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Midfacial Degloving Technique for Free Flap Reconstruction of Nasal and Anterior Skull Base Defects. Plast Reconstr Surg 2021; 147:990e-994e. [PMID: 34019512 DOI: 10.1097/prs.0000000000007978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Traditionally, surgical access for extirpation and reconstruction of midfacial tumors requires external incisions that can cause a myriad of complications, especially in irradiated patients. The modern midfacial degloving approach involves hidden, sublabial and intranasal incisions that provide reliable access for free flap reconstruction of nasal and maxillofacial tumors. Seven patients with a history of radiation therapy underwent free flap reconstruction of the midface. Five patients underwent the technique in a delayed manner, and the remaining two underwent reconstruction immediately at the time of resection. Five patients underwent free radial forearm fasciocutaneous free flaps and two underwent reconstruction with anterolateral thigh perforator flaps. Bone and/or rib cartilage grafting was used in all patients. All patients underwent successful free flap reconstruction of the midface without external incisions. The most common complication was postoperative infection requiring oral or intravenous antibiotics. No patients sustained loss of their grafts or hardware in the postoperative period. The midfacial degloving technique provides satisfactory exposure to the nasal cavity, midface, orbits, and skull base for free flap reconstruction, without disrupting the external soft tissue. The authors describe a novel use of the midfacial degloving technique to provide safe and reliable results with improved cosmetic outcome.
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Zachariah T, Neelakandan RS. Utility of the Midface Degloving Approach for Extended Exposure in Maxillary Pathologies. J Maxillofac Oral Surg 2020; 19:217-224. [PMID: 32346230 DOI: 10.1007/s12663-019-01287-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction A generous exposure of the midface region is essential for a comprehensive and thorough execution of midface surgical procedures, especially bilateral procedures. Traditional approaches to the midface the midface like the lateral rhinotomy and Weber-Fergusson/Dieffenbach incision with their modifications leave a visible scar, and they are limited in their unilateral exposure. The midface degloving approach with its exclusive intranasal and intraoral incisions leaves no external scars and lends excellent bilateral exposure of the maxilla, zygoma, paranasal areas and infraorbital margins from one side to the other. The midface degloving approach is mainly used to expose pathologies of the maxilla, nasal cavities, paranasal sinuses, nasopharynx, and the central compartment of the anterior and middle cranial base. This approach can also be used to treat midface trauma and perform high-level osteotomies. Materials and Methods We describe the midface degloving procedure for nine cases operated in the Department of Oral and Maxillofacial Surgery over a period of 7 years (2012-2018): seven maxillary tumors and two maxillary cysts. Results We obtained excellent exposure for all the cases using this approach. Complications included mild distortion of the lower lateral nasal cartilages and oro-nasal communication. Conclusion The midface degloving approach lends excellent surgical access to the midfacial skeleton including the maxilla, the paranasal areas, the maxillary sinus, the zygoma, and infraorbital rims. The advantages of this approach besides its generous exposure, is the excellent cosmesis it provides leaving no external scars.
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Affiliation(s)
- Thomas Zachariah
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and General Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Alapakkam Main Road, Maduravoyal, Chennai 600095 India
| | - R S Neelakandan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and General Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Alapakkam Main Road, Maduravoyal, Chennai 600095 India
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Yacoub A, Schneider D, Ali A, Wimmer W, Caversaccio M, Anschuetz L. Endoscopic-Assisted Lateral Corridor to the Infratemporal Fossa: Proposal and Quantitative Comparison to the Endoscopic Transpterygoid Approach. J Neurol Surg B Skull Base 2019; 82:357-364. [PMID: 34026413 DOI: 10.1055/s-0039-3399553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022] Open
Abstract
Objective This study was aimed to propose an expanded endoscopic-assisted lateral approach to the infratemporal fossa (ITF) and compare its area of exposure and surgical freedom with the endoscopic endonasal transptergyoid approach (EETA). Methods Anatomical dissections were performed in five cadaver heads (10 sides). The ITF was first examined through the endoscopically assisted lateral corridor, herein referred to as the endoscopic-assisted transtemporal fossa approach (TTFA). After that, the EETA was performed and coupled with two sequential maxillary procedures (medial maxillectomy [MM], and endoscopic-assisted Denker's approach [DA]). Using the stereotactic neuronavigation, measurements of the area of exposure and surgical freedom at the foramen ovale were determined for the previously mentioned approaches. Results Bimanual exploration of the ITF through the endoscopic-assisted lateral approach was achieved in all specimens. The DA (729 ± 49 mm 2 ) provided a larger area of exposure than MM (568 ± 46 mm 2 ; p < 0.0001). However, areas of exposure were similar between the DA and the TTFA (677 ± 35 mm 2 ; p = 0.09). The surgical freedom offered by the TTFA (109.3 ± 19 cm 2 ) was much greater than the DA (24.7 ± 4.8 cm 2 ; p < 0.0001), and the MM (15.2 ± 3.2 cm 2 , p < 0.0001). Conclusion The study demonstrates the feasibility of the proposed approach to provide direct access to the extreme extensions of the ITF. The lateral corridor offers an ideal working area in the posterior compartment of the ITF without crossing over important neurovascular structures. The new technique may be used alone in selected primary ITF lesions or in combination with endonasal approaches in pathologies spreading laterally from the nose or nasopharynx.
