Reconstructing the New Aesthetic Mandibular Angle With Two-Crossed Ostectomy at the Inferior and Posterior Margin of the Mandible

Background: Several operative procedures have been introduced to reshape the aesthetic mandibular angle, but unaesthetic results have occurred now and then. Most studies focused only on the facial shape in frontal view but not on the new gonion angle and gonial position in lateral view. The authors describe a new and satisfactory surgical method of mandibular angle contouring to reconstruct the new aesthetic mandibular angle and reshape an oval face for the excessive prominence of the mandibular angle. Patients and Methods: The surgery was carried out with the two-crossed ostectomy at the inferior and posterior margin of the mandible, respectively. For 10 years from 2009 to 2019, the two-crossed ostectomy of mandibular angle has been performed in 1217 consecutive series of Chinese patients. The gonion angle degree, the facial width between the dual gonions, and the horizontal and vertical distances from the gonial point to auricular lobule were measured and recorded before and after an operation. Results: After the two-crossed ostectomy, the patient’s gonion angle significantly changed to 123 to 128 degrees in both women and men. The vertical distance from the horizontal line of the auricular lobule to the gonial point decreased by 2 to 2.5 cm markedly, and the gonial point became located at about 0.85 cm in front of the vertical line of the auricular lobule. The two-crossed ostectomy of the mandibular angle effectively reconstructed the new aesthetic gonion angle and gonial position, reshaped the oval face, and achieved a highly satisfactory result. Conclusions: For patients with excessively prominent mandibular angle, the two-crossed ostectomy at the mandibular ramus and the body could reconstruct the new aesthetic gonial angle and position, make the lower one third of the face attractive from the lateral and anterior perspectives, and deliver greater patient satisfaction and surgical safety.