Optimal Fixation Location in Intraoral Reduction Malarplasty Using an L-Shaped Osteotomy

Reduction malarplasty, popular among Asians, is currently performed preferably via the intraoral approach. However, to prevent complications such as malunion and cheek drooping, a rigid fixation is essential to compensate for the action of the masseter. Accordingly, the authors aimed to perform an experimental study on the optimal fixation location during intraoral reduction malarplasty using an L-shaped osteotomy.

Fixation points that are not difficult to access during an L-shaped osteotomy were selected as 1 point in the freed zygomaticomaxillary complex and 3 points in the medial part of the malar complex (low, middle, and high levels).After setting the fixation points in the medial malar complex and lateral segment of skull replicates, resistance to traction was measured at each level, and maxillary bone thickness was also measured at each level at the fixation points of the medial malar complex in a cadaveric head.

In the medial malar complex, resistance to traction increased at higher levels, while the maxillary bone was much thicker at the high level than at the low-middle level.

This study demonstrated that it is better to locate the fixation point at a higher level in the medial part of the malar complex, closer to the lateral orbital rim.