Q: I am interested in making my weak jaw look much stronger. My chin is very short and my lower face looks too small compared to the rest iof my face. The more research I do , the more I think I might have micrognathia (abnormally small jaw), and I don’t know that jaw implants would not be enough to make me look normal. I would have to make my jaw bigger through other means like surgery or appliances. All the maxillofacial surgeons I have talked to deny giving me surgery because they claim they only do surgeries for people who have bad bites/deformities etc. and not for people born with a genetically smaller face/jaw. My bite is normal and I have had orthodontics in the past. This is getting me really sad because I feel I have run out of solutions. I need to expand my lower jaw significantly before I get implants. What is a surgical or non surgical way to make the jaw significantly bigger? I am thinking about lower jaw expanders and then add your implants. Or possibly bilateral sagittal split osteotomies (BSSRO) to advance the jaw and then add your implants on top of them.
A: There is no mystery here or need to do research to figure out what you have. You have a short lower jaw…period. A short lower jaw = micrognathia. Your entire lower jaw can NOT be moved forward by orthognathic surgery or a BSSRO. You have to have a bad bite or Class II malocclusion to do so. Moving your lower jaw moves your lower teeth with it. You can do a BSSRO if you want to have a bite where you lower teeth sit in front of your upper teeth and they don’t fit or come together at all. Get the idea of ever moving your lower jaw out of your mind…..unless you want to spend 3 years in orthodontics to reverse your bite and prepare it for surgery by giving you a bad bite. Your lower jaw is so significantly short (> 15mms) that even the biggest chin implant will not provide ideal correction. This is why you need a CHIN OSTEOTOMY, most likely with a chin implant placed in front of the moved chin bone. There is no such thing as a ‘lower jaw expander’ nor are there any non-surgical treatment methods.Your only lower jaw options are jaw angle implants for the back and a chin osteotomy/implants for the front. Focus your attention on these considerations, rather than searching for something that doesn’t exist or can not be done on you. These are your only viable solutions
Dr. Barry Eppley
Can A Jaw Angle Implant Be Used To Give My Jaw Better Shape After A Fibular Free Flap Reconstruction?
Q: I have a problem with the shape of one side of my jaw. I had a fibular free flap surgery done several years ago as a result of an osteosarcoma tumor that was removed from my right bottom mandible. I have since recovered nicely from surgery and I now have dental implants. However, one thing that bothers me from the surgery is that my right bottom mandible is not in alignment with my left bottom mandible. My left mandible is defined and square whereas my right mandible is “heart-shaped.” Side pictures of me are especially embarrassing as well as the stares I get from strangers. What can be done to give me a more normal shape to the reconstructed side of my mandible?
A: Having dental implants placed into a mandible reconstructed with a fibular free flap suggests that you have had a very successful outcome. It takes good bone stock and alignment of the reconstructed jaw segment to the upper jaw to be able to get such dental reconstruction. I suspect that the deformity to which you refer is that you have no defined angle of the mandible on the reconstructed side. This can happen due to the take-off of the fibular graft from the ramus of the mandible. The joining of the fibular bone flap and the remaining mandibular ramus forms a new jaw angle. If this is not done at a 75 to 90 degree angulation, the jaw angle will be blunted or more obtuse. This can be confirmed by a panorex dental film, which you undoubtably have from your dental implant reconstruction, which shows the entire mandible and its shape from side to side quite clearly. This could be improved by the simple placement of a jaw angle implant. This would be best done through your existing neck incisions.
Dr. Barry Eppley
Q: I have a deficient jawbone on my right jaw. I had braces in my teens, but I never had the underlying jaw issue corrected (there is lack of bone on the entire side). My teeth are somewhat slanted to compensate for this (deficient ramus included), and I have a bit shorter jaw on one side. I saw your comment on the custom jaw implant. I have a CT scan and am curious as to the cost of the custom implant. This of course is a cosmetic procedure, and I don’t think I want to suffer another 2 years in braces and jaw surgery when potentially an implant will work out for what I want (especially since my teeth fit very well right now). It does not bother me much, but I could definitely benefit from having more structure to one side of my face, as my chin gives a pointy appearance due to the lack of jawline. What is the estimated cost of a full length jaw implant underneath the bone? I take it this is screwed in? If something goes wrong, can it be removed without damage to the nerves/muscles? Any risks 20 years down the line? Thanks.
A: What is have sounds very similar to a variation of hemifacial microsomia where the one side of the face is shorter than the other, particularly the lower jaw. This cases the bite (occlusion) to be canted upward, the chin deviates to the shorter side and the jawline/jaw angle is less full on that side. The first important question is whether a custom implant is really needed at all for improvement of the right jaw. A common approach is a chin osteotomy to move the chin point to the midline and an extended off-the-shelf jaw angle implant. This may well work fine for you and would obviate the added expense ($7500) for custom implant fabrication. Custom implants are invaluable when nothing else will work well, but more standard techniques with your jaw asymmetry problem may offer similar results.
Dr. Barry Eppley
Q: I read an article on jaw implants in which you wrote “In some cases, no available off-the-shelf chin or jaw angle implant can create the desired effect due to a patient’s unique anatomy or aesthetic needs. In this situation, a customized ‘wrap-around’ jawline implant can be made from a 3-D CT scan of the patient. These can be made as a single implant or in multiple units that can be inserted in pieces and assembled when next to the bone. This approach is particularly useful when the jawline needs to be vertically lengthened. (implant sitting on the bottom edge of the bone)” Can you go into detail about the process of the custom mandibular implant with the 3-D CT scan? And from that how that fits into someone who travels for the surgery?
A: While standard chin and jaw implants will work most of the time, there are some patients whose jaw problem is beyond conventional implant designs. There are also patients who have been successfully implanted but do not like the aesthetic outcome that has resulted. These ‘implant-deficient’ patients have either vertical jawline deficiency, extreme chin deformities or the desire to have a more exaggerated jaw angle prominence. In these cases, only a custom jaw implant will suffice.
The process of making a custom jaw implant begins with the patient getting a 3-D CT scan at a local hospital or x-ray facility. That 3-D mandibular data is then sent to a custom model manufacturer. (I use Medical Modeling, Golden, CO) That model is then sent to me where I will hand carve out of wax or acrylic the desired implant(s) shape. Once approved by the patient, it is then sent to an implant manufacturer who will manufacture and sterilize the final implant(s). It will then be shipped to me for surgical implantation. This entire process takes about 4 to 6 weeks to complete. For someone traveling from afar, they only have to make one visit for the actual surgery. All preparations can be done from afar.
Dr. Barry Eppley