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Original Article |

A Novel Technique for Malar Eminence Evaluation Using 3-Dimensional Computed Tomography

Sami P. Moubayed, MD; Frederick Duong, MD; Christian Ahmarani, MD, FRCSC; Akram Rahal, MD, FRCSC
Arch Facial Plast Surg. 2012;14(6):403-407. doi:10.1001/archfacial.2012.510.
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Objective  To describe a novel method to locate the malar eminence using 3-dimensional computed tomography (3D-CT), and a new axis system for evaluation of malar eminence symmetry.

Methods  A retrospective case series was carried out in 42 disease-free white adult patients. The 3D-CT reconstructions of the face were obtained, and the soft-tissue maxillozygion was used to locate the malar eminence. Other skeletal and soft-tissue landmarks (frontozygomatic suture, zygion, and orbitale) were evaluated. A patient-oriented axis system was constructed using 3 sagittal midline landmarks (nasion, subspinale, and basion). Coordinates were obtained for each landmark, and symmetry was evaluated.

Results  Twenty-one men and 21 women with mean ages of 41.1 and 41.3 years, respectively, were included. The malar eminence was easily localized using the 3D-CT technique for soft-tissue maxillozygion identification. Clinical asymmetry at the level of the soft-tissue maxillozygion was 40.5% (95% CI, 25.0%-56.0%). Other landmarks showed a prevalence of clinical asymmetry ranging from 24.0% to 50.0%.

Conclusions  The malar eminence can be easily and precisely located using the 3D-CT soft-tissue maxillozygion landmark. A reliable patient-oriented axis system can be defined using nasion, subspinale, and basion. The prevalence of malar eminence asymmetry in our study was 40.5%.

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Figures

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Grahic Jump Location

Figure 1. The 3-dimensional (3D) computed tomographic localization of maxillozygion. The skeletal maxillozygion (arrows) is identified as the most anterior point on the maxillozygomatic suture line below the lateral third of the orbit. It is identified on 3D reconstruction (A) (arrows), axial view (B) (asterisks), coronal view (C) (asterisks), and sagittal view (D) (asterisk).

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Grahic Jump Location

Figure 2. Other landmarks of interest (FZS, frontozygomatic suture; Z, zygion; O, orbitale) and their soft-tissue (st) equivalents (arrows). A, Skeletal landmarks; B, soft-tissue landmarks. The small red numbers are used in the computing of the coordinates and have no schematic value.

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Grahic Jump Location

Figure 3. Axis system centered on nasion with axes x, y, and z.

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Grahic Jump Location

Figure 4. Prevalence of clinical asymmetry of 3-dimensional computed tomographic landmarks. Error bars indicate 95% confidence intervals. FZS indicates frontozygomatic suture.

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