Comparison of Bilateral Mandibular Angle Ostectomy Between East Asian Males and Females: A Study Based on Three-Dimensional Computed Tomography Reconstruction

  • Dong Zhang
  • Hong Du
  • Guodong Song
  • Xianlei Zong
  • Xiaoshuang Guo
  • Chenzhi Lai
  • Jingyi Zhao
  • Le Du
  • Xiaolei JinEmail author
Original Article Maxillofacial/Craniofacial



Mandibular angle ostectomy is a common plastic surgery for facial contouring in East Asians. However, rarely we could find reports on differences between East Asian males and females undergoing this surgery.


To describe the differences between East Asian males and females before and after mandibular angle ostectomy.


A total of 22 Asian males and 52 Asian females who underwent mandibular angle ostectomy from April 2015 to November 2018 were enrolled. Three-dimensional computed tomography was used to evaluate the preoperative and postoperative data of the mandible. Thirteen clinical data were measured on reconstructed mandibular models. The differences in data between males and females were analyzed to identify the causes of the differences before and after surgery. The follow-up was 6–12 months, and patient satisfaction was also evaluated.


The ostectomy volume was positively correlated with the distance from the intersection of the occlusal plane and the anterior margin of the mandibular ramus to gonion (MR-Go; female, p < 0.01; male, p = 0.02). There was a positive correlation between the ostectomy volume and the postoperative drainage fluid (The drainage fluid is mainly blood) volume after surgery in females (p < 0.05), while there is no significant correlation between these two data in males (p = 0.19). Patients with a long distance from the second molar to the lower edge of the mandibular body (SM-MB) tended to have a higher risk of postoperative bleeding (female, r = 0.56, p < 0.01; male, r = 0.73, p = 0.01).


Because of the difference in the anatomical size of the mandible and different aesthetic requirements for facial contouring between males and females, surgeons encounter different intraoperative conditions resulting in difficulties during surgery. Understanding differences in mandibular angles predicts differences in ostectomy volume and postoperative bleeding risk, thus aiding surgeons and leading to better operative outcomes.

Level of Evidence III

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Mandibular angle ostectomy Three-dimensional computed tomography reconstruction Ostectomy volume Drainage fluid volumes 



No funding was received for this article.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the clinical research committee of plastic surgery hospital (12100000400266049B) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all patients and can be seen by the editors.


  1. 1.
    Satoh K (2004) Mandibular contouring surgery by angular contouring combined with genioplasty in orientals. Plast Reconstr Surg 113(1):425–430CrossRefGoogle Scholar
  2. 2.
    Chang CS, Bergeron L, Yu CC et al (2011) Mandible changes evaluated by computed tomography following Botulinum Toxin A injections in square-faced patients. Aesthetic Plast Surg 35(4):452–455CrossRefGoogle Scholar
  3. 3.
    Deguchi M, Iio Y, Kobayashi K et al (1997) Angle-splitting ostectomy for reducing the width of the lower face. Plast Reconstr Surg 99(7):1831–1839CrossRefGoogle Scholar
  4. 4.
    Fedorowicz Z, van Zuuren EJ, Schoones J (2013) Botulinum toxin for masseter hypertrophy. Cochrane Database Syst Rev 9:D7510Google Scholar
  5. 5.
    Gui L, Yu D, Zhang Z et al (2005) Intraoral one-stage curved osteotomy for the prominent mandibular angle: a clinical study of 407 cases. Aesthetic Plast Surg 29(6):552–557CrossRefGoogle Scholar
  6. 6.
    Jin H, Kim BG (2004) Mandibular angle reduction versus mandible reduction. Plast Reconstr Surg 114(5):1263–1269CrossRefGoogle Scholar
  7. 7.
    Almukhtar RM, Fabi SG (2019) The masseter muscle and its role in facial contouring, aging, and quality of life: a literature review. Plast Reconstr Surg 143(1):39e–48eCrossRefGoogle Scholar
  8. 8.
    Kaya B, Apaydin N, Loukas M et al (2014) The topographic anatomy of the masseteric nerve: a cadaveric study with an emphasis on the effective zone of botulinum toxin A injections in masseter. J Plast Reconstr Aesthet Surg 67(12):1663–1668CrossRefGoogle Scholar
  9. 9.
    Adams WM (1949) Bilateral hypertrophy of the masseter muscle; an operation for correction; case report. Br J Plast Surg 2(2):78–81PubMedGoogle Scholar
  10. 10.
    Fu X, Rui L, Niu F et al (2016) Reduction gonioplasty: bone regeneration and soft tissue response. Ann Plast Surg 77(6):603–608CrossRefGoogle Scholar
  11. 11.
    Yang DB, Park CG (1991) Mandibular contouring surgery for purely aesthetic reasons. Aesthetic Plast Surg 15(1):53–60CrossRefGoogle Scholar
  12. 12.
    Li HC, Li DM, Zhang ZY et al (2008) 3-Dimensional CT cephalometry before and after mandibular angle osteotomy and its clinical significance. Zhonghua Zheng Xing Wai Ke Za Zhi 24(3):199–202PubMedGoogle Scholar
  13. 13.
    van Vlijmen OJ, Maal T, Berge SJ et al (2010) A comparison between 2D and 3D cephalometry on CBCT scans of human skulls. Int J Oral Maxillofac Surg 39(2):156–160CrossRefGoogle Scholar
  14. 14.
    Zhao J, Song G, Zong X et al (2018) Volumetric mandibular change after angle ostectomy and outer cortex grinding. J Craniomaxillofac Surg 46(3):432–437CrossRefGoogle Scholar
  15. 15.
    Ying B, Wu S, Yan S et al (2011) Intraoral multistage mandibular angle ostectomy: 10 years' experience in mandibular contouring in Asians. J Craniofac Surg 22(1):230–232CrossRefGoogle Scholar
  16. 16.
    Bozdag G, Sener S (2015) The evaluation of MCI, MI, PMI and GT on both genders with different age and dental status. Dentomaxillofac Radiol 44(9):20140435CrossRefGoogle Scholar
  17. 17.
    Ye N, Song H, Zhu S et al (2015) The accuracy of computer image-guided template for mandibular angle ostectomy. Aesthetic Plast Surg 39(1):117–123CrossRefGoogle Scholar
  18. 18.
    Yu P, Song G, Zong X et al (2018) Strategies of mandibular revision: a retrospective study of revisional mandibular surgery for unaesthetic results of previous mandibular reduction. Aesthetic Plast Surg 42(6):1609–1617CrossRefGoogle Scholar
  19. 19.
    Lee ST, Choi NR, Song JM et al (2016) Three-dimensional morphometric analysis of mandible in a coronal plane after bimaxillary rotational surgery. Maxillofac Plast Reconstr Surg 38(1):49CrossRefGoogle Scholar
  20. 20.
    Baek C, Paeng JY, Lee JS et al (2012) Morphologic evaluation and classification of facial asymmetry using 3-dimensional computed tomography. J Oral Maxillofac Surg 70(5):1161–1169CrossRefGoogle Scholar
  21. 21.
    Zhang C, Teng L, Chan FC et al (2014) Single-stage surgery for contouring the prominent mandibular angle with a broad chin deformity: en-bloc Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG). J Craniomaxillofac Surg 42(7):1225–1233CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020

Authors and Affiliations

  1. 1.16th Department, Plastic Surgery Hospital, Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijingChina

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