brief introduction

Zygomatic augmentation is a very common method in facial plastic surgery. Zygomatic bone is cut off, displaced and then fixed again by osteotomy, so that the zygomatic bone is enlarged and widened from the anatomical structure. The surgical method is more effective, thorough and reliable. Zygomatic augmentation surgery is suitable for patients with simple zygomatic dysplasia, zygomatic recession and deformity, and patients with severe low zygomatic height. In addition to routine laboratory examination before operation, we should also measure the height-width ratio, calculate the data to be added, and take local gypsum samples to understand the height to be added.

Surgical procedure

(1) General anesthesia with nasal intubation

(2) Intraoral incision to expose cheekbones: maxillary vestibular sulcus incision was used, starting from the front canine teeth and ending at the second molar incision. First, 1% lidocaine (containing 1∶500 000 adrenaline) was used for local infiltration anesthesia to reduce bleeding. After cutting the mucosa, the submucosa and periosteum were cut off by electricity, and the zygomatic body was peeled off outward and upward with a stripper, and the suborbital foramen and the suborbital neurovascular bundle passing through the foramen were found above the canine fossa for protection.

(3) Incision of the lower orbital margin exposes the lower orbital wall: make an arc 3 cm long incision in the lower orbital margin parallel to the orbicularis oculi muscle, locally infiltrate anesthesia to stop bleeding, cut the subcutaneous tissue of the skin, peel off the lower orbital margin of the orbicularis oculi muscle 0.5 ~ 1.0 cm below the incision plane and pull it upward. Touch the lower edge of the orbit with your fingers in the depth of the incision and peel it off to the surface of the periosteum. Cut the periosteum with a knife aiming at the orbital margin, peel it off to the inner, outer and infraorbital walls with a stripper, and communicate with the intraoral incision at the outer side of the infraorbital foramen.

(4) Osteotomy forward: Mark a transverse osteotomy line from the cusp 1.0 cm above the cheekbone with methylene blue. The medial end of the osteotomy line goes up vertically to the lower orbital margin, then horizontally to the upper middle 1/3 of the lateral orbital wall at 0.5 cm from the lower orbital margin, and then to the outer edge of the zygomatic bone. For the case of orbital wall collapse or dysplasia, the orbital osteotomy line should be designed at a distance of 65438±0.0cm from the orbital floor, and below the horizontal line of the lateral wall of the orbit parallel to the infraorbital foramen and the outer edge of the infraorbital fissure. The lower osteotomy line is connected with the apical osteotomy line.

(5) Osteotomy: use chisel (1.5 ~ 2.0 mm) to perform osteotomy along the calibrated osteotomy line. When osteotomy, use a syringe and spray water with the drill, and the aspirator will suck up the oozing blood and washing water at any time. After amputation, chisel in from the lower part of the apex to the upper part until it is connected with the upper osteotomy line. After prying open the cheekbones, the cheekbones can be raised to a higher height.

(6) Bone grafting and fixation: the ilium was cut into three pieces with the same original height, which were embedded in the medial orbital wall, lateral orbital wall and osteotomy at the orbital apex. Fix with steel wire ligation or mini steel plate screws. Pay attention to bilateral symmetry when bone grafting.

Key points of zygomatic augmentation surgery

1, conventional disinfection towel.

2. Local infiltration anesthesia.

3. Make bilateral mucosal incision at the upper gingival sulcus.

4. Separated from periosteum and subperiosteum through mucosa and submucosal tissue to the surface of cheekbone.

5, do a good job of zygomatic biological or non-biological prosthesis.

6. According to the shape of the zygomatic bone, put the prepared zygomatic prosthesis under the separated periosteum.

7. Suture or screw internal fixation.

8. Place the drainage tube and suture the incision.

Surgical methods of zygomatic augmentation

Including zygomatic osteotomy and zygomatic augmentation.

Osteotomy of zygomatic bone increases height

Through osteotomy, the cheekbones are cut off, displaced and re-fixed, so as to achieve the purpose of increasing and widening the cheekbones from the anatomical structure. It is a thorough method to correct the low or collapsed cheekbones, with reliable effect, and is suitable for patients with serious illness. Surgical method

(1) Osteotomy of zygomatic bone through oral incision (Onizuka method): The maxilla and zygomatic body were exposed through the incision of gingival sulcus, and the osteotomy was vertically upward from the outside of maxillary suture of zygomatic bone, and when the upper edge of forehead arch was horizontal, the medial part of zygomatic bone was cut off, and the broken ends were pried by bone rotation, so that the zygomatic bone moved forward and backward, and hydroxyapatite artificial bone was implanted and supported between the broken ends to achieve the goal.

The disadvantage of this method is that the degree of malar bone elevation is limited, which is not suitable for patients with severe malar bone dysplasia.

(2) Osteotomy and elevation of zygomatic complex through coronal incision: according to the three-column osteotomy and reduction method of zygomatic complex, the whole zygomatic complex was completely cut off and shifted forward and outward, and the zygomatic frontal suture, zygomatic arch and orbital margin were firmly fixed with small titanium plates, and the broken ends were filled with artificial bone or autogenous bone transplantation. In order to make the zygomatic process smoother and more natural, we often stick an autologous skull outer plate on the surface of the zygomatic maxilla after osteotomy, and polish and shape it. After operation, the cheekbone protrusion not only increases, but also has a good shape.

Zygomatic augmentation

It is suitable for patients with slight depression or collapse of cheekbones, and can also be used as an auxiliary surgical method to increase cheekbones after osteotomy. It is characterized by relatively simple operation, no osteotomy and little trauma. The operation can adopt incision under the lower eyelash margin or incision in buccal sulcus. For patients with low or collapsed unilateral cheekbones, the position and height of the bone taken from the opposite side should be referred to ensure bilateral facial symmetry after operation. For patients with bilateral low cheekbones, the highest point of filling bone graft should be located at the intersection of the line from the outer canthus to the ipsilateral corner of the eye and the line from the upper edge of the external auditory canal to the outer edge of the ipsilateral nostril. At present, the main materials used for filling are autogenous bone and other biological substitutes for bone.

Surgical method

(1) Autologous bone graft is usually filled with autogenous iliac bone and ribs. Because of the large proportion of cancellous bone, it is easy to be absorbed after implantation, and the long-term effect is difficult to guarantee. Autologous skull outer plate has good natural curvature and less absorption after being placed for eight times. Mouth J is considered to be the most ideal filling bone graft material. If necessary, shaping the skull outer plate and overlapping bone grafting can achieve good surgical results. The main disadvantage of autogenous bone filling is that it needs to take another bone, which increases the surgical trauma and prolongs the operation time.

(2) The filling of other biological bone substitutes increased, including hydroxyapatite artificial bone. In recent years, chemical synthetic material high-density porous polyethylene has been widely used because it is processed into various specific shapes and easy to cut, shape and fix. Using substitutes to fill and increase cheekbones does not require bone removal, which greatly reduces the operation time and trauma. There is no absorption after placing, and the effect is reliable. However, some materials are expensive and only suitable for cases with good soft tissue coverage and no maxillary sinus rupture and penetration.