How Can My Jaw Angle Implants Be Revised To Look Better?

Q: Dr. Eppley, I am a long-time reader of your blog and it has been a terrific resource over the years, so thanks for all the great work that you do!

I have a concern about the jaw angle implants I had placed about seven weeks ago. I wanted and thought I was getting Medpor “Angle of the Mandible Implants” with 5mm lateral projection and 10mm inferior projection but ended up with “RZ Mandibular Angle Implants” due to a major misunderstanding with my surgeon. The implants currently in place have a whopping 11mm of lateral projection and negligible drop-down. As you can see from my “after” photo, these implants extend well past my zygomatic arch, resulting in an “hourglass” shape that I don’t care for. My question is, if I swap out the implants I have for the implants I originally wanted, do you think (based on my “before” picture) that I will experience a similar version of the same problem–just on a smaller scale? In other words, do my high arches and thin skin doom me to that hourglass shape no matter what? My aesthetic goals are to 1) make my jawline flush with my arches and 2) achieve the drop-down effect available only with the “Angle of the Mandible Implants.”
Thank you so much for your time and consideration!

A: The current problem with your indwelling implants, besides the fact that they have too much lateral projection, is that they are malpositioned high up on the bone rather than wrapping around the lower border of the mandible. This then gives you closer to 15mms lateral projection because the implant is actually rotated 15 to 20 degrees of how it was intended to be positioned on the bone.

I think you can reach your goal by one of two implant approaches. A Medpor RZ style jaw angle implant is fine if it was the small 3mm lateral projection size. Or the Angle of the Mandible Implant (aka Ramus with inferior ridge) with 5mms lateral projection would also work. Both would need to be trimmed to fit but you need a surprising small amount of lateral projection to stay within your zygomatic arch width.

However, the use of these new implants will still create the same problem if they are not in proper position on the bone. Placing jaw angle implants that drop the angle vertically downward are technically difficult. All of the soft tissue must be released from the inferior border, including the tendinous attachment to the jaw angle, to allow the implant to sit in its intended position. Also, when jaw angle implants are placed at this level they are inherently unstable because they is never a precise implant to bone fit. (the shape of your jaw angle I can guarantee is different than the skull model from which the implants are made) This is why screw fixation is almost always needed to ensure proper implant positioning as half of the implant is not on bone.

The problem you have is one I see when the surgeon may be used to placing silicone jaw angle implants, none of which have designs to drop the jaw angle down. This is a much more simpler procedure which involves just sliding the implant along the bone surface, dropping it into place if you will. (this is why your implants look the way they do now)Placing vertically lengthening jaw angle implants is much more difficult to do and is further complicated by the frictional resistance of the Medpor material, further adding to the difficulty of the procedure.

Dr. Barry Eppley

Indianapolis, Indiana