Reduction malarplasty through an intraoral incision: a new method.

Until recently, osteotomies and surgeries to reposition prominent zygoma have been performed by means of a coronal incision or intraoral and preauricular incisions. Such incisions have penalties such as scars, the possibility of facial nerve injury, and long operative times. After reflecting on their past experiences with facial bone surgery, the authors developed an alternative approach. In this method, the cheekbone protrusion is corrected by performing an osteotomy and repositioning through an intraoral incision only. During the past 3 years, the authors have operated on 23 patients with malar prominences. The amount of bone to be removed is determined by preoperative interviews, physical examinations, and x-rays. Intraoral incisions provide access to the zygomatic body and lateral orbital rim. After L-shaped osteotomies (two parallel vertical and one transverse osteotomy at the medial part of the zygomatic body), the midsegment is removed. The posterior portion of the zygomatic arch was approached through the medial aspect and was outfractured using a curved osteotome. After completing the triple osteotomy, the movable zygomatic complex was reduced medially and fixed with miniplates and screws on the zygomaticomaxillary buttress. The patients were followed for 9.5 months, with acceptable results and few complications. The authors conclude that this technique is an effective and safe method of reduction malarplasty.