Radiologic Analysis of Malar Arch Movement in Reduction Malarplasty Without Bony Resection

Abstract

Background: Reduction malarplasty has been popular among Asians with a wide facial width. In general, malar setback after bony resection is regarded as the standard objective of reduction malarplasty. However, unnecessary bony resection may lead to various postoperative complications. Therefore, we suggest the use of reduction malarplasty without bony resection to achieve a similar narrowing effect of the facial width, based on radiographic analysis of malar arch movement. Patients and Methods: This retrospective study analyzed 48 patients with a wide midface who underwent reduction malarplasty between September 2018 and December 2019. We included 40 cases of advancement repositioning malarplasty (AR) without bony resection and 8 cases of setback reduction malarplasty (SR) with bony resection. The three-dimensional position of the malar arch expressed by coordinates (x, y, and z) on threedimensional computed tomography scans was used to compare the positional change between the surgical methods. The paired t-test, Wilcoxon text, and independent t-test were used in data analysis, and statistical analysis was performed using SPSS 23.0 software. Results: Medial and superior movement of the freed malar arch segment was significantly different between AR and SR (P < 0.05). Although medialization and superiorization were not significantly different between AR and SR, there was a significant difference in anterior-posterior movement between AR and SR (P < 0.05). Conclusion:The radiologic analysis based on malar arch movement between AR and SR showed similar narrowing effects on medialization and superiorization of the malar arch regardless of bony resection. Therefore, the AR can be effectively applied in case of arch dominant type or malar asymmetry. In addition, further comprehensive study including analysis on movement of facial soft tissue following malar bony movement is expected based on this study in near future.

Effects of surgical factors on the outcomes of zygoma reduction malarplasty: a quantitative computed tomography study

“…Some surgeons avoid segmentation to improve postoperative functional stability; however, our results indicate that the horizontal reduction of the malar eminence is of limited usefulness without segmentation. Thus, our results differed from previous reports of excellent reduction of the eminence, even when the malar bone was cut without body strip removal [ 12 , 13 , 15 , 24 ].…”

“…Few studies have involved the quantitative evaluation of zygomatic movement using CT images obtained after malar reduction surgery [ 3 , 15 , 17 , 23 ]. Existing reports describe the surgical outcome in a single patient based on CT findings [ 3 ] and the malar eminence reduction after bony segment removal from the anterior portion of the zygoma without arch cutting or internal fixation [ 23 ].…”

“…Existing reports describe the surgical outcome in a single patient based on CT findings [ 3 ] and the malar eminence reduction after bony segment removal from the anterior portion of the zygoma without arch cutting or internal fixation [ 23 ]. In two other studies in which osteotomy and rigid fixation were performed for malar eminence and arch alteration, no detailed description of the surgical method for the arch was provided and only the surgical procedure and outcome for the eminence were evaluated [ 15 , 17 ]. Such an approach does not account for the possible relation between the malar eminence and arch.…”

“…However, the position of the zygomaticotemporal suture, used as the reference point for this plane, may change after surgery [ 17 ]. In another study, the lowest point of the zygomaticotemporal suture was used to measure the AP movement of the malar eminence [ 15 ]; this landmark is useful for the identification of changes in the malar eminence. In the present study, we used the MT as a bony landmark because it projects more visibly than the zygomaticomaxillary suture and is easily measured.…”

“…In this study, we compared preoperative and postoperative protrusion on CT using the same cross-sectional image-based coordinates, in contrast to other studies [ 15 , 17 ]. Facial narrowing may be detected on the basis of horizontal ( x -axis) changes in bony landmarks, such as zygion, defined as the most protruding part in the frontal view.…”