How Is A Cheek Osteotomy Done for Facial Narrowing of Wide Cheeks Bones?
Q: What method of bony cheek narrowing do you use to? Can you explain the procedure to me. Where do you cut the bone etc? How many cuts are made and what can be done to maximize the narrowing effect?
A: To properly understand the bone cuts, you need to know the anatomy of the zygomatic bone and how it articulates anteriorly with the maxillary and orbital bones and the temporal bone posteriorly. The width of the face in the cheek area is a reflection of the prominence of the cheek bone and its attached arch. Basically, cheek narrowing is done by shortening the attachments of the zygomatic process.
Two vertical bone cuts are made, one anteriorly where the zygomatic arch joins the maxilla and orbit and the other small vertical cut is posterior where the thin sliver of the back end of the zygomatic arch joins the temporal bone just above and forward of the TMJ.
The front cut and bone removal (5 to 7mms) is made with a reciprocating saw from inside the mouth incision. It is narrowed and then held together with a small plate and two screws on each side. The back end cut is done with a small osteotome (chisel) from a small incision inside the temporal hairline. It is simply cut and it falls inward naturally on its own due to the pull of the attached muscles.
The facial narrowing effect through cheek osteotomies is maximized by doing both cuts and allowing the entire arch to move inward.
Dr. Barry Eppley