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Revision Surgery afte Zygoma Bone and Zygomatic Arch Plasty

[ Author:Dr. Fushun Ma | Time:2011-10-20 09:59:28 |  Font Size: [Large Medium Small]
Tags: zygoma,revision surgery,zygomatic arch,zygoma plasty,bone displacement

Zygoma bone and zygomatic arch revision surgery is one of the many revision plastic surgeries. Like other cosmetic and plastic surgery, after zygoma plasty some complications or unsatisfied situations may occur. Sometimes a revision surgery is needed. The most common complications after zygoma plasty include the displacement of zygomatic arch, zygomatic arch defect, maxillary sinus anterior wall defect, zygomatic arch weakness and facial expression muscle sagging. These complications may related to the improper selection of surgical procedures. For example, adducted and rotated downward in order to narrow the zygomatic area. Using this method of procedure it is very likely to result in postoperative displacement of bone fragment, expression muscle sagging and depression deformity in the zygomatic area. Unfortunately, a great number of the plastic and cosmetic surgeons still only use this method in their practice. So, postoperative problems are not uncommon.

zygoma ptosiszygoma ptosis restored
Bone fragment displacement after front-end osteotomy zygoma reduction plasty. On the left CT picture the front-end of the zygomatic complex rotates downward forming a gap at the lateral inferior part of the ocular orbit. The CT picture on the right side show the bone fragment restoration and two fixation plates and screws to bridge the gap.

zygoma plasty pre- and post-op, no change noticed
CT pictures of zygoma plasty show no changes in shape of the zygoma bone after operation. On the left side is the preoperative picture. On the right side is the postoperative picture demonstrating the osteotomy lines at the front part of the zygoma bone and nothing else having been changed about the zygoma bone and the zygomatic arch compared to the preoperative picture.

Once the above problems happened most of the patient will seek revision surgery believing the previous surgery has been failed. Another case is that the surgery does not achieve the desired results. After surgery the zygoma simply do not getting smaller and the face has not been narrowed. On CT images most of the time only a osteotomy lines are shown at the front part of the zygoma or the zygomatic arch. The shape and size of the zygoma and zygomatic arch do not change at all. Even nothing has changed on the zygomatic complex, the procedures of the revision surgery is still different than the primary surgery because of the osteotomy line existing already.

As the zygoma bone zygomatic arch have undergone an operation, one choice of timing for the revision surgery is at the early postoperative stage before the healing of the osteotomy lines. That is to do the revision surgery during the 6 weeks postoperatively. The second choice of timing is during the 6 months after operation. At this time the healing process is already finished, a nother osteotomy is needed in order to move the bone. Two kinds of timing both have their advantages and disadvantages. The advantages of early revision surgery include no need of osteotomy, easy to restore the bone fragment and better muscle function recovery, because of the previous osteotomy line has not healed, no adhesion of bone fragment has occurred in the new position and the muscle atrophy has happened. The advantages of delayed revision include less bleeding, longer interval from the first operation and better assessment for the post operation result from the first operation as the swelling has already subsided and the disturbance of facial shape and function have revealed.

Restoration for shifted  zygoma bone and zygomatic arch

symptoms and manifestation: zygoma bone and zygomatic arch displacement is a common complication of some kind of zygoma reduction plasty procedures. Because the bone is deeply situated and the postoperative swelling covers the deformity patients generally notice the problem after the first 6 months postoperatively. As the result of inferior and medial displacement of zygoma bone and the zygomatic arch, sunken midface deformities and facial soft tissue ptosis followed, presenting the appearance of aging. Most patients do not have function limitation. If the displacement is severe shift limitation of mouth opening or local oppression may occur. CT examination can clearly reveal the new location of displaced bone pieces.

zygoma redcution plasty CT, inferior and medial rotation zygoma reduction plasty, post operation indentation in the zygoma area
The CT image on the left show the medial and inferior displacement of zygomatic arch after zygoma reduction surgery. The zygomatic arch is not continuous manner and a step may be notice at the front part of the zygoma. The picture on the right is the facial appearance of the patient. It show an indentation at both side of the zygomatic area which is located at the inferior lateral side of the lateral canthus.

Surgical Revision: If the displacement is not serious and there is no appearance and function disturbance there is no need to do the revision surgery. The timing of the revision surgery depend on the situation of the patient. Although the early revision surgery is more beneficial in restoring the facial appearance and function, in most cases the problems are noted in a quiet late stage postoperatively. Due to changes in soft tissue?? bone atrophy and bone removal it is basically impossible to restore the zygoma and zygomatic arch to its original shape. A more practical way of doing the revision surgery is to achieve a satisfactory result against the present situation. Therefore, as a patient it is essential to express the reason of unsatisfactory and the goal for the revision. At this stage a surgeon should analyze the current situation carefully and judge the possibility to please the patient with a better result while ensuring the function and anatomical structure as intact as possible.

The steps of revision surgery: According to the specific circumstances the key step of revision surgery is to reset the bone pieces to normal anatomic position and to fix them firmly. To be able to move the zygoma bone to narrow the face part the zygoma bone has been removed during the primary surgery. Bone shortage will inevitable when the zygoma bone is restored back and a gap will present at the front part if the zygoma. If the gap is small there is no consequences. If the gap is too big there may be some local indentation in a long run. In this instance the whole zygomatic arch should be mobilized make the gap narrower. When necessary autologous bone graft is needed to fill the gap. No matter whether the plate and screw fixation is applied for the previous operation plate and screw fixation is mandatory once the displaced zygoma bone fragment is restored back. Other ways of fixation is net suggested. In order to fill the gap it is better to apply two or more sets of plate across the gap. See first set of CT images on this page.

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