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Affiliation(s)
- Abraam Yacoub
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland.,Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Daniel Schneider
- Image-Guided Therapy, ARTORG Center for Biomedical Research, University of Bern, Switzerland
| | - Ahmed Ali
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland
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Pangarikar A, G U, Parab P, Kumar S, M V D. Versatile midfacial degloving approach in oral and maxillofacial surgery. J Korean Assoc Oral Maxillofac Surg 2019; 45:192-198. [PMID: 31508351 PMCID: PMC6728623 DOI: 10.5125/jkaoms.2019.45.4.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. Materials and Methods The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. Results Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. Conclusion Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.
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Affiliation(s)
- Anunay Pangarikar
- Department of Dentistry, ESIC Medical College, Gulbarga, India.,Department of Oral and Maxillofacial Surgery, ESIC Dental College, Gulbarga, India
| | - Umamaheswari G
- Department of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, India
| | | | - Suresh Kumar
- Department of Dental Surgery, Trinelveli Medical College and Hospital, Trinelveli, India
| | - Devarathnamma M V
- Department of Periodontology, Navodaya Dental College, Raichur, India
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Kang M, Jee YJ, Lee DW, Jung SP, Kim SW, Yang S, Ryu DM. Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report. Maxillofac Plast Reconstr Surg 2018; 40:38. [PMID: 30588475 PMCID: PMC6281586 DOI: 10.1186/s40902-018-0177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022] Open
Abstract
Background Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction. Case presentation This case report describes a monostotic fibrous dysplasia in which the patient’s right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort. Conclusions In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.
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Affiliation(s)
- Miju Kang
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Yu-Jin Jee
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
| | - Deok Won Lee
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
| | - Sang-Pil Jung
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Se-Won Kim
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Sunin Yang
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Dong-Mok Ryu
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
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Kamalpathey K, Sahoo MGNK, Chattopadhyay CPK, Issar MY. Access Osteotomy in the Maxillofacial Skeleton. Ann Maxillofac Surg 2017; 7:98-103. [PMID: 28713744 PMCID: PMC5502524 DOI: 10.4103/ams.ams_88_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical accesses for the facial skeleton are based on the concept of modular osteotomies. Various techniques and combination of osteotomies facilitate access to the most inaccessible tumors of craniomaxillofacial region. Most appropriate surgical access is determined by considering size, location, extension of the tumor, and experience of the surgical team. These are primarily used for tumors in the nasopharynx or the skull base. The aim of this paper is to review surgical accesses that aid in removal of inaccessible tumors of craniomaxillofacial region with series of cases operated in the Department of Oral and Maxillofacial Surgery, Armed Forces Medical College, Pune, India, between July 2008 and June 2010. The surgical approaches constituted of transfacial, transoral, lip-split mandibulotomy and modified osteotomy of the orbital rim in cases of juvenile nasoangiofibroma, squamous cell carcinoma of the base of the tongue, orbital floor tumour respectively. Only 3 cases (33.33%) reported with postoperative paresthesia of the infraorbital region and mandibular symphysis region which resolved in 6 months. None of the patients presented with occlusal discrepancy, neuromotor deficit or sign of recurrence in the follow up period of one year.
