Background: Various surgical methods have been developed and used to reduce prominent malar bones. The most common reduction malarplasty methods are resection of the bone strip of the malar bone with L-osteotomy or I-osteotomy, followed by setback and fixation. However, these methods could be associated with complications due to the bone strip resection. The present article introduces an effective and safe method that reduces the zygoma without resection of a malar bone strip.
Methods: Through preauricular and intraoral incisions, we performed the current L-osteotomy without resection of the malar bone strip using a reciprocating saw. We created back space for zygoma setback by removing the posterior wall of the maxillary sinus, which acted as a bony interference. We were able to set the lateral segment of the zygoma back about 3-5 mm. We fixed the zygomatic arch with wire and the zygomatic body with a prebent plate and screw. Thereafter, we performed rasping of the anterior part of the zygoma to achieve sufficient reduction. After performing our reduction malarplasty for 139 patients, clinical outcomes were evaluated.
Results: Most patients responded to the satisfaction survey as excellent and good. There were no major complications 6 months postoperatively.
Conclusions: The key of our method of reduction malarplasty is to create posterior space without resecting the malar body strip, which results in an effective setback. This method enables surgeons to effectively maintain the zygoma body, which leads to high satisfaction rates and fewer complications. Therefore, this study proved the safety and effectiveness of our method of reduction malarplasty.
Level of evidence iv: This journal requires that authors assign a level of evidence to each article. 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 .
Keywords: L-osteotomy; Malar setback; Reduction malarplasty.