LAUSR

To the Editor: We have read with great interest the article entitled ‘‘ Optimal fixation location in intraoral reduction malarplasty using an L-shaped osteotomy’’ by Kim et al in the Journal of Craniofacial Surgery. The authors perform an experimental study on the optimal fixation location during intraoral reduction malarplasty using an L-shaped osteotomy. We are appreciated that the authors provide us the worthy experimental results, especially the proper designation of fixation points. In this communication, we would like to propose some opinions to the author. First, the authors told us that during their operation they preferred an intraoral approach. As far as we know, there may be limited exposure of the zygomatic arch area and limited volume of maximal reduction and shaving as a result of the intraoral approach. Yang and Chung proposed a new surgical method that the zygomatic body was performed through an intraoral approach and the zygomatic arch was performed through a short preauricular incision which not only overcome the above limitations but also shortened operation time and lower postoperative edema around the operative region. In our experience, the surgical incision is the same as Yang’s. We would like to show our surgery experience to the authors for communication. In addition, we notice that the average age of the 10 cadaver heads in the article was 68.2 years (range 48–83 years), with a ratio of 7 to 3 males to females. But in practice, most patients undergoing reduction malarplasty were younger female patients aged 20 to 40. Although the relationship between zygomatic thickness and age has not been explored, investigations have found that masticatory muscles decrease with age. Hence, to make the results more accurate and convincing to guide clinical practice, the younger female samples should be added in the future. In conclusion, it is meaningful that the authors have provided us with such a novel idea focus on the fixation location. Although leaving us some questions to evaluate, they provided us with valuable guidance for carrying out clinical work. We look forward to further multi-aged samples for more information in the future.