Classification and treatment of prominent mandibular angle

In Oriental culture, the contour of the mandibular angle is important for f eminine facial shape because a woman who has a wide and square face is thou ght to have had an unhappy life. A prominent mandibular angle, which does n ot coincide with the natural look, produces a characteristic quadrangle, co arse, and muscular appearance. So Oriental women who have a prominent mandi bular angle want to have an ovoid, reduced, and slender face by aesthetic m andibular angle resection. Many satisfactory corrections of a prominent man dibular angle by various operative techniques have been reported. But reaso nable morphologic classification and treatment were not reported. So we cla ssified prominent mandibular angles into four groups by morphology and oper ated on the patients according to their classification with different modal ities: no square shape but only a reduced gonial angle in the profile view- class I, mild form; severe mandibular angle protrusion with lateral protrus ion-class II, moderate form; a definite square-shaped angle (class II) with masseteric hypertrophy-class III, severe form; and combined prominent mand ibular angle and chin deformity-class IV, complex form. We use angle ostect omy through the intraoral route alone or with an additional external stab i ncision for class I. An external stab incision to set up the reciprocating saw is sometimes helpful in class I cases because there is no lateral protr usion of the angle For class II cases, we use conventional intraoral angle ostectomy only or angle splitting ostectomy with contouring. For class III cases, we use angle splitting ostectomy and contouring with partial massete ric myectomy. In class IV, we use angle ostectomy and additional genioplast y. During 7 years, we have performed 46 cases of mandibular angle resection . Of the mandibular angle resection cases, 19 were class I, 15 were class I I, 9 were class III, and 3 were class IV. A total of 42 patients were satis fied with the postoperative results. For reasonable and satisfactory final results, classification according to the mandibular angle shape and suitabl e treatment according to the classification are essential.