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Affiliation(s)
- K Kamalpathey
- Department of Oral and Maxillofacial Surgery, Army Dental Centre (R&R), Delhi, India
| | | | - Col P K Chattopadhyay
- Department of Oral and Maxillofacial Surgery, Army Dental Centre (R&R), Delhi, India
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Rzaev RM, Verdiev ND, Rzaev RR. [The clinical evaluation of the effectiveness of anterior craniofacial resection for the treatmentof disseminated tumours and pseudotumour lesions in the nasal cavity, the paranasal sinuses, and the orbit]. Vestn Otorinolaringol 2016; 80:16-21. [PMID: 26145738 DOI: 10.17116/otorino201580216-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present work was to evaluate the outcomes of anterior craniofacial resection (ACFR) in the patients presenting with disseminated tumours and pseudotumour lesions in the nasal cavity, the paranasal sinuses, and the orbit based on the results of dynamic clinical observations. A total of 24 patients with tumours and tumour-like lesions of these anatomical structures were involved in the study including 14 ones having benign neoplasms, 2 patients with pseudotumour lesion, and 8 patients having malignant tumours. In all the cases, the pathological processes in the form of destruction and infiltration encompassed the anterior portion of the base of the skull (mostly lamina cribrosae) and spread directly into the anterior cranial fossa. It was shown that ACRF ensured the radical elimination of the pathological process and the enhancement of the five-year survival rate in all the patients with benign tumours and pseudotumour lesions and in half of the patients presenting with disseminated malignant neoplasms.
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Affiliation(s)
- R M Rzaev
- Department of Otorhinolaryngology, Head and Neck Surgery, Central Azerbaijan Railway Hospital, Baku, Azerbaijan, AZ 1117
| | - N D Verdiev
- Republican Neurosurgical Hospital, Baku, Azerbaijan, AZ 1123
| | - Rt R Rzaev
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
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Lorenz KJ, Maier H, Wilde F. Nasal meatus plasty: a contribution to plastic reconstruction of the nasal valve during midfacial degloving. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2014; 3:Doc06. [PMID: 26504717 PMCID: PMC4582504 DOI: 10.3205/iprs000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Midfacial degloving is a proven method for easily accessing the midface, the nasal pyramid, the maxillary and ethmoidal sinuses, the orbits, as well as the anterior skull base. Indications for this method of access mainly include tumour resections in the area of the midface, the septum, the maxillary sinus, the paranasal to the sphenoidal sinus as well as the clivus. In addition, this method of access allows for the exposure of the bony structures of the midface in the event of extensive fractures. In general, this method of access combines an incision in the oral vestibule and circular incisions in the nasal vestibule area in order to release the nasal pyramid. After removing the facial wall of the maxillary sinus, extensive exposure of the surgical site is possible. One disadvantage of this method of access is the difficult reconstruction of the nasal valve area, which often leads to cicatricial stenoses and difficulties with breathing through the nose. Furthermore, wound healing problems and osteoradionecrosis in the area of the lateral margin of the anterior nasal aperture after replantation of the facial wall of the maxillary sinus have been described, because in this area sufficient soft tissue coverage cannot be ensured when a conventional technique is used. We describe a soft tissue flap pedicled in the cranial and caudal directions in the nasal valve area which makes both the reconstruction of the nasal vestibule and sufficient soft tissue coverage of the anterior nasal aperture possible.
