Do I Need A Custom Jaw Implant For My Facial Asymmetry?

Q: I have a deficient jawbone on my right jaw. I had braces in my teens, but I never had the underlying jaw issue corrected (there is lack of bone on the entire side). My teeth are somewhat slanted to compensate for this (deficient ramus included), and I have a bit shorter jaw on one side. I saw your comment on the custom jaw implant. I have a CT scan and am curious as to the cost of the custom implant. This of course is a cosmetic procedure, and I don’t think I want to suffer another 2 years in braces and jaw surgery when potentially an implant will work out for what I want (especially since my teeth fit very well right now). It does not bother me much, but I could definitely benefit from having more structure to one side of my face, as my chin gives a pointy appearance due to the lack of jawline. What is the estimated cost of a full length jaw implant underneath the bone? I take it this is screwed in? If something goes wrong, can it be removed without damage to the nerves/muscles? Any risks 20 years down the line?  Thanks.

A: What is have sounds very similar to a variation of hemifacial microsomia where the one side of the face is shorter than the other, particularly the lower jaw. This cases the bite (occlusion) to be canted upward, the chin deviates to the shorter side and the jawline/jaw angle is less full on that side. The first important question is whether a custom implant is really needed at all for improvement of the right jaw. A common approach is a chin osteotomy to move the chin point to the midline and an extended off-the-shelf jaw angle implant. This may well work fine for you and would obviate the added expense ($7500) for custom implant fabrication. Custom implants are invaluable when nothing else will work well, but more standard techniques with your jaw asymmetry problem may offer similar results.

Dr. Barry Eppley

Indianapolis Indiana