Swing Door Reduction Malar Plasty Without the Need for Fixation

Lim, Hong Chul; Kang, Yang Soo; Moon, Jae Won; Cheon, Ji Seon; Yang, Jeong Yeol

Abstract

The zygomatic bone is one of the most important bone in forming the facial contours. Asians, especially Northeast asians, including Koreans have a very wide and protruding zygomatic bone making, they have a very rough and manly look. Most of the malar osteotomy reductions including triangular osteotomy need a fixation of the bone fragment to prevent the nonunion or malunion of the zygomatic bone or the lower margin of the bone fragment after the surgery. 76 cases were reviewed between October 2004 and August 2006 which were operated in Korean hospitals and Shanghai hospital in China. 74 of the 76 cases were done for women, and the average age was 27.5(21-38). The first osteotomy was done where the frontal process and temporal process meet with a safety zone between the orbital margin towards the oral angle. The electronic saw maintains a 45 degrees to the zygomatico-maxillary buttress with preservation of the 5mm of the outer table of the zygomatic bone. However the inner table has a greater preservation of the bone and periosteum from the osteotomy. The second osteotomy line was towards the downward-laterally at a almost 90 degree angle with a 5mm interval between the first cut starting at the zygomatic body inferior laterally. To prevent the mobility and the loss of the bone when using the electronic saw for the preauricular incision or post sideburn incision, osteotome was used. In the 76 cases followed by 2 weeks, no dropping of the buccal area was found nor unwanted anterior dropping of the buccal fat was found. The authors used triangular osteotomy method and the method of creating artificial depression through 3 partial osteotomy prior to this method. There was no inferior displacement of the bone fragment after the surgery. There was essentially no loss of the bone of the osteotomy surface due to the incomplete fracture of the osteotomy-fracture of the swing zygomatic body using the osteotome. Comparing to other operations, operating time was shorter and recovery was faster. It was economical because fixation equipments did not use. Also, it was easy to do asymmetry correction since broken bone and spicule were easily moved as an operator's intention.