The zygoma is essential key element determining midface contour and symmetry. The height and width of the zygoma are changed during midfacial surgery such as reduction of fractured zygoma, esthetic malar reduction and correction of congenital midfacial deformity. The exact preoperative and postoperative evaluation of the zygoma is very important step in midfacial surgery. The estimation of height and width of the zygoma usually depends on gross feature analysis or radiographic measurement. But the results are not accurate and subjective. Several device were used for measuring the height and width of the zygoma, but those are inconvenient and difficult to use. The fracture of the zygoma is frequently combined with blow out fracture resulting enophthalmos. The simultaneous measurement of accurate malar height and degree of enophthlmos is helpful. For this reason, we developed a new zygometer with the function of exophthalmometer. This device is convenient to use and easy for comparative measurement of malar height preoperatively and immediate postoperative period, and the degree of enothphalmos is measured simultaneously with this device. This new zygometer will be applied to many midfacial surgery and craniofacial study.
Congenital Abnormalities ; Enophthalmos ; Postoperative Period ; Zygoma

This study includes 40 patients of post-traumatic facial bone deformities to whom underwent realignment of zygomatic bone. In 13 cases, we modified the approach technique using limited exposure such as subciliary, intraoral and preauricular incisions instead of conventional wide exposure. Preoperative evaluation of deformity was done by using x-rays, photographs and detail communication with the patients. Through this limited exposure, osteotomy and repositioning of the zygoma were accomplished. There were no postoperative differences between wide and limited exposure, but limited exposure was more advantageous in terms of reduced operative time, transfusion, hospitalization and scaring. This approach was an effective method for the relatively simple tetrapod type-malunited fracture of zygoma without comminution.
Congenital Abnormalities ; Facial Bones ; Hospitalization ; Humans ; Operative Time ; Osteotomy ; Zygoma*

Nowadays facial skeletal contouring which have developed in craniofacial surgery, acquired popularity in aesthetic surgery. On planning aesthetic surgery, patient's desire must be considered first but it seems to be essential to have an objective standard of facial form. Anthropometric analysis, cephalometric analysis, and photogrammetric analysis were developed for this purpose but with a limitation in three dimensional analysis. Barnett and Whitaker(1986) developed a simple three dimensional analytic system of middle and lower face and reported average values and standard deviations for young Caucasian women. We performed the same analysis for age matched young Korean women and found some difference between young Caucasian women and young Korean women as follows; 1. Young Korean women's middle and lower face is wider than young Caucasian women's face in horizontal dimension. 2. Young Korean women's middle and lower face is shorter than young Caucasian women's face in anterior-posterior dimension. 3. The difference in vertical dimension between the two groups is minimal. 4. In angular relationship, young Korean women's anterior and inferior angles are larger than young Caucasian women's angles. These findings are coincident with other author's observations that Oriental face is wider and rounder than Caucasian face and Orientals have more prominent malar area and mandible angle. For Korean people, with many needs for aesthetic correction of prominent zygoma and mandible angle, this three dimensional analytic system will be useful in planning surgery and research for middle and lower face deformities.
Congenital Abnormalities ; Female ; Humans ; Mandible ; Vertical Dimension ; Zygoma

Nowadays facial skeletal contouring which have developed in craniofacial surgery, acquired popularity in aesthetic surgery. On planning aesthetic surgery, patient's desire must be considered first but it seems to be essential to have an objective standard of facial form. Anthropometric analysis, cephalometric analysis, and photogrammetric analysis were developed for this purpose but with a limitation in three dimensional analysis. Barnett and Whitaker(1986) developed a simple three dimensional analytic system of middle and lower face and reported average values and standard deviations for young Caucasian women. We performed the same analysis for age matched young Korean women and found some difference between young Caucasian women and young Korean women as follows; 1. Young Korean women's middle and lower face is wider than young Caucasian women's face in horizontal dimension. 2. Young Korean women's middle and lower face is shorter than young Caucasian women's face in anterior-posterior dimension. 3. The difference in vertical dimension between the two groups is minimal. 4. In angular relationship, young Korean women's anterior and inferior angles are larger than young Caucasian women's angles. These findings are coincident with other author's observations that Oriental face is wider and rounder than Caucasian face and Orientals have more prominent malar area and mandible angle. For Korean people, with many needs for aesthetic correction of prominent zygoma and mandible angle, this three dimensional analytic system will be useful in planning surgery and research for middle and lower face deformities.
Congenital Abnormalities ; Female ; Humans ; Mandible ; Vertical Dimension ; Zygoma

BACKGROUND: Patients who have undergone enucleation during infancy due to retinoblastoma can develop microorbitalism due to the decreased growth stimulation from the eyeball and the surrounding soft tissues. Anatomically, the orbit consist of parts of the frontal bone superiorly, the maxilla inferiorly, the ethmoid bone medially, and the zygoma laterally. Considering the possibility of surgically expanding the orbit using tripod osteotomy, in this study we conducted tripod osteotomy on adult patients with microorbitalism of retinoblastoma. METHODS: Tripod osteotomy was conducted to expand the orbital volume in adult patients with microorbitalism due to enucleation in infancy for retinoblastoma. The orbital volume was measured using the Aquarius Workstation ver. 4.3.6 and the orbit width was measured with preoperative and postoperative 3-dimensional facial bone computed tomography (CT) imaging. Preoperative and postoperative photographs were used to visualize the difference produced by the surgery. RESULTS: The orbital volume of the affected side was 10.3 cm3 before and 12.5 cm3 after the surgery, showing an average increase in volume of 2.2 cm3 (21.4%). The increase in the obital width was confirmed by the preoperative and postoperative 3-dimensional facial CT images and aesthetic improvement was observed by the preoperative and postoperative photographs. CONCLUSIONS: Tripod osteotomy, which realigns the orbital bone, zygoma, and maxilla, is used to correct posttraumatic malunion as well as non-traumatic congenital abnormalities such as that seen in facial cleft. We applied this procedure in microorbitalism secondary to enucleation for retinoblastoma to allow orbital expansion and correct asymmetry.
Adult ; Congenital Abnormalities ; Ethmoid Bone ; Facial Bones ; Frontal Bone ; Humans ; Maxilla ; Orbit ; Osteotomy ; Retinoblastoma ; Zygoma

