Zygoma and zygomatic arch smoothing reduction plasty is come from Dr. Fushun Ma's technique of the multiple osteotomy zygoma and zygomatic arch plasty. On the basis of anatomy and anthropometry study, large volume CT measurement study and reviewing the existing of surgical methods of zygoma and zygomatic arch reduction plastyon the basis of a trial, through a large number of and CT measurement analysis . Dr. Ma Fushun put forward a new surgical procedure for zygoma and zygomatic reduction plasty in 1995. He call it multiple osteotomy zygoma and zygomatic arch reduction plasty. This procedure narrows the face by multiple osteotomy of the zygomatic complex, displacing the arch inward and reducing the bulging of the arch.
Why multiple osteotomy
Zygomatic arch is an curved structure of rigid bone, by making two of less osteotomy sites one can not change the curvature of the rigid bony object. Before we can make the zygomatic arch straighter we have to cut the bone at three or more sites and make the arch in two or more pieces. On the other hand to straighten an arch-shaped object, its length, which is the distance between points A and B in the following diagram, is bound to increase. Therefore after the straightening the original position sport of the zygomatic arch will not be able to accommodate the enlarged length of the zygomatic arch, in order to dock the straighten zygomatic arch perfectly a certain length of the zygomatic arch has to be removed .
Photo caption: The bone fragment between C and D is removed. A and B indicate the osteotomy site. Two ends of the zygomatic arch is pushed inward letting the C and D point docking using steel wire or titanium plates for fixation (previously fixation is needed, now no fixation is needed for this procedure). After the straightening of the zygomatic arch the face is slimmer and there are no longer any bulging zygomatic arch can be seen from the side of the face.
Surgical principle of mutiple osteotomy zygoma and zygomatic arch reduction plasty
Along the zygomatic complex three osteotomies is done and in the middle portion of the zygomatic arch (between C and D ) is removed, so that the reduced zygomatic arch chord length, the distance between A and B remains the same to ensure the straightened zygomatic arch still can be fit in the site perfectly. Therefore, how much of the zygomatic arch will be removed is key to the design of this procedure and the length of bone been removed determines reduction magnitude of the zygomatic arch.
With this method one may say we can reduce the zygomatic arch on the magnitude of whatever we wanted. It is not true. If the osteectomy length between C and d is too long the two ends can not be directly docked in the middle. The soft tissue will be embedded in between and new zygomatic arch can not be healed properly. On the other hand, beneath the zygomatic arch muscles, other soft tissues and even bone structure are present. If the zygomatic arch is displaced inward too much these structures will be squeezed and lay impact on there functions.。
The pre-operation planning steps of multiple osteotomy zygoma and zygomatic arch reduction plasty. First of all CT scans of the zygomatic arch is carried out and arch height is calculated. This height indicates the maximum reduction amount of the zygomatic arch. Over reduction of the zygomatic arch will cause zygmatic arch indentation. The amount of the reduction is decided by the facial reshaping demanding. Clinical experience the maximum reduction amount is 1.5CM on each side, bilaterally total reduction amount will reach 3CM as 1/ 5 to 1 / 4 of the face width being trimmed away thus narrowing the face significantly. Once the reduction amount is confirmed the supposedly removed segment length between C and D can be calculated according to the zygomatic arch length and the mathematic formula.
The fixation of the multiple osteotomy zygoma and zygomatic arch reduction plasty
The major functions of the zygoma bone and the zygomatic arch are to provide attachment points for the facial expression muscle and to protect the skull. See the anatomy of zygoma bone and the zygomatic arch. The multiple osteotomy zygoma and ygomatic arch reduction plasty will not cause any adverse effect on the facial appearance and the function of the zygoma bone and the zygomatic arch depends on its reliable fixation technique. After the osteotomy the zygomatic arch is completely oruncompletely fractured and combination forces from the masseter muscle and the gravity are tend to move free pieces of zygoma bone downward resulting in facial depression and sagging. In realizing that Dr. Fushun Ma invented the mortise and tenon fixation technique of zygoma bone to acquire solid fixation with out any external plate and screw fixation and no foreign body left in the face.
zygma and zygomatic arch smoothing reduction plasty
The clinical application of multiple osteotomy zygoma redcution plasty proved successful. Zygomatic osteotomy combined application of clinical and acquired good results. It fundamentally overcomes the major drawback of grinding and simple simple osteotomy procedures. But its procedure is still a bit complicated to handle and in addition to the mucosal incision in the oral cavity another relatively large incision, about 6cm's long, is needed. In recent years, Dr. Fushun Ma reformed this procedure by change the osteectomy position and its operation steps. The incision in the hair line reduced to only 1cm. The multiple osteotomy can be done and the zygomatic arch can be displaced inward smoothly with an effective facial narrowing result. Thus the surgical trauma is much less savior and the recovery time is much shorter. Greatly reduced surgical trauma, faster postoperative recovery. Dr. Fushun Ma calls the surgical technique zygma and zygomatic arch smoothing reduction plasty.
As the undermining area is smaller and less muscle is been stripped down from the bone attachment the facial soft tissue sagging is better avoided. The operation is very well tolerated with minimum surgical trauma, only 4-6 drainage hours and about 10 hours bandage time.wound is small, placing drainage tube for only 4-6 hours, wrap time is very short, usually in 10 hours. The majority of the patients were able to resume work after the second or third day. Patients can eat normally the next day. However, local external collisions should be avoided for three months.
The CT scan images at the level of zygomatic arch show the curved structure of the zygomatic arch before operation and the much straighter appearance after operation. This change narrows the distance between the most bulging points of the zygomatic arch both sides of the zygomatic arch, so the narrowing of the face.
The features of the zygoma and zygomatic arch smoothing reduction plasty
1. The incision: oral mucosal incision plus a 1cm long incision in the hair line. The hair line incision is hardly visible after healing. After the incision healed basically invisible.
2. No external fixtures, such as titanium plate titanium screw fixation are needed. No need to worry about the bone and soft tissue sagging.
3. Bandage for only one day. Eating normally the following day.After the next day the patient can eat normally.
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