Strategies of Mandibular Revision: A Retrospective Study of Revisional Mandibular Surgery for Unaesthetic Results of Previous Mandibular Reduction.

BACKGROUND

Mandibular reduction has been developed and popularized in Asia for decades. Despite the technical advancement and experience accumulation, complications and unaesthetic results still occur, and some need a revision surgery. This study aims to introduce the experience of revision surgery to reshape the unaesthetic mandibular contour after previous mandibular reduction.

METHODS

From May 2011 to September 2017, patients dissatisfied with the result of previous mandibular reduction and who received a secondary mandibular revision were retrospectively reviewed and analyzed.

RESULTS

Twenty-five patients were included in this study. Under-correction (88%, 22/25) was the most common aesthetic problem requiring revision, followed by asymmetry (56%, 14/25), broad chin (40%, 10/25), second mandibular angle (32%, 8/25), and over-correction (8%, 2/25). As revision techniques, long-curve mandibular reduction, simple mandibular reduction, and mandibular grinding were performed on 60% (15/25), 36% (9/25), and 4% (1/25) of the patients, respectively. All the patients were satisfied with the results. Cephalometric measurements indicated a significant bone removal after revision.

CONCLUSIONS

When performing a revision surgery to reshape the mandibular contour, the surgeon should have a clear surgical plan based on comprehensive evaluation, focus on the balanced harmony of the entire face, use proper technique and instruments, and avoid concomitant injury and complications. The one-staged technique that treats the whole mandible as an entirety is superior than multistaged techniques to improve the aesthetic outcomes to the largest extent.

LEVEL OF EVIDENCE IV

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