The Importance of Remodeling the Physiological Mandibular Angle: Mandibular V-Line versus Long Curved Ostectomy.

Background: Numerous surgical options for correcting prominent mandibular angles in East Asian patients have been reported. The objective of this study was to investigate the importance of remodeling physiological mandibular angle by comparing the surgical effects and complications of mandibular V-line ostectomy and long curved ostectomy.

Methods: A retrospective study was conducted on patients who underwent either mandibular V-line ostectomy (group 1) or long curved ostectomy (group 2). The outcomes were evaluated using computed tomography images in combination with medical records and photographs. Data were collected preoperatively and at 6- to 12-month intervals postoperatively. Mandibular angle, posterior mandibular ramus height, radian of the ostectomy line, and mandibular symmetry, as well as complications, were investigated. FACE-Q reports of facial appearance and psychosocial measures were also compared between the 2 groups.

Results: All 106 patients showed improved lower facial contours. Although the postoperative mandibular angle (116.67 ± 7.14 versus 118.31 ± 6.80 degrees; P = 0.233) and mandibular symmetry (2.36 ± 1.21 mm versus 2.56 ± 1.19 mm; P = 0.395) were similar in the 2 groups, larger postoperative posterior mandibular height and lower radian of the ostectomy line were observed in group 1 ( P < 0.001). Physiological mandibular angle was also remodeled in group 1. The gonial deficiency, more soft-tissue sagging, and significantly lower FACE-Q scores for facial appearance were observed in group 2 ( P < 0.001).

Conclusions: V-line ostectomy is better suited for achieving a more physiological mandibular angle with fewer complications compared with mandibular long curved ostectomy. V-line ostectomy may be the preferred option for mandibular contouring.

Clinical Question/level Of Evidence: Therapeutic, III.