The 'sandwich' zygomatic osteotomy: technique, indications and clinical results

The classical approach to lateral midface hypoplasia is reconstruction with onlays. Dislocation and asymmetry, early and late infection, and extrusion are possible complications with alloplastic implant materials. Unpredictable resorption, irregular contours and asymmetry are problems that can arise with autogenous, homogenous and hetergenous onlay grafts. We describe a technique by which the zygomatic body is luxated laterally and ventrally after a combined oblique-horizontal and vertical osteotomy. The resultant greenstick fracture at the temporo-zygomatic suture together with minimal lateral degloving causes the malar body to return to its former position. An interpositional porous hydroxyapatite block acts as a space maintainer until the osteotomy sites are ossified. The restoration of contour is performed by the zygomatic body itself, not by the implants. The indications are discussed and the results of three year follow-up are illustrated.