The treachery of mandibular angle augmentation

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic Surgery
• Biomaterials Engineering

Background:

• Alloplastic jaw angle augmentation aims to enhance facial aesthetics but carries risks.
• Commonly used materials include silicone and porous polyethylene implants.
• Implant placement near the pterygomasseteric sling presents unique surgical challenges.

Observation:

• Breaching the lower pterygomasseteric sling during silicone implant placement results in masseter muscle detachment and visible bulges.
• Porous implants with ledges, if not properly fitted, can violate the sling, leading to malposition and muscle disruption.
• Five cases illustrate these complications, with one requiring revision surgery due to implant overhang.

Findings:

• Failure to preserve the pterygomasseteric sling integrity is a primary cause of implant-related complications in jaw angle augmentation.
• Both silicone and porous implants are susceptible to malposition if surgical technique compromises the sling.
• Revision surgery may be necessary to correct aesthetic deformities arising from sling violation.

Implications:

• Surgical techniques for jaw angle augmentation must prioritize the preservation of the pterygomasseteric sling.
• Understanding implant material properties and anatomical relationships is vital for successful outcomes.
• Further research into implant design and surgical approaches could mitigate risks associated with jaw augmentation.