Widening mandible/rami

[Optimistic]

So far it looks like achieving a wider jawline requires HA paste or implants. Is there really no way to actually widen the rami using DO or another kind of osteotomy?

[Tiny]

Maybe it can be done via sandwich osteotomy like for the malar bone?  Never heard of it being done though....I know implants in that area are problematic but I'm not sure why, but maybe it's a difficult area to tinker around with?

Get paste, and hopefully by the time it absorbs titanium implants will be more widely available

[overbiter]

You can widen the mandible by making an osteotomy down the middle of the chin. I'm not sure if that is the effect you are going for, but it is possible.

[overbiter]

Chin wing osteotomies can also give a widening effect to the mandible.

[pekay]

sometimes even a BSSO might do the trick

[overbiter]

Yes, BSSO's can make the jaw look wider sometimes. When the front of the mandible is pushed back through recession it creates a kind of optical illusion. People see the area close to the chin in the position where the mid-jaw should be and they think 'narrow'.

[Optimistic]

You can widen the mandible by making an osteotomy down the middle of the chin. I'm not sure if that is the effect you are going for, but it is possible.

That would be basically the same as using distraction osteogensis to widen the mandible then, right? I have actually considered that however it looks as though DO or indeed a BSSO in that fashion would simply widen the entire mandible both anteriorly and posteriorly. Unfortunately I could never find too much info, however the cut down the centre of the chin made it appear as though the entire jaw would be widened. I had hoped that there may be a method, possibly one still involving an osteotomy down the middle of the chin, that would expand the posterior parts of the mandible outwards whilst leaving the rest relatively in tact. See my terrible image below for a better idea of what I mean 



Probably ignore the blue lines if you want. Think of it more as the two posterior parts of the mandible and rami rotating outwards around the chin. From an aesthetic point of view I imagine that this would give more of a V-shape to the jaw as opposed to a wider U-shape that would occur if all parts of the mandible were being laterally extended.

Does that make any sense at all? Is such a thing possible?

I'm just trying to look at options other than HA paste as I'd much rather try and make the actual mandible larger without the use of foreign objects to give that illusion.

[Optimistic]

sometimes even a BSSO might do the trick

A few surgeons now have told me that a BSSO will improve my jaw angle. Honestly I could never understand how this is possible. Even if cut was made further back in the mandible, wouldn't that  just make the front part wider whilst still leaving a posterior deficiency?

The other thing I did consider was an osteotomy of the rami - if that could somehow widen them and not just add length.

[Lestat]

That would be basically the same as using distraction osteogensis to widen the mandible then, right? I have actually considered that however it looks as though DO or indeed a BSSO in that fashion would simply widen the entire mandible both anteriorly and posteriorly. Unfortunately I could never find too much info, however the cut down the centre of the chin made it appear as though the entire jaw would be widened. I had hoped that there may be a method, possibly one still involving an osteotomy down the middle of the chin, that would expand the posterior parts of the mandible outwards whilst leaving the rest relatively in tact. See my terrible image below for a better idea of what I mean 



Probably ignore the blue lines if you want. Think of it more as the two posterior parts of the mandible and rami rotating outwards around the chin. From an aesthetic point of view I imagine that this would give more of a V-shape to the jaw as opposed to a wider U-shape that would occur if all parts of the mandible were being laterally extended.

Does that make any sense at all? Is such a thing possible?

I'm just trying to look at options other than HA paste as I'd much rather try and make the actual mandible larger without the use of foreign objects to give that illusion.

This is genius!

Anyone knows if such an osteotomy exists?

https://www2.aofoundation.org/wps/portal/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAx8jfULsh0VAdAsNSU!/?approach=&bone=&classification=&contentUrl=%2Fsrg%2F95a%2F05-RedFix%2FHFM%2FP184-LateralMovementOsteotomy%2F05_GraftingFixation.enl.jsp&implantstype=&method=&redfix_url=&segment=&showPage=&soloState=lb&step=0&subStep=12&treatment=

Please also take a look at this site:

http://itemcliniceng.com/plastic-surgery/facial-contouring/v-line-mandibular-contouring/?ckattempt=1

[kjohnt]

No surgeons are going to do a mandibular midline osteotomy (or as shown within the picture at the blue lines) to widen your gonial angle width.  That would affect the position of your condyles and is just asking for TMD.

The thing I've noticed about myself is that my rami curve inward at the gonial angles.  So the mandible is really only narrow at the angles.  It would be nice if a procedure existed in which diagonal cuts could be made just at the angles to rotate them outward and rigid fixation i.e. steel plates to set in place.  But I imagine the musculature in that area would cause problems both in surgery and recovery.