Shaving mandible

[triple_banker]

Hi, I had bimax one year ago and overall happy with the results. However, on my left side the mandible has a little bump at the anterior edge of the bone cut (link below with pictures illustrating what I mean).

https://imgur.com/a/1saAgao

I asked my surgeon about shaving down this bump but his response was that it will only provoke anterior displacement of the bump and that it is better to wait for spontaneous remodeling of the bone or use fillers to camouflage it. I've never heard or read about bone displacement like this and wonder if you agree with the surgeon or if I should try to find another surgeon.

I should also mention that I removed the lower metal plates on both sides recently and it made a small visual improvement, making the jaw appear slightly more angular and defined and since the bump is at the same spot where the plate was previously I am pretty sure shaving it down would have the same effect. 

I don't see any risks of shaving this area because it is in the middle of the mandible and masseter is not in the way. Anyone have experience with similar and think shaving is reasonable?

Note: the ct-scan pictures were taken before the plates were removed.

[GJ]

That looks like the anti-gonial notch. In general, that happens due to trauma in youth when the jaw is developing, and it can lead to downward growth. I think grafting the notch would probably be the best idea if someone is willing to do that, but that means more cuts, more scar tissue, infection risk, etc.

I'm not sure if that's what is going on, but that's what it looks like, so I'd ask about all that and see what they say.

[triple_banker]

Thanks for your response. I do have quite a significant antegonial notch too which can be seen from the side view, but I am ok with that.

However, the bump I am refering to is also visible from the front view making the left side of the jaw looking a bit more rounded/bloated than the right side. The reason for why the bump only exists on the left side is because the bimax advancement was slightly larger on the left side and thus rotating the mandible and "pushing" out laterally the area where the cut was made.

[GJ]

Thanks for your response. I do have quite a significant antegonial notch too which can be seen from the side view, but I am ok with that.

However, the bump I am refering to is also visible from the front view making the left side of the jaw looking a bit more rounded/bloated than the right side. The reason for why the bump only exists on the left side is because the bimax advancement was slightly larger on the left side and thus rotating the mandible and "pushing" out laterally the area where the cut was made.

Ooh, gotcha. Can that be filled with bone grafting/HA? I wouldn't want to inject something every few months. That's a hassle and expensive.

[triple_banker]

Sorry if I was unclear, I want to reduce the prominence of bump, i.e shave it down (filling below the bump with something is the opposite of what I want to achieve). In one of the photos I have photoshopped the effect of shaving down the mandible to illustrate what I would like to achieve.

[kavan]

Your illustration of what you want via shaving the bump can't be considered a predictor of what you would get out of that. Surgeon's prediction of a bone response is more reliable than moving pixels around.

A bone bump is basically the body's reaction to heal a bone wound (ie a cut to the bone is wound to be healed). Shaving it down could just result in formation of new bump.

If you think your prediction trumps your surgeon's advice, then take the risk of your prediction trumping his.

[triple_banker]

Thanks Kavan, in this case I think the bump is not a reaction from wound healing, rather because my left side of the mandible was advanced around 12mm while right side 10mm which created a rotation which caused the left posterior side of the distal segment of the mandible to push out the left proximal segment (like a door that is opened up a bit).

But ok, so the risk I would have to take is that shaving it will form a new bump again.

[kavan]

Thanks Kavan, in this case I think the bump is not a reaction from wound healing, rather because my left side of the mandible was advanced around 12mm while right side 10mm which created a rotation which caused the left posterior side of the distal segment of the mandible to push out the left proximal segment (like a door that is opened up a bit).

But ok, so the risk I would have to take is that shaving it will form a new bump again.

Well, all bone cuts are wounds and new bone formation is part of the healing process of the bone wounds. So both sides would have more bone formation but side with more stress on it might kick up more of healing process. Now, if one segment is pushed out more than the other and that part sticks out, then part of the bump very well could be your own bone segment in addition to the bone healing over that.