Midfacial Degloving Approach

[hermantheshocker]

The midfacial degloving approach was described for the removal of tumors from the nasal cavity, paranasal sinuses, nasal septum, and nasopharynx in 1979. The operative technique was originally described in 1974.


Fig.1 Midfacial degloving approach. Sublabial and intranasal incisions allow elevation of the nasal envelope and lower lateral cartilages. The left maxilla has been exposed to the infraorbital rim for medial maxillectomy. Note preservation of the infraorbital nerve on the left.

Bilateral intercartilaginous incisions are performed and extended to a transfixion incision posterior to the medial crura. The upper and lower lateral cartilages are separated and the nasal envelope is elevated off the upper lateral cartilages through the intercartilaginous incisions. The intranasal incision is extended circumferentially around the piriform aperture and nasal floor effectively separating the nasal tip and bilateral lower lateral cartilage from the nasal septum, nasal dorsum, and piriform aperture.


Fig.2 Complete transfixion, intercatilagenous and nasal floor incisions will result in a complete circumvestibular incision.


Fig.3 Elevation of the soft tissue off the nasal pyramid, glabella, frontal bone, and both anterior maxillary walls.

Bilateral sublabial incisions are connected across the midline, and the periosteum is elevated to the inferior orbital rim with care taken to preserve the infraorbital nerves. A medial maxillectomy is performed by making bone cuts through the medial buttress superiorly and inferiorly, and then removing the lateral nasal wall with the attached inferior turbinate.


Fig.4 Sublabial incision.


Fig.5 The midfacial skeleton is "degloved."

The anterior and posterior walls of the maxillary sinus can also be resected if indicated. This provides access to the nasal septum, maxillary sinus, pterygopalatine fossa, infratemporal fossa, and nasopharynx. Exposure to the superior ethmoid sinuses and the frontal sinus as well as the anterior skull base is limited with this approach.

After tumor removal, the medial buttress can be plated back into position as a free bone graft. Careful attention should be directed to closure of the circumferential intranasal incisions to prevent vestibular stenosis.

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[navajojoe]

Thanks Herman! Love the drawings with explanations! Good Job!

[ride]

Nice grille, DJ Section8.

That's an awful lot of cutting just to get a jellybean out of his nose.

[*Ragdoll_Cutie*]

it's amazing the things they can do

[winvens]

I live for DR content this good and informative. Thanks, Herman!

[LadyCPlum]

That's one hairy nose

[winvens]

Originally Posted by ride

Nice grille, DJ Section8.