Reduction malarplasty by bidirectional wedge ostectomy or two percutaneous osteotomies according to zygoma protrusion type.

Abstract

Reduction malarplasty to correct prominent malar complex is popular in Asians. Despite the popularity of reduction malarplasty, most of the surgical methods applied are not selected according to the degree of zygoma protrusion. In this study, we analyzed the effectiveness of two different surgical procedures to clarify their appropriateness for each zygoma type. One of the procedures used was the "bidirectional wedge ostectomy," in which a bidirectional wedge-shaped bone fragment was removed from the zygomatic body via oral incision and oblique complete osteotomy of the zygomatic arch via sideburn incision. Another was the "quick osteotomy," a greenstick osteotomy of the zygomatic body and complete osteotomy of the zygomatic arch via two skin incisions. We classified zygoma protrusion into two categories: only zygomatic arch protrusion (group 1) and zygomatic body and arch protrusion (group 2). The cross-sectional area of the most prominent malar region decreased by 9.4±2.5mm laterally (zygion-to-zygion) and by 2.9±0.8mm obliquely (average of center-to-right and left maxillozygion) after the ostectomy. However, in patients who underwent the osteotomy, while the cross-sectional area decreased by 10.9±2.7mm laterally, it did not decrease obliquely. Thirty patients (73.2%) in group 1 underwent the osteotomy, and the remaining eleven (26.8%) underwent the ostectomy. In group 2, 83% (n=39) underwent the ostectomy. We were able to find the more appropriate procedure for each zygoma protrusion type through outcome analysis. With these results, we suggest that if each procedure is performed according to this classification, more favorable esthetic results of zygoma reduction can be achieved.