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Affiliation(s)
- Kai J Lorenz
- Clinic for Otorhinolaryngology, Head and Neck Surgery, Federal Armed Forces Hospital, Ulm, Germany
| | - Heinz Maier
- Clinic for Otorhinolaryngology, Head and Neck Surgery, Federal Armed Forces Hospital, Ulm, Germany
| | - Frank Wilde
- Clinic for Oral, Maxillary and Plastic Facial Surgery, Federal Armed Forces Hospital, Ulm, Germany
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Affiliation(s)
- Rui Fernandes
- Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Florida College of Medicine, Jacksonville, 653-1 West Eight Street, Jacksonville, FL 32209, USA
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Abstract
PURPOSE OF REVIEW Surgical approaches to the upper facial skeleton comprise the coronal, lower eyelid and midface degloving approaches. These are routinely employed in both ablative and reconstructive craniofacial procedures. The ability to perform them in a well tolerated and predictable manner is predicated on knowledge of the indications and the exposure afforded by each approach, detailed appreciation of the anatomy and awareness of potential complications. This article reviews the literature for recent advancements and surgical refinements for each approach. RECENT FINDINGS Multiple studies over the past 20 years have offered insight into many technical refinements in these surgical approaches. The choice of dissection plane in the lateral extension of the coronal approach affects the integrity of the frontal branch of the facial nerve and the temporal fat pad. A transcaruncular extension of the transconjunctival approach provides unprecedented access to the medial orbital wall and the midface degloving approach renders complex reconstructive procedures feasible. SUMMARY These techniques continue to evolve and become more precise so that better results can be achieved and devastating complications can be avoided. This study reviews the literature and summarizes preferred options for craniofacial exposure, recent technical refinements, and our current preferred surgical approaches.
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Kim HJ, Kim CH, Kang JW, Shin WC, Kim YS, Do YK, Lee JG, Yoon JH. A modified midfacial degloving approach for the treatment of unilateral paranasal sinus tumours. J Craniomaxillofac Surg 2010; 39:284-8. [PMID: 20673637 DOI: 10.1016/j.jcms.2010.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 04/07/2010] [Accepted: 06/09/2010] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The midfacial degloving approach (MFDA) is the primary option for the removal of benign and malignant sinonasal tumours. However, the classic MFDA does not compensate for the fact that most benign and malignant paranasal sinus (PNS) tumours are unilateral and the incisions may lead to some unnecessary complications?. Surgical exposure is limited to the upper and deep part of the PNS. Modifications of the classical MFDA that minimize complications and improve surgical field exposure are warranted. PATIENTS The medical records of 27 consecutive patients who had undergone surgery using a modified MFDA for treatment of unilateral benign or malignant tumours from 2000 to 2006, were reviewed. RESULTS We developed and performed a modified MFDA utilizing a hemigingivobuccal incision, a transfixion incision, mucosal detachment of the pyriform aperture and separation of the upper lateral cartilage from the nasal bone in 27 patients with unilateral benign (85%) or malignant (15%) PNS neoplasms. Adequate surgical exposure was achieved in all cases. No technical problems and no intraoperative complications related to the surgical procedure were encountered. CONCLUSION Our modified MFDA provides sufficient surgical exposure for the removal of unilateral malignant or benign PNS tumours with few surgical or cosmetic complications.
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Affiliation(s)
- Hyun Jik Kim
- Chung-Ang University, College of Medicine, Department of Otolaryngology and Head & Neck Surgery, Seoul, Republic of Korea
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Sun J, Shen Y, Weng YQ, Li J, Zhang ZY. Lateral Lip-Splitting Approach for Total and Subtotal Maxillectomy. J Oral Maxillofac Surg 2009; 67:1197-205. [DOI: 10.1016/j.joms.2008.06.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 04/17/2008] [Accepted: 06/16/2008] [Indexed: 11/28/2022]
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Abstract
A perfect surgical approach to nasal cavity and paranasal sinus tumors should provide a broad exposition preserving the important structures with no cosmetic defect. Midfacial degloving (MD) technique provides good exposure without incisions and scars in the face. Classic MD technique includes rhinoplasty incisions. However, combination of the facial plastic skills of the rhinoplasty techniques with an oncologic approach limits its popularity. We modified the classic technique, which is performed without classic rhinoplasty incisions. The surgical approaches to 55 patients with benign and malignant sinonasal neoplasms are reviewed, and the modification of MD technique performed without rhinoplasty incisions is described. The study includes 41 male and 13 female patients with both benign and malignant sinonasal neoplasms. The ages of the patients were between 9 and 78 years with a mean age of 41.15 years. Follow-up of the patients ranged from 2 to 96 months with a mean of 31.7 months. Most of the cases were angiofibroma and inverted papilloma. Modified MD approach was used for all patients, and in 6 cases, the technique was combined with subcranial approach. We successfully resected the tumors in all of the patients. The most frequently encountered complaint in the postoperative period was temporary nasal crusting and epistaxis. An important complication was the rupture of subpetrous part of the internal carotid artery in one patient and also a temporary facial palsy in another one. Palatal dysfunction, oroantral fistula, or vestibular stenosis, which are significant complications of MD, were not observed in any of our cases. In this modified technique, rhinoplasty incisions are not used; therefore, the duration of operation is shortened, the technique becomes easier, and the incisions of the rhinoplasty procedure, which could cause circular stenosis, are avoided.
