「OPERATIVE STRATERGIES FOR MANDIBULAR ANGLEPLASTY」
世界美容外科学会2005 / 2005年11月 / 東京院 院長 広比利次
In Asia, mandibular angleplasty is a common procedure due to the fact that Asian people find prominent mandibular angles unattractive in appearance. Patients usually wish to improve their facial contours, especially those of the lower third of the face, and often ask for a more oval shaped face.
There is a lot of literature on mandibular angleplasty available today. However most of it focuses on the technical aspect of bone resection and little on the actual anatomy of the mandible. I found that angle osteotomy alone, is not enough to create the perfectly shaped face, as osteotomy only reduces the angle sharpness of the lateral view, and does little to improve the frontal view. After analyzing the anatomy of the lower third of the face, I came to the conclusion that to achieve optimal results, the whole mandible must be addressed and not only the mandibular angle.
During my career, I have performed over a thousand angleplasty operations and my technique has evolved steadily over time. While operating on my earlier patients I felt that they were not receiving satisfactory results. I realized that I had not fully understood the 3-dimensional anatomy of the mandible, so this led me to study it more deeply. After careful scrutiny, I came to the conclusion that it is vital that the frontal angle be reduced, and hence I started to develop my current technique.
Generally, my procedure has been broken up into two stages to achieve the desired results. The first stage is focused on sculpting the frontal view, and the second stage the lateral view. Corticectomy is performed in the first stage to reduce the thickness of the mandible in order to lessen the width of the lower face. In the second stage, mandibular smooth curved osteotomy is performed to reduce angle sharpness of the mandibular. We will only achieve the patient's desired shape if both techniques are done.
I would like to show you a technique that I have developed myself over the past few years in my clinic. By using specialized instruments that I developed myself, I am able to achieve optimal results. As you will see, these instruments can greatly help any surgeon create the desired shape.
The most difficult aspect of my procedure is removing a perfectly smooth curved piece of bone from the mandible. This is extremely important if a perfect shape is to be achieved. I will demonstrate how to use my instruments to extract a bone fragment with tapered ends, so that the jaw line levels off, leaving the mandible with a smooth natural surface. It is through this technique that the jaw will appear without any angles and therefore appear soft and natural.