Purpose: To present our approach to zygomatic osteotomy and repositioning using technological aids: virtual surgical planning, custom guides, and implants. Background: The zygomatic complex is highly 3-dimensional, establishing cheek prominence, facial width, and orbital morphology. Functionally, the zygoma supports soft tissues and is vital to mastication. The zygoma may require reconstruction after a variety of congenital or acquired conditions; however, Zygomatic Osteotomy and Repositioning (ZyOaR) is a complex operation with many technical considerations. The advent of virtual surgical planning (VSP) has enhanced efficiency, accuracy, and reproducibility, while permitting utilization of custom-designed guides and implants. There remains a paucity of literature on ZyOaR and its unique challenges. Methods: This case series includes all patients older than 18 years old undergoing ZyOaR with VSP between 2010 and 2024. Demographics and clinical etiology were noted. Outcomes included fidelity to preoperative plan, facial symmetry, mastication defects, and globe malposition. Results: Eight patients age 18 to 60 years old (mean = 38) met inclusion criteria. Three patients had congenital deformities, and 5 were post-traumatic. Follow-up time ranged from 1 to 50 months (mean = 17 months). There were no intraoperative or postoperative complications. No patient had visual changes at latest follow-up. Preoperative VSP plans were compared to postoperative CT scans, showing a high degree of fidelity. All patients underwent secondary reconstructive and/or soft tissue procedures to achieve final results. Conclusions: Zygomatic Osteotomy and Repositioning (ZyOaR) is inherently difficult, and there is a current gap in the literature on its unique technical challenges. We present 8 cases of ZyOaR using VSP for patients with a range of disease etiologies. The procedures were well tolerated and maintained high surgical fidelity. In our experience, keys to optimize ZyOaR include comprehensive analysis of regional bony and soft tissue anatomy, virtual planning with production and use of surgical transfer guides, and custom 3D printed patient-specific implants.
MehoudarEArizpeJBakerCIYovelG. Faces in the eye of the beholder: Unique and stable eye scanning patterns of individual observers. J Vis. 2014;14(7):6. doi:10.1167/14.7.6
5.
ObuekweOOwotadeFOsaiyuwuO. Etiology and pattern of zygomatic complex fractures: a retrospective study. J Natl Med Assoc. 2005;97(7):992-996.
6.
DavidsonEHKhavaninNGrantMKumarAR. Correction of complex neurofibromatosis orbital and globe malposition using the orbital box segmentation osteotomy with patient-specific internal orbit reconstruction. J Craniofac Surg. 2019;30(6):1647-1651. doi:10.1097/SCS.0000000000005369
7.
JacqueminCBosleyTMSvedbergH. Orbit deformities in craniofacial Neurofibromatosis type 1. AJNR Am J Neuroradiol. 2003;24(8):1678-1682.
8.
LuSMPessinoKGrayRLRodgersSDSchneiderSJBastidasN. Virtual planning for exchange cranioplasty in cranial vault remodeling. J Craniofac Surg. 2021;32(1):320-321. doi:10.1097/SCS.0000000000007148
SalehEGovshievichAJustinoJWeilAGBorsukDE. The use of virtual surgical planning for reduction cranioplasty. Plast Reconstr Surg Glob Open. 2020;8(1):e2565. doi:10.1097/GOX.0000000000002565
11.
HirschDLGarfeinESChristensenAMWeimerKASaddehPBLevineJP. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg. 2009;67(10):2115-2122. doi:10.1016/j.joms.2009.02.007
ModabberAGerressenMAyoubN, et alComputer-assisted zygoma reconstruction with vascularized iliac crest bone graft. Int J Med Robot Comput Assist Surg. 2013;9(4):497-502. doi:10.1002/rcs.1557
14.
ZhangWBYuYMaoC, et alOutcomes of zygomatic complex reconstruction with patient-specific titanium mesh using computer-assisted techniques. J Oral Maxillofac Surg. 2019; 77(9):1915-1927. doi:10.1016/j.joms.2019.03.014
15.
Valls-OntañónAMezquida-FernándezCGuijarro-MartínezRHernández-AlfaroF. Three-dimensional surgical planning and simulation to improve surgical accuracy and reduce invasiveness of cranioplasties. Int J Oral Maxillofac Surg. 2017;46(5):586-589. doi:10.1016/j.ijom.2017.01.020
16.
QiaoTHouMYang LinYYuan WangY. Digital localization of osteotomy position in prominent zygomatic arch. J Craniofac Surg. 2021;49(11):1000-1004. doi:10.1016/j.jcms.2021.06.002
17.
ZhaoZBaoJShenGCaiMYuH. Integrating virtual surgical planning and 3D-printed tools with iliac bone grafts for orbital and zygomatic reconstruction in hemifacial microsomia patients. J Clin Med. 2023;12(24):7538. doi:10.3390/jcm12247538
18.
LiuXJHeYGongXAnJGGuoCBZhangY. [Application of computer navigation system in the treatment of post-traumatic reconstruction]. Chin J Stomatol. 2012;47(11):645-650. doi:10.3760/cma.j.issn.1002-0098.2012.11.002
19.
MurtezaniISharmaNThieringerFM. Medical 3D printing with a focus on Point-of-Care in Cranio- and maxillofacial surgery. A systematic review of literature. Ann 3D Print Med. 2022;6:100059. doi:10.1016/j.stlm.2022.100059
20.
ParthasarathyJ. 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg. 2014;4(1):9-18. doi:10.4103/2231-0746.133065
21.
ArdeleanLBortunCMRusuACPArdeleanLCBortunLRusu AcpCM. Thermoplastic resins used in dentistry. In: Das CK, ed. Thermoplastic Elastomers - Synthesis and Applications. IntechOpen; 2015: 172-173.
