek and other soft tissues safely out of the way. The masseter muscle, a large chewing muscle attached to the angle, is detached from the area to be resected.
Using the preoperative 3D CT scans as a guide, the surgeon marks the planned osteotomy line on the bone. A specialized instrument, such as a reciprocating saw or a piezoelectric tool, is used to make precise cuts through the bone and remove the targeted wedge.
After the piece is removed, the remaining edge of the mandible is meticulously smoothed and contoured with a burr to ensure a natural-looking transition. The same procedure is then repeated on the other side. Finally, the incisions inside the mouth are closed with dissolvable sutures.
Recovery and Healing Process
After surgery, the patient is monitored in a recovery room as the anesthesia wears off, and an overnight hospital stay is common for observation. Significant swelling and bruising are expected, typically peaking around the second or third day. An elastic compression garment is often worn around the head and jaw to help minimize swelling and support the tissues.
Pain management is an important part of the initial recovery, and the surgeon will prescribe medication for comfort. A strict diet is necessary due to the intraoral incisions. For the first week or two, patients are limited to a liquid-only diet, gradually progressing to soft, non-chew foods for several weeks to prevent strain on the healing jawbone.
Most patients plan to take one to two weeks off from work or school. Strenuous activities and exercise are restricted for at least four to six weeks to prevent complications and allow the body to heal. Follow-up appointments are scheduled to monitor healing progress and ensure there are no signs of infection.
Expected Outcomes and Potential Complications
The primary outcome is a permanent alteration of the lower jaw’s shape. While initial changes are noticeable once post-operative swelling decreases, the final aesthetic result can take several months to become fully apparent as all residual swelling gradually resolves.
As with any surgery, there are potential complications. A significant risk involves the inferior alveolar nerve, which provides sensation to the lower lip and chin. This nerve can be bruised or damaged during the osteotomy, leading to temporary or, in rare cases, permanent numbness in these areas.
Other potential complications include infection at the surgical site, which is managed with antibiotics, or asymmetry if the two sides of the jaw heal unevenly. There is also the possibility of patient dissatisfaction with the final aesthetic outcome. Choosing a highly experienced, board-certified surgeon is important for achieving a satisfactory result and minimizing these risks.