Mandibular angle surgery process

I believe that many patients are unaware of the process of mandibular angle surgery. We must pay attention to the care methods of the mandibular angle and must follow the doctor's advice to make pre-operative preparations and post-operative care. We must cooperate with the doctor during the operation to reduce the side effects of the operation. Before the mandibular angle surgery, we cannot wear makeup when taking a head X-ray and before and after the surgery. We also need to take medicine according to the doctor's advice.

Preoperative precautions

1. Before mandibular angle plastic surgery, frontal and lateral X-rays of the skull should be taken so that the doctor can accurately determine the amount of bone to be removed.

2. Before mandibular angle plastic surgery, you should maintain a good mood, stay healthy and prevent colds.

3. Before the mandibular angle plastic surgery, you should undergo routine systemic examinations. You should stop taking aspirin, vitamin E, and other blood-activating drugs and blood-activating Chinese medicines two weeks before the surgery. Surgery should not be performed during menstruation.

4. You should take a shower, wash your face and remove facial makeup the day before mandibular angle surgery.

5. Do not smoke one week before mandibular angle surgery and do not drink alcohol three days before surgery.

Postoperative precautions

1. After mandibular angle plastic surgery, the patient must stay in the hospital for observation for 3-5 days.

2. After the mandibular angle surgery, the head mask should be bandaged for 5 to 7 days. It should not be removed without special circumstances. If it is removed, it should be bandaged in time, and attention should be paid to check whether the skin is damaged. If a drainage strip is placed in the oral wound, it should be removed 48 hours after the operation.

3. Do not use any type of supplements or medicines that may accelerate blood circulation, reduce coagulation mechanism, and affect wound healing, such as ginseng, aspirin, blood-activating drugs, weight-loss drugs, menstrual regulating drugs, etc. If necessary, consult the surgeon.

4. Eat liquid food for the first two days after mandibular angle plastic surgery, and try to avoid biting hard objects within one month; rinse your mouth after eating to keep your mouth clean

5. Do not perform facial cosmetic massage or rub the surgical area within three months after mandibular angle surgery.

6. The stitches will be removed 7 days after the mandibular angle surgery. After that, you can brush your teeth gently with a soft-bristled toothbrush.

Surgical method

Applied anatomy

The mandible is arched and consists of a horizontal mandibular body and a vertical mandibular ramus. The intersection of the mandibular body and the ramus is called the mandibular angle. The outer side of the mandibular angle is the masseter tuberosity, where the masseter muscle is attached. On the inner side is the pterygoid tuberosity, to which the medial pterygoid muscle is attached. During surgery, the tendon attachment at the mandibular angle must be fully stripped away. There are large individual differences in the size of the mandibular angle. The normal angle is 120°. There is no obvious large bone marrow cavity inside the mandible, which is mainly cancellous bone, and can serve as the anatomical basis for mandibular angle thinning surgery.

There is a mandibular pore at the upper and posterior center of the inner surface of the mandibular ramus. In adults, this hole is approximately equivalent to the mandibular plane of the mandibular molar, and is located lower in females. There is a mandibular nerve groove at the posterior and superior part of the mandibular foramen. The inferior alveolar nerve and vascular bundle enter the mandibular foramen through this groove, which is the injection site for intraoral block anesthesia of the inferior alveolar nerve. In front and below the mandibular foramen, there is a jaw bulge formed by the confluence of the coracoid process downward and backward and the medial condyle forward and downward. The buccal nerve, lingual nerve and inferior alveolar nerve pass through here from front to back. Injecting anesthetic at this bulge can anesthetize these three nerves at the same time and obtain anesthesia of the mandible, teeth and oral mucosa on one side.

Preoperative preparation

a. Take X-rays of the mandible in anteroposterior and lateral positions and curved sections as a reference for mandibular classification and osteotomy.

b. Ask the patient to face the mirror and cover the lower facial part to be removed with both palms. Analyze the type of mandibular angle hypertrophy with the patient, and reach a consensus on the surgical plan, including the range of bone removal and whether to remove the masseter muscle or buccal fat pad.

Mandibular angle

According to the appearance and X-ray of the mandible, the mandible is divided into three types:

a. Composite type: It has the characteristics of the first two types.

b. Ectropion type: (Viewed from the front) the mandibular angle is obviously tilted outward, and the distance between the mandibular angles exceeds the distance between the zygomatic bones.

c. Posterior protrusion type: (side view) the mandibular angle protrudes downward and backward, and the angle is usually less than 110°.