Dental Pulp Necrosis as a Rare Complication of Reduction Malarplasty

Iatrogenic arteriovenous fistula of the superficial temporal artery after reduction malarplasty

A 34-year-old woman who had a history of undergoing reduction malarplasty at a local clinic about 1 year ago developed gradually increasing pulsatile tinnitus in the right preauricular area since the last 6 months. On physical examination, there were an approximately 1 × 0.5-cm nontender, soft, pulsatile mass with a palpable thrill and a continuous machinery-like buzzing sound in synchrony with the heartbeat. She had a fine scar near the mass, which was supposed to be a postoperative scar of reduction malarplasty. A three-dimensional computed tomographic angiogram revealed a direct arteriovenous fistula between the superficial temporal artery and superficial temporal vein in the right preauricular area. The arteriovenous fistula was embolized using Tornado coils. After coiling, the thrill and disturbing tinnitus disappeared immediately, and postembolization angiography confirmed obliteration of the arteriovenous shunt. This is the first case of an arteriovenous fistula of the superficial temporal artery after reduction malarplasty, and it indicates that arteriovenous fistula can occur as a delayed complication of reduction malarplasty.

Influence of the maxillary sinus exposure in reduction malarplasty with an L-shaped osteotomy

BACKGROUND

The zygomatic bone forms the prominence of the midface and plays an important role in determining the human facial attractiveness. The Oriental face is mesocephalic, with a prominent zygomatic body and wide zygomatic arch. Nevertheless, as an oval face is considered ideal, reduction malarplasty is always requested by Oriental people. Currently, L-shaped zygomatic osteotomy is often reported in literature yet no previous study has documented the exact outcome of this approach after exposure of the maxillary sinus. The objective of the study was to investigate the outcome and complications of intraoral L-shaped zygomatic osteotomy with the opening of maxillary sinus.

METHOD

All patients were subjected to computed tomography before and 12 months after surgery. All parameters were obtained with morphometric analysis for clinical evaluation, so as to reveal the change in maxillary sinus, postsurgical results, and complications.

RESULTS

All patients were satisfied with the optimal outcome of reduction malarplasty. Morphometric analysis indicated that the volume and surface area of maxillary sinus statistically significantly changed before and after surgery. Complications included deeper nasolabial fold, infraorbital nerve injury, and so on, yet no patients reported infection or dental pulp necrosis.

CONCLUSIONS

Intraoral L-shaped osteotomy of the zygoma can improve the appearance of the patients greatly, and the exposure of maxillary sinus caused only a few complications.

Lateral rectus muscle injury, orbital fracture, mouth locking, and facial palsy resulting from reduction malarplasty

I report here on a patient with serious complications (lateral rectus muscle injury, orbital fracture, mouth locking, and facial palsy) that were caused by reduction malarplasty. A 32-year-old woman was referred to our department with complaints of inability to move her right eyeball laterally and inability to open her mouth. She has undergone reduction malarplasty 30 days previously at a local clinic. On examination, her maximal mouth opening was less than 3 mm. Her upper lip deviated to the left side when whistling. The orbit was displaced laterally and inferiorly. The upward and lateral gaze were limited. Computed tomography revealed fracture of the right orbital floor and lateral orbital wall extending to the orbital roof. The right lateral rectus muscle showed disconnection. The osteotomized segments were displaced inferiorly, and they pressed on the masseter muscle and coronoid process on the left side. On the 43rd postoperative day, a revision operation for the zygoma and orbit was carried out. Four days after the revision operation, surgery was performed for the myorrhaphy of the lateral rectus muscle and transposition of the medial rectus muscle. This case suggests the possibility of orbital fracture that can occur as a result of sawing in the wrong direction when using the intraoral approach. Although orbital fracture is extremely rare, it is hoped that this case will heighten the awareness of surgeons for this potential orbital fracture.

Pulp necrosis during septorhinoplasty

OBJECTIVES/HYPOTHESIS

Bony manipulation near the nasal spine or maxillary crest trimming can predispose teeth to injury during septorhinoplasty, especially when there is an aberrant vascular supply or a highly situated root apex in the premaxilla.

STUDY DESIGN

Prospective cross-sectional study.

METHODS

A prospective cross-sectional study was carried out on 438 teeth (maxillary incisors and canines) that were supposedly affected and 73 control teeth (mandibular lateral incisors) in 73 candidates of septorhinoplasty before and after surgery to determine the frequency of pulp necrosis using electrical, heat, and cold pulpal tests. Those with difficult intubation, history of root canals or orthodontic procedures, history of dental trauma, or a positive preoperative test were excluded from the study. Patients were followed up 2 weeks, 3 months, and 6 months postoperatively, and test results were compared before and at three intervals after the surgery.

RESULTS

Seventy-three consecutive patients, including 11 males and 62 females, met the study criteria. Septoplasty with anterior maxillary crest trimming and anterior nasal spine manipulation was performed in 63 and 52 cases, respectively. Only 10 cases underwent septoplasty without manipulation of the maxillary crest or the anterior nasal spine. Based on pulp testing, no case of pulp necrosis was seen during the 6-month follow-up.

CONCLUSIONS

Considering there are very few reports of dental problems during septorhinoplasty, it is an unlikely cause of serious dental complications such as pulp necrosis. An abnormal anatomy might be a good explanation for rare cases.