Square Jaw Reduction Surgery: CT Analysis of Post-Operative Swelling and Bone Changes - A Specialist's Perspective

Hello, I am Dr. Jong-Cheol Park, a specialist in Oral and Maxillofacial Surgery.

I have a keen interest in the changes in swelling experienced by patients after undergoing square jaw reduction surgery. Many patients are particularly curious about how quickly post-operative swelling subsides. To address this, I conducted an objective analysis using CT images to examine the swelling patterns.

Pre-operative Planning: The Cornerstone of Successful Square Jaw Surgery

Preoperative CT analysis for square jaw surgery

Thorough pre-operative planning is crucial. In this case, the patient presented with a prominent bony square jaw and significant soft tissue volume. While the cheekbones were also somewhat pronounced, the square jaw made them appear less prominent in comparison. Before surgery, I utilized digital square jaw surgery planning to ensure a safe distance from the inferior alveolar nerve canal.

Square jaw resection design considering the path of the inferior alveolar nerve canal

To maximize the facial width reduction effect in the frontal view, I adjusted the osteotomy line to a more medial position, carefully considering the course of the inferior alveolar nerve canal.

Post-Operative Swelling and Skeletal Changes at 2 Weeks and 4 Months: A CT Scan Analysis

Immediately following the surgery, CT scans confirmed adequate resection of the square jaw as planned. Subsequent CT scans were taken at 2 weeks and 4 months post-surgery to compare and analyze changes in swelling and bone structure.

• Immediately Post-Surgery:

  • The CT scans clearly verified that the square jaw had been sufficiently resected according to the pre-operative plan.

    

    Pre and Postoperative CT images of square jaw surgery

    

    Pre and Postoperative CT images of square jaw surgery
  
  

• 4 Months Post-Surgery:

  • At the 4-month mark, a noticeable reduction in soft tissue volume was observed across all areas compared to the pre-operative state.

    

    Soft tissue changes 4 months after square jaw surgery

  • Notably, in the mandibular angle region, a significant soft tissue reduction of over 9mm was measured.

    

    CT crosssectional changes 4 months after square jaw surgery

  • Bone regrowth was observed in the mandibular angle area. This phenomenon is considered a physiological bone remodeling process influenced by the masseter muscle.

    

    Bone regrowth after square jaw surgery

  • The thickness of the masseter muscle decreased by an average of 6mm, representing a reduction rate of approximately 25-30%.

    

    Changes in masseter muscle thickness after square jaw surgery

  • CT imaging confirmed that the skeletal line in the square jaw area had been ideally improved.

• Swelling Changes at 2 Weeks and 4 Months Post-Surgery:

  

  Swelling changes between 2 weeks and 4 months after surgery

  • Analysis of swelling changes between 2 weeks and 4 months post-surgery revealed that approximately half of the total swelling had already subsided by the 2-week mark.

    
    

Muscle Resection: A Carefully Considered Approach

Let's examine a case where muscle resection was performed in conjunction with square jaw surgery.

Square jaw surgery with muscle resection case

In this patient, the muscle thickness reduction was more pronounced. On the right side, the thickness decreased by 24% (4.57mm reduction from 18.9mm), and on the left side, it decreased by 39% (7.57mm reduction from 19.04mm). Comparing to the right side of this patient, the swelling reduction is similar to our primary case, while the left side showed an even greater reduction.

I selectively perform muscle resection only in patients who exhibit minimal response to Botox injections. Muscles are highly vascularized tissues, and resection can potentially prolong swelling. This tendency is sometimes observed in younger male patients, but further data is needed to draw definitive conclusions.

Post-Operative Swelling After Square Jaw Surgery: No Need for Excessive Worry!

This analysis demonstrates that post-operative swelling after square jaw reduction surgery significantly decreases within the first 2 weeks, and gradually diminishes over 4 months. Bone regrowth is a natural part of the healing process, and soft tissue volume also shows a marked reduction.

For those concerned about swelling after square jaw surgery, rest assured that it is a temporary phase, and the results progressively improve over time. If you have any questions, please do not hesitate to contact me.