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Natl J Maxillofac Surg. 2019 Jul-Dec;10(2):146-152. doi: 10.4103/njms.NJMS_53_18. Epub 2019 Nov 12.

Zygomaticomaxillary "lateral swing" osteotomy for augmentation of midface deficiency.

Author information

1
Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and General Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.

Abstract

Introduction:

Various surgical modalities have been proposed for the augmentation of midface deficiency without correction of the occlusal component. They include autogenous bone and cartilage grafts, alloplastic materials, and osteotomies. We propose an innovative osteotomy technique for augmentation of the midface including the infraorbital rims, the zygoma, the anterior maxillae, and the paranasal areas without advancing the dental-bearing segment.

Materials and Methods:

This procedure was carried out on a 21-year-old male patient who had a deficiency of the anterior maxillae including the infraorbital rims. His occlusion was in Class I molar relation. The surgical exposure was carried out through a midface degloving approach. This bilateral osteotomy encompasses the anterior maxillae and the zygoma; the osteotomy line running superiorly from the medial aspect of the infra-orbital rim to the root of the frontal process of maxilla. Inferiorly, the line runs above the apices of the maxillary teeth laterally underneath the zygomatic buttress, separating part of the zygomaticomaxillary suture posteriorly. Medially, the osteotomy line runs parallel to the piriform aperture. The osteotomy is pedicled on the zygomaticotemporal suture. A greenstick fracture at the zygomatic arch pedicled the osteotomized segment to the zygomatic process of the temporal bone. The entire segment was swung laterally outward, effectively separating part of the zygomaticomaxillary suture posteriorly. Fixation was achieved with a single 2-mm L-shaped, 4-hole plate with gap at the zygomatic buttress region.

Results:

This osteotomy technique resulted in fullness of the anterior maxillae and infraorbital rims, with increased anterior and lateral projection of the zygoma.

Conclusion:

The zygomaticomaxillary "lateral swing" osteotomy is a reliable and stable technique for total midface augmentation not requiring occlusion correction.

KEYWORDS:

Maxillomalar osteotomy; midface augmentation; midface deficiency; zygomaticomaxillary osteotomy

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