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Midfacial degloving


Medical editor Olav-Øystein Nerheim MD
Otolaryngologist
Oslo University Hospital

General

Midfacial degloving provides wide access to the maxilla . An incision is made in the sublabial mucosa where the skin/subcutaneous tissue and periosteum are dissected from the surface of the maxilla. With the help of an incision in the nasal septum as well as floor and lateral side of the nose, the soft tissue contents over the nasal bone can be elevated together with soft tissue contents above the upper jaw. This access is an alternative to a lateral rhinotomy.

Indications

Tumor in the following locations:

  • Maxillary sinus
  • Sphenoidal sinus 
  • Ethmoidal sinus and/or nasal septum

Goal

  • Tumor resection 

Equipment

  • Septal/ethmoidal tray
  • Maxillary tray
  • Hall drill + saw
  • Fissure drill + Rosen drill

Preparation

  • The surgery is performed under general anesthesia.
  • The patient lies supine.
  • Antibiotic prophylaxis is given. 
  • A steroid regimen may be given.

Implementation

  • The nasal cavities are vasoconstricted with adrenaline/tetracain tampons. 
  • The tumor is inspected with endoscopy.
  • Xylocain/adrenaline is injected into the appropriate area.
  • An incision is made 1 cm anterior to the tumor in the craniocaudal direction on the septum. 
  • The incision is brought all the way down to the floor of the nose.
  • An incision is made along the entire gumline.
  • The periosteum is dissected off the bone and the infraorbital nerve is identified bilaterally up to the aperture. 
  • The nasal floor is cut and the septum is separated toward the premaxilla.
  • The mid face is lifted providing good access to the nasal cavities.
  • The nasal septum is divided with scissors caudal to the tumor.
  • The septum is divided cranially with macroscopically free margins.
  • The specimen is removed and marked for histological purposes. 
  • The mucosa is inspected.
  • A frozen section is made of the mucosa and remaining cranial content of the septum.
  • Two tampons are inserted and saturated with Terra-Cortril® on the appropriate side. On the other side, a smaller Terra-Cortril® tampon is inserted. 
  • The nasal septum is sutured toward the nasal spine.
  • The incision is closed.

Follow-up

  • Terra-Cortril® tampons are removed after two days.
  • Saline is used for rinsing.

A follow-up appointment should be after one week with the surgeon.


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