Zygomatic Arch Reduction
Q: Dr. Eppley, I have had a few questions occur to me about my upcoming zygomatic arch reduction surgery.
First, lowering my zygomatic arch seems like I could be creating a weak spot that could fail under pressure. I live an active life and would hate to have it crushed in during a snowboard fall should the hardware fail. Do you feel this is an issue? You mentioned you couldn’t get to the zygomatic arch to grind it down. I’m not sure what this means other than get to it without leaving a scar. I think I might prefer a small scar than a weak point. From the original CT scan it appeared to my untrained eye as much more bone than the opposing side and possible to grind down.
Let me know your thoughts.
A: In answer to your zygomatic arch reduction questions:
1) In regards to the zygomatic arch, it is not being lowered. Rather it is being medialized, meaning moved inward not down. This is a very stable position when secured with plate and screws. I would have no concerns about how it would respond to a traumatic event later.
2) You can’t get to the zygomatic arch to burr it down because of the size of the incision needed for that exposure plus the risk of injury to the frontal branch of the facial nerve which crosses over its middle portion at the highest point of its arc.
3) Also burring down the zygomatic arch is not an option because the bone is too thin to do so. One would simply have nothing left when even burring it down a few millimeters.
4) To do zygomatic arch reduction (aka cheekbone reduction osteotomies) this is done through a combined intraoral and small external incision (1 cm) in the sideburn hair.
Dr. Barry Eppley