Novel technique to narrow the wide midface in Asians

To develop a novel technique for narrowing the wide midface in Asians using virtual surgical planning (VSP) and 2-bent plate fixation.

A total of 19 patients with a wide midface underwent midface narrowing by VSP and 2-bent plate fixation from 2009 to 2013. In each case, a 3-dimensional spiral computed tomography (CT) scan of the skull was obtained before surgery. The CT data were imported into the SurgiCase software, and VSP was performed. VSP was used to direct the amount of adduction and advancement during the midface narrowing surgery. During the actual surgery, we combined zygomatic arch osteotomy and I-shaped osteotomy of the zygomatic body and moved the zygomatic complex upward and inward in accordance with the preoperative data. We then reset the free zygomatic complex to a target position and fixed it with 2 bent plates. The correction effectiveness was then evaluated using 3-dimensional CT and pre- and postoperative standard facial photographs.

Most patients were satisfied with the results and experienced no severe complications. No cases of nonunion or permanent facial nerve injury were reported.

VSP can provide precise data to guide modified reduction of a zygomatic arch protrusion. The bent-plate fixation method can provide sufficient support and ideal midfacial contours. Our technique is recommended for narrowing the wide midface caused by a lateral prominent zygomatic arch.