Since maxillofacial injury is frequently accompanied by other diseases, its evaluation and treatment are open delayed. When the evaluation is delayed, the surgical treatment can be difficult or impossible. A 21-yr-old man presented with right facial swelling and deformity after injury. We planned immediate surgical repair for his right tetrapod fracture, but the operation was delayed for two months due to severe hyperthyroidism. During the operation, we reducted and fixed the deviated bone after refracture of the zygomatic arch with an osteotome to achieve mobility. The facial deformity and difficulty in mouth opening were improved after the operation. Even in the presence of accompanying fractures, early evaluation and proper management can prevent complications and achieve acceptable cosmetic outcomes in maxillofacial trauma patients. In patients with malunion of fracture sites, fixation after refracture using an osteotome can be a good treatment option for obtaining good mobility.
Congenital Abnormalities ; Cosmetics ; Facial Injuries ; Fracture Fixation ; Humans ; Hyperthyroidism ; Maxillofacial Injuries ; Mouth ; Zygoma

BACKGROUND: The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline. METHODS: A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results. RESULTS: The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable. CONCLUSIONS: In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome.
Congenital Abnormalities ; Depression ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Retrospective Studies ; Zygoma ; Zygomatic Fractures

OBJECTIVE: To evaluate the craniofacial asymmetry in adults with neglected congenital muscular torticollis (CMT) by quantitative assessment based on craniofacial three-dimensional computed tomography (3D-CT). METHODS: Preoperative craniofacial asymmetry was measured by 3D-CT for 31 CMT subjects > or =18 years of age who visited a tertiary medical center and underwent 3D-CT between January 2009 and December 2013. The relationship between the age and the severity of craniofacial asymmetry was analyzed in reference to anteroposterior length asymmetry of the frontal bone and zygomatic arch, vertical and lateral displacements of the facial landmarks, and mandibular axis rotation. RESULTS: The age at CT was 27.71+/-7.02 years (range, 18-44 years). All intra-class correlation coefficients were higher than 0.7, suggesting good inter-rater reliability (p<0.05) of all the measurements. The frontal and the zygomatic length ratio (i.e., the anteroposterior length asymmetry on the axial plane) was 1.06+/-0.03 and 1.07+/-0.03, respectively, which was increased significantly with age in the linear regression analysis (r2=0.176, p=0.019 and r2=0.188, p=0.015, respectively). The vertical or lateral displacement of the facial landmarks and rotation of the mandibular axis did not significantly correlate with age (p>0.05). CONCLUSION: Craniofacial asymmetry of neglected CMT became more severe with age in terms of anteroposterior length asymmetry of the ipsilateral frontal bone and zygomatic arch on the axial plane even after growth cessation. This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.
Adult* ; Axis, Cervical Vertebra ; Craniofacial Abnormalities ; Facial Asymmetry ; Frontal Bone ; Humans ; Linear Models ; Torticollis* ; Zygoma

The Treacher-Collins syndrome is a rare congenital anomaly characterized by mandibular, maxillary, and malar bone hypoplasia, bilateral deformities of auricles, lower lid defects, and antimongoloid slant of the palpebral fissures. The syndrome is associated with considerable difficulty in airway management during anesthesia; difficult, often impossible, endotracheal intubation and face mask ventilation. We report case of Treacher-Collins syndrome in 13-year-old girl who was intubated with fiberoptic bronchoscope and discuss anesthetic consideration.
Adolescent ; Airway Management ; Anesthesia ; Bronchoscopes ; Congenital Abnormalities ; Female ; Humans ; Intubation* ; Intubation, Intratracheal ; Masks ; Ventilation ; Zygoma

BACKGROUND AND OBJECTIVES: The zygomatic arch is the bony arch on both sides of the face consisting of the zygomatic bone. The zygomatic fractures are common maxillofacial injuries second only to nasal fractures due to its anatomical location of its structures. Various techniques have been applied for the treatment of zygomatic arch fractures but there is no desirable modality not only for the reduction but also for supporting depressed bony fragments without esthetic problems. The authors suggest aqua splint suture method, which is a new modality for the treatment of zygomatic arch fractures. SUBJECTS AND METHOD: In the period from March of 2004 to March of 2005, nine patients who had been performed reduction for zygomatic arch fractures were selected for clinical analysis. We repositioned depressed bony fragments by Gillies approach and stabilized repositioned bony fragments by external & internal fixation using aqua splint suture method. RESULTS: There were eight men and one woman, ranging in age from 19 to 68 years. All patients had chief complaints for trismus and facial deformities. Postoperative photographs and computed tomography, checked after 3 postoperative months, showed that all patients had the good facial contour and well stabilized bony fragments. CONCLUSION: The authors suggest that aqua splint suture method is a very simple, quick & effective technique for stabilizing repositioned zygomatic arch fractures.
Congenital Abnormalities ; Female ; Humans ; Male ; Maxillofacial Injuries ; Splints* ; Suture Techniques* ; Sutures* ; Trismus ; Zygoma* ; Zygomatic Fractures