Clinical extension of corrective malarplasty with tripod osteotomy

Facial asymmetry can be produced by congenital or acquired factors, and surgical correction is one of the very important and difficult fields in plastic surgery. Zygoma plays a key role to keep facial symmetry, and diverse methods have been tried to correct asymmetric face. We used the malarplasty with tripod osteotomy to correct nontraumatic asymmetric face.

From December 2008 to February 2010, 3 patients presenting with facial asymmetry and enophthalmia were selected, and their average age was 18 years. One of the patients has undergone surgeries 4 times without improvement for rare facial cleft no. 4 from other hospitals. The other 2 cases had hypoplastic zygoma complex caused by early enucleation and radiation therapies because of retinoblastoma in their childhood. Through a bicoronal approach, malarplasty and calvarial bone graft were done after tripod osteotomy including the zygomaticofrontal suture, zygomatic arch, and zygoma body.

The surgery results were evaluated by radiographic inspection and the photographs of the patients. Differences in preoperative heights of both normal and hypoplastic zygoma-orbit complex in Waters and zygomatic view were estimated. After corrective operation, the height of the zygoma complex was almost close to normal height, and orbital volume was increased, and ectropion was corrected at the same time in patients.

Using corrective malarplasty with tripod osteotomy, we achieved satisfactory results of zygoma expansion and improvement in orbital area. Therefore, malarplasty via tripod osteotomy cannot be applied only on the patients with traumatic zygoma deformation, but also on the patients with nontraumatic facial asymmetry.