In a case where malar bone protrusions are noted, radiographs should be taken preoperatively in the arch positions and water positions. On the basis of the condition of the malar bodies and arches, it is necessary to plan how much and where to shave off the bone. First the malar body is exposed and shaved down thoroughly with a round burr, and the region just before the synthetic line of the body and arch is cut completely with a reciprocating saw, and at 1-2 cm of the upper edge of the zygomatic body it is not cut completely.
Next, the tubercular region of the arch is bluntly exposed and obliquely cut completely. Then, a green-stick fracture is made to get movability of the arch. The cutting edges of the upper and lower sides of the arches are bluntly displaced, and the middle part of the arch is indented and fixed. Wiring or a miniplate
Fig. 46.7. A 45-year-old woman showing the condition of malar bone protrusion. a Preoperative condition and b postoperative condition
is used if necessary (Figs. 46.4, 46.5). Several cases are illustrated in Figs. 46.6-46.9.
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