Is Augmentation Required to Correct Malar Deficiency with Maxillary Advancement?

Publication date: Available online 14 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Chad Petersen, Michael R. Markiewicz, Michael Miloro
PurposePatients with maxillary hypoplasia also have malar deficiency, therefore planning may include consideration for simultaneous malar augmentation. The purpose of this study is to compare pre- and post-operative profiles of subjects who underwent Lefort I advancement, with and without malar augmentation, to assess the subjective perception of changes in malar eminence projection.Materials and MethodsSubjects who had maxillary advancement and mandibular setback with and without malar augmentation were evaluated via a survey consisting of pre- and post-operative photographs that were assessed by two groups: professionals and laypersons, and a visual analogue scale was used to assess the malar region. Next, pre- and post-operative images were shown side-by-side, and participants were asked to indicate which subjects had undergone malar augmentation. Statistical analysis used a Wilcoxon signed rank test, independent samples t-test, Spearman's rank order correlation, and Mann-Whitney U tests.ResultsOf 43 patients, 23 met the inclusion criteria, and only 7 of the 23 subjects received simultaneous malarplasty. Subjects in both groups were perceived as having an increase in malar eminence projection postoperatively. In both the malarplasty and non-malar cohorts, laypersons and professionals noted an increase in projection (p<.05). Laypersons tended to overestimate the number of malar procedures performed (sensitivity 59.5%, specificity 56.8%), while professionals were better able to accurately exclude malar augmentation (sensitivity 44.2%, specificity 69.9%).ConclusionsMost patients with maxillary hypoplasia undergoing Lefort I advancement may expect a subjective improvement in malar projection. The decision for malar augmentation at the time of maxillary advancement should be considered based upon patient desires, but, in general, maxillary advancement alone may be sufficient for an optimal malar esthetic outcome.



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