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Asian Malar and Mandibular Surgery Workup

  • Author: Charles S Lee, MD, FACS; Chief Editor: Jorge I de la Torre, MD, FACS  more...
 
Updated: Mar 21, 2014
 

Laboratory Studies

Order routine preoperative laboratory studies, including a CBC count. Order other studies, such as coagulation profiles and ECGs, as indicated.

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Imaging Studies

See the list below:

  • Zygomatic reduction: A cephalogram and facial series is usually obtained to assist in surgical planning.
  • Mandibular angle reduction: Obtain Panorex films (to assess the course of the inferior alveolar nerve), submental vertex views (to assess the angle between the mandibular [intergonial] angle), and a lateral cephalogram (to measure the gonial angle, ideally 105-115°, and the mandibular plane, ideally 30°). The preferred angle and contour of the mandibular border is drawn on a duplicate radiographic film and used as a template for surgery.
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Contributor Information and Disclosures
Author

Charles S Lee, MD, FACS Private Practice, Beverly Hills, CA

Charles S Lee, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, California Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

S Anthony Wolfe, MD Chief, Division of Plastic Surgery, Miami Children's Hospital; Voluntary Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine

S Anthony Wolfe, MD is a member of the following medical societies: American Academy of Pediatrics, American Cleft Palate-Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society of Plastic Surgeons, Florida Medical Association, Southeastern Society of Plastic and Reconstructive Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

John Arthur Persing, MD Chief and Professor, Department of Surgery, Sections of Plastic Surgery and Neurosurgery, Yale University School of Medicine

John Arthur Persing, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Plastic Surgeons, American Association of Neurological Surgeons, American Cleft Palate-Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, New York Academy of Sciences, Society for Neuroscience

Disclosure: Nothing to disclose.

References
  1. Mu X. Experience in East Asian facial recontouring: reduction malarplasty and mandibular reshaping. Arch Facial Plast Surg. 2010 Jul-Aug. 12(4):222-9. [Medline].

  2. Baek RM, Kim J, Lee SW. Revision reduction malarplasty with coronal approach. J Plast Reconstr Aesthet Surg. 2010 Dec. 63(12):2018-24. [Medline].

  3. Onizuka T, Watanabe K, Takasu K, Keyama A. Reduction malar plasty. Aesthetic Plast Surg. 1983. 7(2):121-5. [Medline].

  4. Watanabe K. Cosmetic contouring of the midface. In: Song IC, ed. Facial Cosmetic Surgery in Orientals. Problems in Plastic and Reconstructive Surgery. Vol 1. 1991:643-53.

  5. Baek SM, Chung YD, Kim SS. Reduction malarplasty. Plast Reconstr Surg. 1991 Jul. 88(1):53-61. [Medline].

  6. Morris DE, Moaveni Z, Lo LJ. Aesthetic facial skeletal contouring in the Asian patient. Clin Plast Surg. 2007 Jul. 34(3):547-56. [Medline].

  7. Ahn J, Horn C, Blitzer A. Botulinum toxin for masseter reduction in Asian patients. Arch Facial Plast Surg. 2004 May-Jun. 6(3):188-91. [Medline].

  8. Baek SM, Kim SS, Bindiger A. The prominent mandibular angle: preoperative management, operative technique, and results in 42 patients. Plast Reconstr Surg. 1989 Feb. 83(2):272-80. [Medline].

  9. Kim JH, Shin JH, Kim ST, Kim CY. Effects of two different units of botulinum toxin type a evaluated by computed tomography and electromyographic measurements of human masseter muscle. Plast Reconstr Surg. 2007 Feb. 119(2):711-7. [Medline].

  10. Al-Ahmad HT, Al-Qudah MA. The treatment of masseter hypertrophy with botulinum toxin type A. Saudi Med J. 2006 Mar. 27(3):397-400. [Medline].

  11. Castro WH, Gomez RS, Da Silva Oliveira J, Moura MD, Gomez RS. Botulinum toxin type A in the management of masseter muscle hypertrophy. J Oral Maxillofac Surg. 2005 Jan. 63(1):20-4. [Medline].

  12. von Lindern JJ, Niederhagen B, Appel T, Berge S, Reich RH. Type A botulinum toxin for the treatment of hypertrophy of the masseter and temporal muscles: an alternative treatment. Plast Reconstr Surg. 2001 Feb. 107(2):327-32. [Medline].

  13. Al-Muharraqi MA, Fedorowicz Z, Al Bareeq J, Al Bareeq R, Nasser M. Botulinum toxin for masseter hypertrophy. Cochrane Database Syst Rev. 2009 Jan 21. CD007510. [Medline].

  14. Jin, H, Kim, BG. Mandibular angle reduction versus mandible reduction. Plast Reconstr Surg. October 2004. 114(5):1263-9.

  15. Jin H, Kim BG. Mandibular osteotomies after drawing out the inferior alveolar nerve along the canal. Aesth Plasti Surg. 2003. 27:126-129.

  16. Kang J, Han K. Cosmetic contouring of the lowerface. Song IC, ed. Facial Cosmetic Surgery in Orientals. Problems in Plastic and Reconstructive Surgery. 1991. Vol 1: 654-66.

  17. Ousterhout D. Mandibular width reduction including surgical treatment of benign masseteric hypertrophy. Aesthetic Contouring of the Craniofacial Skeleton. Boston, Mass: Little Brown; 1991. 451-69.

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Zygomatic osteotomies are performed at the junction of the body and arch, just anterior to the zygomatic tubercle. After mobilization, the fragment is in-fractured and/or repositioned cephalically. The mandibular angle is contoured as marked.
Reduction of mandibular angle, AP view image.
surgical reduction of the mandibular angle (same patient as in media file 6).
Ostectomy segment, retromandibular approach.
Sagittal split ostectomy bone segment, removing the outer cortex of the mandible.
 
 
 
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