Your Questions

Q: Dr. Eppley, I am interested in jaw asymmetry correction. I was referred to you by a friend and I would like to consult you over my concern. I have a slightly asymmetrical face with a swelling on the right side of my face. Based on the scan my right mandible is longer than the left side while it is more bended (curved) than left as well. To me the chin misalignment is not a big issue and doesn’t have that much impact on my look but rather the swelling on my right side of face is very noticeable and unpleasant. So my main concern is just getting rid of the swelling on the prominent side with the least manipulation on my face. Please note that I am not looking for a perfect face. More of a normal face is what I am asking for. I was wondering what options I have here to just get rid of swelling?

A: Thank you for your inquiry and sending your picture. What you refer to as right jawline swelling is not really swelling. This is reflection of your lower jaw asymmetry due to how it developed. As you appear to have had a CT scan it shows that the right jawbone is bigger and longer than that of the left side. This will also include the overlying soft tissues as well. In essence your entire lower jaw is shifted during development of which also consist of chin asymmetry and a left jawline/facial ‘shortness’.

It would be helpful to see the CT scan and hopefully it was a 3D type. But having seen many such jaw asymmetries before, the treatment approach is fairly straightforward. In an ideal world I wish just reducing the larger jaw on the right side would straighten out your face and give it substantial better symmetry. But this is unlikely to happen by itself. The reason is that you can not reduce the larger bone enough to make a big difference. (there are teeth and nerves in the bone so that is a limiting factor as to how much bone can be reduced) In addition it is not possible to reduce  any of the thickness of the overlying soft tissues as it contains muscle and branches of the facial nerve.

For these reasons this is why many jaw asymmetry corrections must employ a ‘triple point’ approach. This means all three points of the jaw (chin and two jaw angles) are treated. Reducing the right jawline, straightening the chin and augmenting the left jaw angle provides the best method of jaw asymmetry correction. Even with this approach perfect lower facial symmetry is not usually possible. But it is usually the best approach to mask the lower facial disproportion which now exists.

In short, you have three options:

1. Right jawbone reduction with the understanding that it will only produce a modest improvement,
2. Right jawbone reduction and left jaw angle augmentation since you have stated that you are not bothered by the chin asymmetry, and
3. Right jawbone reduction, left jaw angle augmentation and a leveling chin osteotomy for straightening.

With each treatment option the degree of jaw asymmetry improvement increases.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have jaw asymmetry as a result of a prior fracture. My idea for the jaw was to break just the mandible in and reposition it as it originally had been before the trauma with a little added refinement. I already had wires/braces and even though it sucked, I don’t mind going through it again for better results. I was also wondering if you could give me a breakdown of the total that a mandibular osteotomy to restore the jaw to its original form would cost with braces, surgeon fee, anesthesia, and facility. Thank you.

A:  When trying to improve jaw asymmetry, the choice of a mandibular osteotomy must be considered very carefully. The reason to go through a mandibular bony repositioning through ramus osteotomies is because of either an existing malocclusion or an occlusal cant with an open bite or a cant with an otherwise good occlusion. The first step is to consider whether a mandibular osteotomy is worth the effort by getting an evaluation by an orthodontist. This is a decision ultimately based on its effect on the occlusion and only secondary on the shape and position of the mandible

But for the sake of discussion, let’s say it is a worthy procedure. This will require 6 to 12 months of orthodontic preparation and 5 months or so of  after surgery orthodontics. A cost estimate would need to come from an orthodontist but we’ll use the general figure of $5,000. The cost of a  mandibular sagittal split osteotomy include surgeon’s fee, operating room and anesthesia with an overnite stay would be in the range of $ 17,000 to $19,000. For an over $20,000 investment, one needs to be absolutely certain that the end result justifies this effort.

If this degree of effort is deemed excessive, then there are other camouflages procedures for jawline enhancement such as implant, bony shaving and reductions and chin osteotomies.   

Dr. Barry Eppley

Indianapolis, Indiana