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• W2891355024 abstract "Sir: We read with great interest the recent article entitled “Strategic Considerations for Effective Sagittal Resection of the Mandible to Achieve a Slim and Attractive Jawline” by Sanghoon Park and Tae Sung Lee1 in Plastic and Reconstructive Surgery. In this article, the authors made clear some terminology used during mandibular reduction, including maximal ramus point, biramus distance, and bigonial distance; classified mandibles into straight line, outcurved, and incurved types; and applied a strategy for sagittal resection and curved ostectomy based on the classification. The authors’ work is of vital of importance for the establishment of a surgical strategy and also good guidance for those who misunderstand the procedure and the effect of sagittal resection and curved ostectomy. We agree with the authors that curved ostectomy alone has a limited narrowing effect on incurved mandible, and sagittal resection focused on the body should also be performed. However, different from the authors, we never perform sagittal resection alone even when it may produce a reasonably good aesthetic result in such cases. Patients requiring mandibular surgery are usually highly demanding. Some are even morbidly anxious for the mandibular angle and critical of the effect of surgery. Their focus of attention is not confined to the facial contour but also includes the shape of the remaining bone, the line of the inferior mandibular border, and the existence of every undesirable bony projection, even when these may only be present on imaging films. The persistence of the incurved angle, although it makes no difference regarding the aesthetic result, will significantly decrease patient satisfaction and in a worse condition exacerbate their anxiety and stress. From the description in the article, we know that the authors perform mandibular reduction by curved ostectomy first and then sagittal resection. What we do is just the opposite.2,3 Sagittal resection is always performed before curved ostectomy for two purposes. The first purpose is to reduce the width of the lower face, which is the same as the authors suggested. The second purpose is to expose the surgical site for a safe and effective ostectomy. In the intraoral approach, the posterior border of the mandibular ramus and the angular part are hard to expose, especially when they are shaded by maximal volume point and maximal ramus point in incurved cases. Sufficient sagittal resection of the mandibular body and ramus is beneficial for better surgical exposure, more accurate ostectomy, and less damage to the surrounding soft tissues. In our practice, the outer cortex is regularly ground using a large round burr. After satisfactory width reduction and posterolateral exposure, a curved ostectomy line is marked using a small round burr. Along the designed marking, a single-stage ostectomy technique is performed with a short and long oscillating saw successively to saw off the outer and inner plate of the mandibular bone. If the saw fails to completely cut off the posterior border of the incurved ramus, a sharp curved osteotome is inserted to chisel it off while carefully protecting the temporomandibular joint. Lastly, grinding using a round burr is performed again to smoothen the bone surface and inferior mandibular border. The whole procedure described above usually takes 30 to 40 minutes and the patients are satisfied with the result. DISCLOSURE The authors report no financial interest in relation to the content of this communication. Panxi Yu, M.D.Guodong Song, M.D., Ph.D.Xianlei Zong, M.D., Ph.D.Xiaolei Jin, M.D., Ph.D.Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, People’s Republic of China" @default.
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• W2891355024 date "2018-12-01" @default.
• W2891355024 modified "2023-10-14" @default.
• W2891355024 title "Strategic Considerations for Effective Sagittal Resection of the Mandible to Achieve a Slim and Attractive Jawline" @default.
• W2891355024 cites W2043589258 @default.
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• W2891355024 doi "https://doi.org/10.1097/prs.0000000000005032" @default.
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