Many procedures have been used in zygomatic reduction surgery. The first reduction procedure was not invented by Chinese surgeon. However as there are so many Chinese candidates underwent zygomatic reduction surgery Chinese surgeons now is leading the world in this surgical area. Below are a brief descriptions of few traditional zygomatic reduction plastic surgery procedures. Some of them is still very popular while the others are not widely used anymore. Yet many new methods is still coming.
Zygomatic Ostectomy(Simple Zygomatic Bone Reduction??
The pioneer methods of zygomatic reduction mainly trim the zygomtic and zygomatic arch bone to make the zygomatic bone or zylgomatic arch bone smaller. This method is easy to learn and many plastic surgeons still use it now. However it's drawback is obvious. First of it, as the zygomatic bone is classified as flat bone. They are relatively small. If a large amount of bone is removed the strength of the bone is compromised and zygomatic bone and zygomatic
Zygomatic bone and zygomatic arch plastic surgery--Simple Reduction Method
arch fracture may easily happen under compact. Secondly, as the incisions are in the mouth it is impossible to expose both side of the zygomatic bone and zygomatic arch at the same time. The surgeon can't compared the size of the zygomatic bone or zygomatic arch and also it is difficult to collect the grinded bone dust for comparison. So the chances of getting a post operative asymmetric zygomatic bone or zygomatic arch are increased. Thirdly, the bone dust from the operation site can't be totally removed. The remaining dust may cause localized hypertrophy compromising the surgical result. Using a simple reduction method only a small amount of bone can be trimmed from the zygomatic bone and zygomatic arch. A restricted surgical result can be achieved. Thus the simple reduction method is only good for those who have nodular zygomatic bone hypertrophy with a minimal protruding zygomatic bone or zygomatic arch.
Zygomatic bone and Zygomatic Arch Osteotomy
Then, zygomatic arch and zygomatic bone osteotomy was introduced. At the early stage the zygmatic bone reduction oeteotomy was just a transform of the zygoma augmentation osteotomy. Zygoma osteotomy augmentation plastic surgery was originally designed for Caucasians to cut the front end of the zygomatic arch open, a piece of bone graft is inserted and fixed into the incision line to augment the zygomatic bone. Reversely a piece of bone was removed from the front end of the zygomatic arch. The zygoma is reduced and fixed in the new position to make the face smaller and narrower. This method is named as the Front End Osteotomy Zygoma and Zygomatic Arhc Reduction Plastic Surgery.
1.Front End Osteotomy Zygoma and Zygomatic Arhc Reduction Plastic Surgery
Front End Osteotomy Zygoma and Zygomatic Arhc Reduction Plastic Surgery reduces the front end of zygomatic arch efficiently, suitable for candidates with protruding zygomatic bone and protruding front end of the zygomatic arch. For this method the surgical result can be controlled by adjust the amount of bone been removed.
Compared to the simple reduction method this method has a good control of symmetry and lower later on bony hpertrophy rate. However as it deals only with the front end of the zygomatic arch, post operatively the rear part of the zygomatic arch will seemed wider than the front part and stick out of the lateral face giving an unbalanced and even wider middle face appearance. Further more when the front end of the zygomatic arch is puched inward it tend to move downward, or the strong biting muscles will pull the front end of the zygomatic arch downward under the circumstances of week fixation. The attached expression muscles on this part of the zygoma such as Zygomaticus major, Zygomaticus minor and Quadratus labii superioris etc will fall down accordingly causing unwanted post operation effects of facial sagginess and nasal labial folder swelling. In order to overcome this side effects some surgeons employing "L" style osteotomy plus rigid fixation to fix the bone. Though the falling down problem can be solved by fixation the steps formed by front end osteotomy and back end bulginess still exist (see fig below).
The Front end osteotomy can only change the height of the front end of the zygomatic complex and has no effect on the middle and post part of the zygomatic complex.
2.The Post End Osteotomy Zygomatic Arch Reduction Plastic Surgery
In order to reduce the post part of the Zygomatic arch the Post End Osteotomy was invented. It's mechanism of reduction is similar to those of the Front End Osteotomy. An osteotomy is made at the rear end of the zygomaitc arch just before the ear. A fracture at the front end of the zygomatic arch is also made. Then the post end of the zygomatic arch is push inward to narrow the face. This method is useful to those whose zygomatic arch is protruding while the zygomatic bone is not big. Some kind of fixation such as stainless wire fixation is normally needed to prevent post operative bone movement. The drawback of this method is that it cant' be utilized in patients with big zygomatic bone. Otherwise when the rear part of the zygomatic arch is reduced the front end zygomatic bone will look even bigger making the face look even unpropotional.
Rear End Zygomaitc Arch Osteotomy is suitable for candidates with protruding zygomatic arch. It has minimal effect on zygomatic bone and the front end of the zygomatic arch.
3.The Front and Rear End Osteotomy
Both the front and rear end of the zygomatic arch are been cut open so the whole zygomatic arch body been moved inward. This method can reduce the zygomatic bone and the post end of the zygomatic arch by moving the zygomatic complex inwardly. The down side of this method includes difficulty to fix the bone, possible post operation bone movement, bulginess of the middle portion of the zygomatic arch and frontal postal end steps formation. The zygomatic arch is an arch structure. Two site osteotomies are not enough to straighten the zygomatic arch. Post operatively the middle portion bulginess can still be pulped even after a considerable inward movement of the zygomatic arch. As the arch is still curved too much inward movement may cause symptoms of temporalis depression even worse interfering the movement of the lower jaw making mouth open difficult.
4.The Tripod Osteotomy
This method can effectively improve the facial outline for those whose zygomatic bones are protruding. It narrows the wide face while making the flat face more dynamic. For those who has simple zygomatic arch protruding this method is not suitable. The surgical procedure is more complicated and difficult to perform.
Tripod Osteotomy Zygomatic Bone and Zygomatic Arch Reduction Surgery. The Zygomatic bone is cut free anterior, superior and posteriorly. The bone fragment is moved inwardly and posteriorly. It is useful to improve the facial outline of a flat face with protruding zygoma.
The surgical processes include cutting the zygomatic bone free superior, anterior and posteriorly. The free zygomatic bone is in a "tripod" shape. A piece of bone is removed from the zygomatic arch so that the freed zygomatic bone can be moved backward. Like in the Figs above illustrated the "tripod" can be moved inward and backward to change the contour of this part of the face. However the rear part of the zygomatic arch in blue color remains unchanged. So it doesn't do any help for those whose zygomatic arch is protruding. AS this method is very useful to reduce the zygomatic bone the author still apply it to selected patients.
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