Evaluation of Different Fixation Methods Combinations After L-Shaped Osteotomy Reduction Malarplasty: An In Vitro Biomechanical Study.

BACKGROUND: This in vitro study compared the stability of different fixation method combinations for the zygomatic complex after simulated L-shaped osteotomy reduction malarplasty, a common facial contouring surgery in East Asia with high postoperative complications due to poor fixation methods. MATERIALS AND METHODS: The study used 108 zygoma replicas with various fixation methods combinations in the zygomatic body (L-shaped plate with short wing on zygoma and on the maxilla, two bicortical screws, one bicortical screw with L-shaped plate, square plate, and rectangular plate) and zygomatic arch (Mortise-Tenon structure, 3-hole plate, and Mortise-Tenon structure plus short screw). The failure force under incremental load was applied through the Instron tensile machine to a well-stabilized model using a rubber band simulating the masseter muscle and recorded the increasing force digitally. ANOVA test was used for comparison between recorded values (P < 0.05). RESULTS: The results showed that the most stable combination was a six-hole rectangular plate and a Mortise-Tenon structure plus one short screw (358.55 ± 51.64 N/mm2). The results also indicated that the placement vector of the fixation methods around the L-shaped osteotomy and the use of the two-bridge fixation method were important factors in enhancing the stability of the zygomatic complex. CONCLUSION: The study suggested that surgeons should choose appropriate fixation methods based on these factors to reduce postoperative complications and improve surgical outcomes. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reduction malarplasty using a zygomatic arch-lifting technique.

BACKGROUND: Broad or excessive malar protrusion is a trait associated with aggression and old age in Asian cultures. Although various methods of shifting the zygoma have been introduced for reduction malarplasty, soft tissue sagging and inadequate bony union still remain great challenges. We have devised an arch-lifting technique that helps overcome these issues. An analysis of surgical outcomes is presented herein. METHODS: A total of 54 patients subjected to lifting malar reductions between January 2013 and November 2014 were retrospectively reviewed. The reduction procedure entailed an L-shaped osteotomy of the zygomaticomaxillary junction via an intraoral approach. In addition, a prefabricated U-shaped microplate was applied for arch fixation in the lifted position. The follow-up period ranged from 6 to 18 months (average, 9.2 months), during which medical records, photographs, and facial bone computed tomography (CT) images were obtained to assess the postoperative results. RESULTS: Patients were generally satisfied with aesthetic outcomes, thus rating the procedure excellent in terms of zygomatic prominence, midfacial width, symmetry, and resistance to cheek drooping. There were no major complications, such as facial nerve damage or trismus. An inadequate bony contact occurred in two instances due to unanticipated trauma, with immediate reduction and fixation thereafter. Minor wound infections developed in three patients but responded well to antibiotics. CONCLUSION: Zygomatic reduction procedures must consider the dynamics of the adjacent muscles, which are stabilized through arch fixation. The use of our arch-lifting technique for reduction malarplasty efficiently elevates the zygomatic complex, thereby ensuring an adequate bone-to-bone contact. Predictable and accurate outcomes are thereby achieved.

Clinical application of modified reduction plasty of malar and zygoma / 中华医学美学美容杂志

Objective To introduce a new method for correcting prominent malar complex deformity. Methods Through an intraoral incision, the highest area of zygomatic body marked preoperatively was grinded. Then an L shape incomplete osteotomy of the zygomatic body was performed with a reciprocating saw, and a complete osteotomy just 1 cm anterior to the articular tubercle of the zygomatic arch was made. Light pressure on the posterior part of the arch produced a greenstick fracture of the anterior osteotomy site, resulting in posterior-inward repositioning of the malar complex. Internal fixation was unnecessary. Results Operative procedures for reductive malar complex plasty were performed in 650 cases, which included 60 males and 590 females whose age ranged from 19 to 39 years.Incisions of all cases healed well. One case had maxillary sinusitis 2 weeks postoperatively, and recovered after 1 week by using antibiotics and drainage. There was 1 case with skin necrosis about 1 cm in diameter in the area of zygomatic body because of local liposuction, and the wound was healed by changing dressing. The forehead wrinkle of one side had disappeared in 1 case 1 week postoperatively, but had recovered 2 weeks later. Postoperative follow-up for 2-24 months showed satisfactory results.Conclusions This modified method has many advantages, such as simplicity, without internal fixation, short operation and recovery time, and little complications. The authors conclude that this technique is an effective and safe method of reduction malarplasty.

Endoscopically assisted reduction malarplasty / 中华医学美学美容杂志

Objective To evaluate the value of the clinical application of endoscopieally assisted re-duction malarplasty. Methods A total of 12 women (aged 21 -36 years) with prominent zygoma were re-shaped by the endoscope-assisted technique. Results The use of an endoscope offered a clear view of the operating field and facilitated accurate and easy manipulation. These patients were successfully treated for this new technique: reduced risk of operating injuries. Conclusion It is showed that the endoscopic assis-ted correction of prominent zygoma offers more satisfactory clinical results with a clear view of operation and a minimally invasive technique.