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Preservation of the deep facial vein in reduction malarplasty
Bong-Kyoon Choi1, Kyeong Tae Lee, Kap Sung Oh
1KIES_U Plastic Surgery Clinic, Seoul, Republic of Korea.
Purpose:
Many facial bone contouring surgeries, including reduction malarplasty, are performed in Asian countries to give the face an oval shape. When performing reduction malarplasty, a few large vessels can be injured, including the deep facial vein. The aim of this study was to determine the anatomy of the deep facial vein and to investigate the best method to prevent injury of deep facial vein during reduction malarplasty.
Patients And Methods:
A retrospective chart review was performed for all patients who underwent reduction malarplasty with L-shaped osteotomy between March 2009 and February 2010. We performed a chart review focusing on complications associated with bleeding, which result in an emergency operation.
Results:
A total of 324 patients underwent reduction malarplasty with L-shaped osteotomy during the study period. In 2 cases, the deep facial vein was injured during vertical osteotomy at the posterior wall of the maxillary sinus, resulting in major bleeding. Because it was difficult to access the deep facial vein that lies just behind the posterior side of the maxillary sinus, the fixed free zygomatic bone segment had to be disassembled to access the vessels.
Conclusions:
In reduction malarplasty using L-shaped osteotomy, the subperiosteal dissection should be performed carefully and osteotomy should be performed cautiously not too deep to reach the periosteum of the posterior side of the maxillary sinus. The surgeon should consider the possibility of major bleeding because of injury to the deep facial vein, and it may be necessary to notify patients and explain this risk.
