How Can I Fix My Left-Sided Mandibular Hyperplasia?

Q: Dr. Eppley, my surgeon  told me about Dr. Eppley, that he could possibly help me with my jaw asymmetry. I have hemi-mandibular hyperplasia on the left side. I attached a photo I took of one of my x-rays. I was wondering if it was even possible to “move” the “hole” on that side of my jaw, the mental foramen? Its placement is so low that a previous doctor couldn’t shave off enough bone to make it even with the other side. That is the after x-ray of when I had my jaw shaved. He was only able to shave off a few millimeters. Thanks for your help,

A: Like all mandibular hyperplasias all structures in the elongated side are lower, most pertinently the intrabony course of the inferior alveolar nerve whose exit from the bone is the hole to which you refer (aka mental foramen). The course of the nerve in the bone and the mental foramen are fixed structures that can not be moved unless one can accept permanent numbness of the lower lip on that side…which I doubt would never be a good tradeoff.

The key to attempting inferior border reduction on the elongated side is a preoperative 3D CT scan with nerve imaging from which the exact amount of bone that can be safely removed can be determined. ‘Eyeballing’ or guessing in surgery what is safe to remove is not the most effective strategy. Even by guessing what I think can be removed (see attached picture) it is more than just a few millimeters.

Dr. Barry Eppley

World-Renowned Plastic Surgeon