Zhang Yuguang, Tang Mengyao, Jin Rong, Zhang Yan, Zhang Ying, Wei Min, Qi Zuoliang
From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Ann Plast Surg. 2014 Aug;73(2):131-6. doi: 10.1097/SAP.0b013e318273f81f.
For Asians, prominent zygomatic region is a sign of masculinity; therefore, reduction malarplasty is becoming more and more popular in Asian women.
The purpose of this study is to analyze the biomechanical changes of zygomaticus and masseter, and to explore the underlying causes of relevant complications using the 3 popular techniques of reduction malarplasty.
From May 2000 to August 2009, 259 female patients underwent traditional osteotomy through coronary incision, malomaxillary suture with L-shaped osteotomy through intraoral approach, and the modified X.M.'s technique. The mechanical and anatomical causes of the relevant complications such as facial asymmetry caused by detachment of zygomaticus and masseter, facial sagging, and downward movement of malar point in 3 surgical procedures were analyzed and compared postoperatively among the 3 procedures.
In the traditional osteotomy through coronary incision, the inside cheek fat pad moved interoinferiorly because the greater and lesser zygomatic muscles were stripped from the attachment points, whereas masseter was relatively less stripped from its attachment point, which affects mechanical direction and contraction strength less, which possibly leads to the downward movement of the fractured extremity of zygomatic bone. In the L-shaped osteotomy, the zygomatic arch slided interoinferiorly because of the operative design, and masseter's strong extroinferior traction often caused fixation loosening between the former and latter bone margin. As a result, the fractured zygomatic bone moved downward along with zygomaticus, masseter, and fat pad. In the modified X.M.'s technique, complications were relatively fewer, which may be related to less injury to the fixation system of zygomatic bone and less biomechanical changes in masseter and zygomatic muscles.
Surgeons should base their choice of reduction malarplasty not only on thoroughness of the operation but also on biomechanical changes in the zygomatic region and patients' individual conditions.
对于亚洲人而言，颧骨突出是男性化的标志；因此，颧骨缩小整形术在亚洲女性中越来越受欢迎。
本研究旨在分析颧骨缩小整形术中3种常用技术对颧肌和咬肌的生物力学变化，并探究相关并发症的潜在原因。
2000年5月至2009年8月，259例女性患者分别接受了经冠状切口的传统截骨术、经口内入路的L形截骨下颌骨上颌骨缝合术以及改良的X.M.技术。术后分析并比较了这3种手术中因颧肌和咬肌附着点分离导致面部不对称、面部下垂以及颧骨点下移等相关并发症的力学和解剖学原因。
在经冠状切口的传统截骨术中，由于颧大肌和颧小肌从附着点剥离，颊脂垫向内下移动，而咬肌从其附着点的剥离相对较少，对其力学方向和收缩强度影响较小，这可能导致颧骨骨折端向下移动。在L形截骨术中，由于手术设计，颧弓向内下滑动，咬肌强大的外向内下牵引力常导致前后骨缘之间的固定松动。结果，骨折的颧骨随颧肌、咬肌和脂肪垫一起向下移动。在改良的X.M.技术中，并发症相对较少，这可能与颧骨固定系统损伤较小以及咬肌和颧肌的生物力学变化较小有关。
外科医生选择颧骨缩小整形术时，不仅应基于手术的彻底性，还应考虑颧骨区域的生物力学变化和患者的个体情况。
