Combined partial coronoidectomy and reduction malarplasty versus reduction malarplasty alone in patients with elongated coronoid processes: A comparative retrospective study.

BACKGROUND

Reduction malarplasty is a common procedure for midface contouring in Asian populations. However, patients with elongated coronoid processes face an increased risk of postoperative mouth opening restriction. This study aims to evaluate whether combining partial coronoidectomy with reduction malarplasty yields superior outcomes compared to malarplasty alone in this specific patient population.

METHODS

A retrospective analysis was conducted on 54 patients (2019-2024) with radiologically confirmed elongated coronoid processes. Patients were divided into two groups: Group A (n = 27) underwent L-shaped reduction malarplasty combined with partial coronoidectomy, while Group B (n = 27) received L-shaped reduction malarplasty alone. All procedures were performed by the same senior surgeon. Surgical outcomes were evaluated through CBCT imaging (preoperative, 7-day, and 6-month postoperative), skeletal stability assessed by root mean square error (RMSE) analysis using Mimics and Geomagic software, complication rates, and FACE-Q satisfaction scores.

RESULTS

Group A demonstrated a superior safety profile with no serious complications observed. In contrast, Group B experienced seven complications, including nonunion (n = 3), mouth opening restriction (n = 2), facial asymmetry (n = 1), and microplate fracture (n = 1). RMSE analysis revealed significantly better skeletal stability in Group A (t(52) = 2.68, P < 0.05). While both groups showed improvement in FACE-Q scores postoperatively, Group A reported significantly higher levels of patient satisfaction.

CONCLUSIONS

For patients with elongated coronoid processes, the combination of partial coronoidectomy with reduction malarplasty significantly enhances skeletal stability, reduces complication rates, and improves patient satisfaction compared to malarplasty alone. This integrated surgical approach provides a superior treatment strategy, optimizing both functional and aesthetic outcomes in this specific patient population.

LEVEL OF EVIDENCE: IV.