Intraoral zygoma reduction using L-shaped osteotomy

Abstract

Background: Because of the various defects of malarplasty, including a large incision, much bleeding, visible scars after the operation, and so on, caused by the conventional coronal incision or the temporal incision with the intraoral incision approach, the malarplasty by simple intraoral approach is an innovative development.

Methods: Through the intraoral approach and subperiosteal dissection, we can reach the osteotomy point on the zygomatic body directly and arrive at the osteotomy point at the zygomatic arch end along the medial side of the zygoma. A new L osteotomy is applied with the reciprocating saw. In addition, the osteotomy was performed on the zygomatic arch from the inside out with an angle of 20 degrees horizontally.

Results: From 1997 to 2010, we were satisfied with the results of 114 cases of malarplasty with the intraoral approach and L osteotomy as the observed objects. There are 103 cases for women and 11 for men. Ages ranged from 16 to 48 years. The mean operation time is approximately 1 hour. We just had a few complications: 3 nonunion at the osteotomy line and needed a second surgery to repair as well as 2 slight cheek drooping during the initial period and required face lifting.

Conclusions: The method of intraoral approach and L-shaped osteotomy for zygoma reduction can reduce prominent zygoma while maintaining the natural curves of the zygomatic body and arch. Because of the simple procedures, fewer complications, and excellent results, this method will be considered a relatively desirable way.

Level of evidence: Therapeutic, III.

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FIGURE 1

Design: The view of L-shaped osteotomy of zygomatic body and the zygomatic arch osteotomy line with an angle of 20 degrees horizontally. The black L marked at the zygomatic body is the osteotomy line. The width of the L is the width of osteotomy, which determines the reduction of the prominent zygoma after the surgery.

FIGURE 2

A, During the osteotomy from the inside out of the zygomatic arch, the periosteum around the osteotomy line only approximately 1 cm need to be dissected; the isolation should be conducted outside the zygomatic arch to protect the facial nerve in osteotomy. B, Osteotomy on the zygomatic body with the saw blade (3 or 5 mm): make the bone groove as the osteotomy line and then remove the bone with the straight reciprocating saw.

FIGURE 3

A and B, Operative views showing the L-shaped osteotomy area clearly from the incision (after osteotomy). C, Bones that were removed and the cheek fat picked out in the operation.

FIGURE 4

Radiologic findings. A and B, Preoperative x-ray films. The prominent zygomatic body and arch can be seen clearly. C and D, Postoperative x-ray films. The zygomatic arch was completely reduced and the bone was moved backward, upward, and inward, which led to the reduction of zygomatic body.

FIGURE 5

A 26-year-old woman for comparison. Above, Preoperative view shows that the woman has a seriously prominent zygoma that makes her cheek obviously hollow. Below, Postoperative view shows that the prominent zygoma is drawn inward and upward after the intraoral approach L-shaped osteotomy for both sides of the malar reduction and that her face looks soft and younger, without deep facial wrinkle caused by the facial drooping. The operation is successful.

FIGURE 6

A 44-year-old woman with prominent zygoma and mandibular angle for comparison. The comparison of her photograph before and after the surgery shows her corrected malar and natural arc from body to arch. Above, Preoperative view. Her overprotruding zygoma is more obvious than the prominent mandibular angle. Below, Postoperative view. The intraoral approach L-shaped osteotomy has been done. Even her prominent zygoma was corrected, without the mandibular angle reduction. Her prominent mandibular angle is extraordinarily obvious to make her facial profile a square shape.