Jaw Angle Implants and Mandibular SSRO Osteotomies

Dr. Eppley, I have read almost your entire website and have learned a lot about implants! Thank you for keeping it so up to date. I had jaw implants in 2010, didn’t like my results, but kept them in because I looked better than before. Though last year, I found out I have sleep apnea and need double jaw surgery. I have the option to have my jaw implants kept in (if they can manage), they may be able to trim them in the places where it’s very wide, or have them removed. My major concern having them removed is that it will look horrible underneath when the swelling goes does. I think having them trimmed maybe the best option. I have attached my before and afters. In your expertise and experience could tell me what you would advise? Thank you so much for your time.

A: The question you are asking is whether at the time of your sagittal split ramus osteotomy (SSRO) of the mandible to move your jaw forward, should the jaw angle implants be put back in to not. (whether they are trimmed down or not. Clearly they will initially have to be removed as the first step in surgery to access the mandibular ramus to cut the osteotomy, move the distal mandibular segment forward and fix it in place with a plate and screws. At that point should the implants be put back in before the wound is closed?

While their are obvious aesthetic advantages in doing an immediate replacement jaw angle implant surgery, the question comes down to the risks in doing so. The risk is that of an infection occurring over the proximal mandibular ramus site which has been partially devascularized to do the osteotomy. Should that happen you could end up with osteomyelitis of the jaw…which would be a devastating complication to say the least. The odds are that it might not happen and all would heal well. But in the uncommon event it does happen it would be the biggest regret of your life.

In short, like many choices in surgery and life, it is all about how you want to ‘gamble’ so to speak. A second surgery to put new jaw angle implants six months later would be a safer bet than the risk of jaw infection and osetomyelitis. In my opinion it just isn’t worth the risk and paying an implant over and around a fresh osteotomy site which requires fairly wide subperiosteal undermining.

Dr. Barry Eppley
Indianapolis, Indiana