The L-Shaped Zygomatic Reduction with Oblique or Vertical Resection: Which One Is the Optimal Choice?

Background: This study aimed to investigate the optimal surgical techniques in reduction malarplasty by comparing the difference between the L-shaped osteotomy with vertical and oblique bone resection.

Methods: A total of 120 patients who visited the authors' department for L-shaped osteotomy with either vertical (group I) or oblique bone resection (group II) from 2015 to 2021 were reviewed retrospectively. The preoperative and postoperative spiral computed tomographic data were analyzed. The preoperative computed tomographic data were also used to simulate the virtual and model surgery.

Results: The results showed that a broken bridge-like structure with a bony gap of 2.86 ± 1.03 mm at the zygomatic arch root was observed in group I, and a mortice-and-tenon joint structure with a bone overlap of 2.28 ± 0.58 mm was formed in group II. The zygoma in group I displaced significantly in the vertical direction and horizontal direction during the follow-up. Simultaneously, the incidence of complications was higher in group I. In the mechanism analysis through virtual and model surgery, the zygomatic segment was shifted anteriorly and inferiorly in group I, and a bony gap was detected at the zygomatic arch root. Conversely, a superior and posterior movement was performed in group II and it maintained the zygomatic complex integral with bone overlap at the zygomatic arch root on repositioning.

Conclusion: This study suggested that L-shaped osteotomy with oblique bone resection could be the optimal choice for reducing zygomatic prominence.

Clinical question/level of evidence: Therapeutic, III.