Six year's experience with the zygomatic "sandwich" osteotomy for correction of malar deficiency

Purpose: This study discusses the rationale, modifications, and complicatio ns of an osteotomy technique used to increase malar projection. Patients and Methods: Seventy "sandwich" zygomatic osteotomies were perform ed in a 6-year period. Hydroxyapatite (HA) blocks were used to stabilize th e anterolateral rotation of the zygomatic body in 44 osteotomies, calcium c arbonate blocks were used in 23, calvarial bone grafts in three, a piece of bovine cartilage in one, and a bone graft from a chin ostectomy procedure combined with mesh osteosynthesis in one procedure. Fifty-six zygomatic ost eotomies were combined with Le Fort I-type osteotomies (eight with a midlin e split). Nineteen zygomatic osteotomies were performed simultaneously with a Le Fort I-type osteotomy and a rhinoplasty with lateral osteotomies. Results: The increase of malar projection and the stability of the procedur e could not be measured on conventional three-plane cephalograms. However, patient's and surgeon's satisfaction were high and remained so during the f ollow-up period (maximum, 6.5 years; minimum, 6 months). Three patients developed maxillary sinusitis. In two of them, this was clea rly related to fragmentation of an HA block. A Treacher-Collins patient dev eloped a chronic fistula in the upper vestibule, caused by leakage of infra orbitally placed HA granules. In two cases, a fracture of the zygomatic arc h occurred. Osteosynthesis was performed in one of them. Conclusion: With proper technique and care not to fracture the interpositio nal HA block, complications are rare. The procedure is expedient and provid es predictable and stable correction of malar deficiency.