Zygomatic Sagittal Split Osteotomy: A Novel and Simple Surgical Technique for Use in Midface Corrections

Modified high-level Le Fort I advancement without malar augmentation: assessment of effect on midfacial aesthetics

The 'beauty arch', an aesthetic feature of the midface, is a double-S-shaped curve that extends downward from the lateral canthus. This retrospective study evaluated whether modified high Le Fort I advancement (combined with impaction or down-grafting) without malar augmentation can approximate a patient's 'ideal' beauty arch (IBA). Pre- and postoperative profile (natural head position) photographs for 36 patients with midfacial hypoplasia were aligned digitally. For each individual, standardized methods were used to identify landmarks and draw the preoperative real beauty arch (RBA), postoperative RBA, and IBA. Distances from a defined landmark to each arch were measured and means were compared. The mean advancement range was 4.2 ± 2.2 mm, and the mean pre- and postoperative RBA distances were significantly different (138.7 ± 24.1 vs 145.0 ± 25.8 pixels, respectively; P = 0.0001). In the impaction and down-grafting subgroups, there was no significant correlation between amount of maxillary movement and the difference between pre- and postoperative RBA distances (P > 0.05 for both). The postoperative RBA was satisfactorily close to the IBA in 35 cases (97.2%); one patient required later augmentation. The findings suggest that modified high Le Fort I advancement surgery without malar augmentation provides satisfactory malar projection for most patients with maxillary hypoplasia.

The U-Shaped Maxillary Osteotomy: A Novel Resource for the Treatment of the Middle Third Facial Hypoplasia

The purpose of orthognathic surgery procedures is to manipulate the elements of the facial skeleton to reestablish normal anatomy and function. These elements could be repositioned with the technique known as Le Fort I osteotomy. This technique can be modified to be adapted on each patient, depending on the anomaly presented and the planned objective. The versatility, offered by the modifications of the Le Fort I osteotomy, has taken us to design one that allows the capability to correct the malar region hypoplasia in the same surgical procedure. A total of 9 patients were included with malocclusion as indication for orthognathic surgery who also presented with malar hypoplasia diagnosed clinically and cephalometrically. A modified technique, the "U"-shaped maxillary osteotomy, was performed with excellent functional and aesthetics results, and none of the patients presented complications associated directly to the maxillary osteotomy. Some patients with maxillary zygomatic deficiency combined with malocclusion continue to present a special challenge to clinicians treating these deformities. This technique is useful in improving zygomatic projection in bloc with the Le Fort I advancement without the need to place a bone graft and the advantage of rigid fixation along with the one used in the Le Fort I osteotomy. The U-shaped maxillary osteotomy is a safe, trustworthy, and reproducible technique that allows the resolution of the maxillomalar hypoplasia in a single surgical time, providing satisfactory aesthetic results. Any surgeon with adequate training in orthognathic or craniofacial surgery could perform it and incorporate it to his technical armamentarium.

Trancutaneous Versus Intraoral Approach to Isolated Zygomatic Arch Fractures: A Comparison of Two Techniques

Zygomatic arch fractures are caused by a vector force orthogonal to the bone segment that causes the collapse of the arch through depression of the bone fragments. Reduction of isolated zygomatic arch fractures are usually only of esthetic interest, with the exception of those cases where the fracture causes an impingement with the underlying mandibular coronoid process, causing limitation of mandibular movements. Reduction is usually performed with an extraoral approach, more rarely through a transoral approach. In this article, authors compare the traditional transcutaneous technique with the intraoral approach in 2 groups for a total number of 42 patients.For what concerns the correct alignment of the fragments, the 2 techniques have shown being equivalent. Although the intraoral approach has shown being a faster surgical procedure leaving no visible incision, allowing faster recovering and reduced postoperative pain.

The "beauty arch: " a new aesthetic analysis for malar augmentation planning

Midface is a critical area for the aesthetics of the face. Despite malar hypoplasia is often combined with a class III malocclusion, there are few studies focusing on the results of a combined approach of malar implants and Le Fort I. We describe a new aesthetic analysis, named "beauty arch" analysis, for the assessment of sagittal projection of the malar region. We took a reference group of 74 Italian women participating in a national beauty contest in 2011 on which we performed our analysis. We used the ideal values to elaborate the surgical treatment planning of a second group of 45 consecutive female patients affected by skeletal class III malocclusion.Twenty-three patients undergo simultaneous Le Fort I osteotomy and malar implants. From the descriptive statistical comparison of the patients' values before and after orthognathic surgery and malar implants with the reference values, we observed how all parameters considered got closer to the ideal population. We consider our beauty arch a useful help for surgeon in the treatment planning of patients with skeletal malocclusions and malar implants.