J Korean Assoc Oral Maxillofac Surg.  2025 Apr;51(2):108-116. 10.5125/jkaoms.2025.51.2.108.

Zygomatic osteotomy for improving aesthetic results in orthognathic surgery: a report of two cases

• Demétrio MS
• Barbosa SdM
• Lima RK
• Medeiros YdL
• Marlière DAA
• Assis NMSP

• KMID: 2567946
• DOI: http://doi.org/10.5125/jkaoms.2025.51.2.108

Abstract

Patients with anteroposterior maxillary deficiency and mandibular prognathism associated with a long-face pattern exhibit reduced anterior and lateral projection of the zygomaticomaxillary complex. Several techniques have been combined with orthognathic surgery to enhance the volume and definition of this region, such as zygomatic osteotomy. Two female patients, aged 22 (Case A) and 29 (Case B), with class II (Case A) and III (Case B) malocclusion, respectively, complained about facial aesthetics due to a long face and lack of malar projection. Le Fort I osteotomy to advance the maxilla, bilateral mandibular ramus osteotomy to set back the mandible, mentoplasty for advancement and width reduction, and zygomatic osteotomy were erformed. The patients underwent computed tomography scans, and superimposed images indicated that a volumetric increase in the malar region was achieved through the anterolateral movement of the zygomatic body. Improvements were noted in the paranasal region (Case A), better alignment of the upper and lower lips, the chin region, and an improved chin-neckline ratio (in both cases). The patients were satisfied with the results and are under follow-up. In summary, zygomatic osteotomy combined with orthognathic surgery proved to be a predictable and safe strategy for increasing malar prominence, with satisfactory aesthetic and functional outcomes.

Keyword

Aesthetic Surgery; Osteotomy; Zygoma; Orthognatic surgery

Figure

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  Fig. 1 Case A. Extraoral images at rest and smiling positions, showing paranasal deficiency, limited upper lip support, and mandibular prognathism. Intraoral image shows class III malocclusion.

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  Fig. 2 Case B. Extraoral images at rest and smiling positions, showing vertical maxillary excess and mandibular retrognathism. Intraoral image shows class II malocclusion.

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  Fig. 3 Three-dimensional reconstruction images from computed tomography scans for virtual planning. A. Case A showing maxillary advancement and mandibular setback. B. Case B showing maxillary impaction and mandibular advancement.

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  Fig. 4 Clinical photographs illustrating the cutting and repositioning of the zygoma osteotomy.

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  Fig. 5 Postoperative computed tomography reconstruction at 1 month for (A) Case A and (B) Case B showing appropriate occlusion, with skeletal structures repositioned using rigid internal fixation regarding orthognathic surgery. The zygoma osteotomy may be assessed either via design or skeletal repositioning, demonstrating an increase in width and projection in both cases.

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  Fig. 6 Pre- and postoperative computed tomography superimposed volumes for (A) Case A and (B) Case B, with green representing preoperative and gray representing postoperative images.

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  Fig. 7 Postoperative extraoral and intraoral images of Case A.

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  Fig. 8 Postoperative extraoral and intraoral images of Case B.

Reference

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