Revision Surgery for a Square Jaw

 

1)     Reasons for considering revision surgery

Cases where there is little change in the lower facial contour after square jaw surgery

-       The contour of the face is not determined by the facial bones alone; it is also greatly affected by the soft tissues covering the facial bones (muscles, subcutaneous fat layer, and skin).

Therefore, even if the contour of the facial bones was not prominent, or if the muscles covering the facial bones were well developed, or if there was a lot of facial fat, the change in contour may not be very large even after reshaping the jawbone. Square jaw revision surgery

 

-       On the other hand, errors in the surgical method may be considered in the following cases.

If only a small portion of the angular area of the lower jaw is cut or shaved, there will be little change in facial contour, as shown in the figure below (Fig. 1). Square jaw revision surgery

 

In cases where the facial contour line after square jaw surgery looks unnatural Square jaw revision surgery

-       The facial contour should connect in a smooth curve. However, if the contour of the facial bones is shaved into an excessively steep straight line, or if a secondary angle is created at the point where it connects to the body of the lower jaw, the facial contour may look excessively unnatural, or instead of the face becoming softer after square jaw surgery, it may end up looking only longer (Fig. 2). Square jaw revision surgery

 

In cases where there is a large difference between the facial contours on both sides after square jaw surgery Square jaw revision surgery

-       Everyone has some small differences between the left and right sides of their facial contour. These differences are not caused by the facial bones alone, but are influenced by various complex factors such as the position of the temporomandibular joint, the length of the maxilla, and the condition of the soft tissues.

-       However, even when the contour of the lower jaw has been shaped unevenly due to technical surgical error, a large difference between the left and right facial contours may appear after square jaw surgery (Fig. 3).

 Square jaw revision surgery

 

 

2)     Preparation when considering revision surgery Square jaw revision surgery

-       Surgery that changes facial contour is performed through the inside of the mouth under limited visibility. In such intraoral surgery, it is desirable to perform the operation under general anesthesia for safety.

Therefore, it is necessary first to check whether the patient is in a health condition suitable for general anesthesia.

-       In the case of facial contour revision surgery, the procedure is intended to reshape bone contours altered by a previous operation. To establish an accurate surgical plan and to understand the expected results after the second surgery, it is necessary to carefully examine and analyze the condition of the deformed facial bones.

3)     Revision surgery method Square jaw revision surgery

 

In cases where there is little change in the lower facial contour after square jaw surgery

-       After analyzing the altered bone shape from the previous surgery, checking the location of the nerve running through the lower jaw, and reviewing whether there is remaining bone that can be further reduced, the remaining bone can be further contoured through the inside of the mouth (Fig. 4).

-       The technique itself is not more complicated or particularly difficult compared with doing it for the first time, so you can think of it comfortably.

 

In cases where the facial contour line after square jaw surgery looks unnatural Square jaw revision surgery

-       The most common situation is when, during the previous surgery, the lower jaw contour was shaved in a straight line, leaving a secondary angle in the area connected toward the front (Fig. 5).

-       In such cases, the area connected to the anterior body through the inside of the mouth — the newly formed secondary angle (figure) — can be smoothed out further.

 

In cases where there is a large difference between the facial contours on both sides after square jaw surgery Square jaw revision surgery

-       Even when square jaw surgery is performed, it is not possible to make both sides of the facial contour exactly the same.

However, it is natural to aim for a result that reduces the degree of difference between the two sides of the jawbone before surgery, and if the contour difference between both sides of the jawbone has become even more severe despite the surgery, it can be corrected only by smoothing it through revision surgery (Fig. 6).

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Square jaw revision surgery