Novel Approach for Midface Depression

BACKGROUND: Although Le Fort type II, prosthesis detainment, and orthodontic treatment are considered for the management of midface retraction, they may be limited by their high cost, infection risk, and excessive amount of tooth movement. Therefore, the Point A-Koji method was devised as a novel treatment in patients with midface retraction. METHODS: This is a case report of a 26-year-old woman who presented with a feeling of depressed midface and protrusion of the mouth. Preoperatively, the position of the lip and line connecting the nasal apex and mental muscles (E-line) were normal, but the subnasale was located posteriorly. The patient had a narrow nasolabial angle of 74 degrees and the subnasale-Pog’ to the upper lip of 6.5 mm. After insertion of a metallic-plate implant under the periosteum, the plate was screwed and fixed to the bone. The Point A-Koji method was used for treatment in this patient. This is characterized by the A-point anterior migration technique in which the periosteum of hard tissue A-point circumferential attachment was shifted anteriorly, thereby preventing the return of soft tissue. RESULTS: The following changes with respect to preoperative findings were noted 5 months postsurgery: facial convexity from 3.3 degrees to 7.6 degrees; nasolabial angle from 74 degrees to 90.2 degrees; true horizontal line from 50 degrees to 73 degrees; and subnasale-Pog’ to the upper lip from 6.5 mm to 4.7 mm. This resulted in an improved midface retraction. CONCLUSION: The Point A-Koji method may be an ideal method to improve the midface retraction in patients.