External Approach to Jaw Angle Implants

Q: Dr. Eppley, I have been thinking about getting custom made jaw implants to compliment my cheek implants, but the ONLY thing that scares me is an infection. I am terrified of infections, which is why I had the cheek implants inserted through the eye lid.

Which brings me to this series of questions:

1. Would it be possible to have the jaw implant inserted from outside my face in order to dramatically decrease the chance of infection? 

2. Is this easier or harder on you compared to inserting from inside the mouth? I don’t want to make things harder on you since that increases the chance of things going wrong

3. Are there any risks associated with inserting them from the side of the face that I should know about? Maybe increased chance of nerve damage or something?

4. Have you ever done this before or would I be the first special case like this?

Sorry about all the questions, and thank you for your time.

A: I have done several times both primary insertion of jaw angle implants as well as secondary revisions of them through an external skin approach in men. In answer to your questions in that regard:

1) The external approach is done through a small skin incision right over the jaw angle area. See attached picture of scar.

2) Whether it is harder or easier than an intraoral approach depends on what material and implant style/size of jaw angle implant is being placed. To keep the incision small I would only use a silicone jaw angle implant for an external approach.

3) Other than the scar, the only other remote risk is marginal mandibular nerve injury. But the course of that nerve is lower than the level of the incision.

4) see #1 above.

Dr. Barry Eppley

Indianapolis, Indiana