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Danesi G, Panciera DT, Harvey RJ, Agostinis C. Juvenile nasopharyngeal angiofibroma: Evaluation and surgical management of advanced disease. Otolaryngol Head Neck Surg 2008; 138:581-6. [DOI: 10.1016/j.otohns.2008.01.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 10/05/2007] [Accepted: 01/23/2008] [Indexed: 11/24/2022]
Abstract
Objective Evaluate preoperative imaging in predicting operative stage. Describe the outcomes in surgically treated juvenile nasopharyngeal angiofibroma (JNA) with the influence of middle cranial fossa, carotid, or dural involvement on recurrence. Study Design Retrospective cohort of surgically treated patients with JNA. Subjects and Methods Eighty-five patients from a regional Italian referral center were assessed for recurrence, radiologic, and operative staging. High risk areas involved were recorded at surgery. Results Recurrence for advanced disease (IIIb+) was 18.2% (6 of 33) and 15.3% (13 of 85) overall. Preoperative staging poorly correlated with operative stage ( P = 0.15). No single high risk area was predictive for recurrence, but the absence of any risk factor was associated with a favorable outcome ( P < 0.01). Conclusion Dural involvement by tumor is rare and imaging may overstage disease. Anterior access, endoscopic or open, is sufficient to address intracranial involvement. When an open approach is used, a midface degloving technique affords excellent exposure even for advanced disease. Lateral approaches with their associated morbidity can be reserved for selected recurrent disease.
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Huber GF, Park PS. Superior nasal hinge approach: an alternative access to tumors of the frontal skull base and paranasal sinuses. Laryngoscope 2007; 117:559-62. [PMID: 17279056 DOI: 10.1097/mlg.0b013e31802ca4c2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gerhard Frank Huber
- Department of Surgery (Otolaryngology - Head and Neck Surgery), University of Calgary, Calgary, Alberta, Canada.
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Kitagawa Y, Baur D, King S, Helman JI. The role of midfacial degloving approach for maxillary cysts and tumors. J Oral Maxillofac Surg 2003; 61:1418-22. [PMID: 14663806 DOI: 10.1016/j.joms.2002.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The midfacial degloving approach has been used as a surgical approach to gain access to regions of the midface that would otherwise require external incisions. This article describes the role of this technique for various maxillary lesions. PATIENTS AND METHODS Thirteen patients underwent the midfacial degloving technique for 8 maxillary benign lesions and 5 malignant lesions. This procedure uses 4 basic incisions: 1) sublabial incision, 2) bilateral intercartilaginous incisions, 3) septocolumellar-complete transfixion incisions, and 4) bilateral piriform aperture incisions extending to the vestibule. RESULTS All patients successfully underwent the planned procedures after the midfacial degloving technique for the treatment of benign or malignant lesions without significant complications. Postoperative sequelae were nasal crusting and infraorbital hypesthesia, both of which resolved. CONCLUSIONS The midfacial degloving approach offers good exposure of the mid third of the face with excellent cosmetic results. This approach may be combined with downfracture of the maxilla for access to expose and resect sinonasal malignancies. The midfacial degloving technique is a viable procedure with low morbidity and excellent cosmetic outcomes.
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Affiliation(s)
- Yoshimasa Kitagawa
- Section of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor 48109-0018, USA
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Bulsara KR, Fukushima T, Friedman AH. Management of malignant tumors of the anterior skull base: experience with 76 patients. Neurosurg Focus 2002; 13:e5. [PMID: 15771404 DOI: 10.3171/foc.2002.13.4.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As the management of anterior cranial fossa malignancies has undergone significant evolution, decreases in morbidity and mortality rates have occurred. In this article, the authors discuss the clinical presentation, neuroimaging findings, and management options for common anterior skull base malignancies. Also discussed are surgery-related indications and principles.
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