Analysis of Flap Tension in Midface Surgery

Abstract

Problem Despite a large volume of literature addressing rejuvenation of the midface, there is an absence of objective data addressing the various approaches to midface lifting. This study compares flap tensions generated by midface lifts though transblepharoplasty (TB) and transtemporal (TT) surgical approaches, with and without the additional intervention of a transoral periosteal release. Methods 12 fresh cadaver heads underwent standard TB and TT approaches for midface lifting with Endotine (Coapt Systems, Inc, Palo Alto, CA) fixation devices. A machined apparatus, designed for this experiment, pulled the midface flap one centimeter along a posterior-superior vector while a precision digital load cell recorded the generated tension (grams). A transoral periosteal release was performed and flap tensions were measured again after this intervention. Green-house-Geisser test allowed analysis of the three-way interaction between surgical approach, periosteal release, and the number of times the test was repeated. Results Flap tension decreased significantly during testing with each sequential repeated pull on the midface (p<0.0001). Average flap tension for TB approach did not differ significantly from that of TT approach, whether or not a periosteal release was performed. However, while no particular approach was found to have a significant reduction in flap tension, a transoral periosteal release produced a significant reduction in flap tension (12%) when compared to trials without periosteal release (p=0.0191). Conclusion A significant reduction in flap tension as a result of transoral periosteal release is demonstrated in both transtemporal and transblepharoplasty approaches for midface lifting. This objective reduction in flap tension may allow the surgeon greater mobility of the midface tissues and perhaps less tension opposing flap fixation. Significance The objective reduction in flap tension by employing a transoral subperiosteal release may allow the surgeon greater mobility of the midface tissues and perhaps less tension opposing flap fixation. Support Coapt Systems, Inc, (Palo Alto, CA) provided the endotine devices utilized in the experiment.