Simultaneous Reduction of Contralateral Malar Complex in Cases of Unilateral Zygoma Bone Fracture

Purpose: Reduction by simply assembling bones is recognized as treatment for a zygoma fracture. However, in patients who originally had a protruding zygoma, the fractured parts look like malarplasty after the edema subsides, giving a soft impression which patients notice. Thus, we created symmetry through simultaneous contralateral malar reduction in a unilateral zygoma fracture. Methods: In this study, the patients who had surgery between July, 2008 and December, 2009 with admission were object. In 76 patients with a zygoma fracture, the patients with bilateral zygoma fractures were excluded. Among 48 patients who had a reduction only after a unilateral zygoma fracture, the patients hoping for a reduction of their rough protruding zygoma were analyzed with front cephalometry. The study progressed on 22 patients who had simultaneous contralateral malar reduction in a unilateral zygoma fracture with consent. After fixing the fracture, we did a straight zygoma osteotomy through a 1.5 cm intraoral incision. After that, we created symmetry with a special ruler and fixed the broken zygomatic arch with a screw and plate. We evaluated the facial index and satisfaction with a statistical analysis before and after the surgery. Results: In 22 patients, there was no reoperation except for 1 patient who had a zygoma fracture. None of the patients were treated for infection or hematoma. Two patients complained of paresthesia after the malar reduction operation, but this subsided in 4 months. Most of them were satisfied with the malar reduction, especially the women, and we obtained a better mid facial contour with decreased facial width ($p$ <0.05). Conclusion: Existing zygoma fracture surgery focuses on anatomical reduction. However, we need to have a cosmetic viewpoint in fractures as interests of face contour arise. Thus, contralateral malar reduction got a 4.7 (range 0~5) from patients who had malar reduction surgery in our hospital. Although adjusting to all zygoma fractures has limitations, it can be a new method in zygoma fractures when there are limited indications of protruding zygoma and careful attention is given to patients' high demands.

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