Midfacial Degloving Approach Research Articles

Maxillary Ossifying Fibroma Managed Using Cosmetically Acceptable Facial Degloving Approach with Iliac Bone Graft Reconstruction.

Ossifying fibroma is benign, slowly expansile, painless, well defined fibro-osseous tumour composed of calcified products such as bone, cementum, or both [1]. We opted for a novel approach for the management of ossifying fibroma of maxillary region through scarless midfacial degloving approach with iliac bone graft reconstruction. A 20 years old young female presented with left sided facial swelling involving anterior wall of maxilla and lifting the ala of nose. CT and FNAC suggested a benign lesion. Surgery was performed to remove the tumour completely and managed with scarless midfacial degloving approach with iliac bone graft reconstruction. The iliac crest free flap is an optimal method for maxillary defect reconstruction. The main advantages of the flap are the large amount of bone provided, its height, and the possibility of including the internal oblique muscle [2].

A Case of Advanced Nasal Septal Carcinoma That Was Resected by the Midfacial Degloving Approach with Endoscopic Assistance

A Case of Advanced Nasal Septal Carcinoma That Was Resected by the Midfacial Degloving Approach with Endoscopic Assistance

Bilateral maxillectomy via mid-facial degloving approach in an extensive case of post-Coronavirus disease invasive fungal sinusitis

<p class="abstract">Coronavirus disease associated invasive fungal sinusitis has affected many and several have succumbed to the disease during the second wave of COVID-19 pandemic. Mucormycosis is a rare, opportunistic, fulminant, angioinvasive fungal infection caused by Rhizopus species of the order Mucorales. It mainly affects immunocompromised individuals, predisposed by diabetes mellitus, corticosteroids, immunosuppressive therapy, haematological malignancies and organ transplantation. We reported here a case of a 45 years old male with past history of Coronavirus disease, presenting with symptoms of invasive fungal sinusitis. With this case we emphasised on use of an alternate approach for bilateral total maxillectomy via midfacial degloving approach instead of a classical external Weber Ferguesen incision in extensive cases with several associated co-morbidities. Mid facial degloving approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. This approach is advantageous in comparatively having less complication rate, less morbidity and excellent cosmetic outcome.</p>

Midfacial Degloving Approach Facilitated with Endoscope for Nasal, Paranasal & Nasopharyngeal Pathologies

Background: Endoscopic sinus surgery is mostly conducted for the removal of the inflammatory as well as infectious diseases of sinus and malignant or benign nasal, paranasal & nasopharyngeal pathologies. The various surgical approaches that have been used range from transpalatine to a lateral rhinotomy and to mid-facial degloving. Aim: To determine the outcome of mid-facial degloving approach facilitated with endoscope for nasal, paranasal and nasopharyngeal pathologies. Methods: Forty five patients that fulfilled the inclusion criteria were enrolled in the study. All the patients were then underwent surgery by the researcher along with a surgical team under general anesthesia by using Mid-facial degloving approach. The patients were followed - up on 3 & 6 months after the surgery and underwent clinical examination and endoscopic nasal examination to assess the complications, cosmetic outcome and recurrence after the procedure during the follow-up period. Data was entered & analyzed using SPSS v. 23. Results: Mean age of the patients in the sample was 25.47±10.52 years. There were 39(86.7%) male patients and 6(13.3%) female patients. Cosmetic outcome was excellent in 31(68.9%) cases, satisfactory in 12(26.7%) while 2(4.4%) variable comments about the cosmetic effects of the procedure. Bleeding was most common complication 3(6.7%), however recurrence occurred in 3(6.7%) cases. Conclusion: It is concluded that mid-facial degloving approach is a highly successful method for removal of nasal, paranasal or nasopharyngeal pathologies. Key words: Mid-facial degloving, endoscope, nasal, paranasal, nasopharyngeal, pathologies

Midfacial Degloving Technique for Free Flap Reconstruction of Nasal and Anterior Skull Base Defects.

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.

Midfacial degloving for juvenile angiofibroma: A case-series of 21 adult males: An alternative to the endoscopic approach and when it should be considered.

To describe the midfacial degloving approach and compare the varying surgical approaches to juvenile angiofibromas. To demonstrate the efficacy of midfacial degloving in treating large juvenile angiofibromas in a unique patient cohort. A retrospective case-series between 2006 and 2019. All patient care was undertaken at a regional skull base referral centre. Twenty-one male patients with a median age of 18 (range 16-45years). Presenting symptoms, imaging, stage, age at operation, residual disease, estimated blood loss and operative time were all recorded. Postoperative outcomes included complications, length of stay and recurrence. The median surgical time was 105minutes (range 55-219minutes), median estimated blood loss 600mls (range 150-900mls) and median length of stay was 4days (range 2-13days.). Complications included two episodes of epistaxis, one requiring packing and one return to theatre. 14% (3/21) of patients had residual disease, none requiring further treatment and one patient had recurrence. MFD for JNA in our series resulted in low recurrence rate and no progression of residual disease. The approach has been successful in our cohort of patients and is an option in males over the age of 16years, with JA extending beyond the nasopharynx and sinuses, involving the infratemporal fossa, cavernous sinus or orbital region.

Trend analysis in management of juvenile nasopheryngeal angiofibroma: our institutional experience

<p class="abstract"><strong>Background:</strong> Juvenile nasopharyngeal angiofibroma is a vascular malformation rather than true neoplasm. It accounts for 0.5% of all head and neck tumors and its general incidence is 1:150,000. It is uncommon, benign, extremely vascular tumor that arises from tissues in the sphenopalatine foramen, the pterygoid base causing Early spread submucosally towards nasopharynx. Surgical excision is mainstay of treatment.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective observational study carried out from March 2002 to March 2019, 130 patients underwent surgical resection of juvenile nasopharyngeal angiofibroma at Civil Hospital, Ahmedabad. Patients were divided in two groups with Group-A having patients from 2002-2010 and Group B having patients from 2011-2019.</p><p class="abstract"><strong>Results:</strong> A total 130 cases of juvenile nasopharyngeal angiofibroma with a mean age of 16.25 years (range 9-33) were treated by surgical excision from March 2002 to March 2019. In Group A patients open approach was used most often with endoscopic approach used only till stage II-A. In Group B patients the preferred surgical approach was trans-nasal endoscopic approach cases up to stage IV-A and open approach including the midfacial degloving approach and infratemporal approach was used cases with extensive intracranial, lateral infratemporal fossa, orbit, optic nerve, cavernous sinus involvement.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows that over the years there has been shift in surgical approaches used in treating angiofibroma with the advent of newer endoscopic method and addition of various technology such as coblation, navigation has made the procedure for a highly vascular tumor simpler.</p><p class="abstract"> </p>

RESECTION OF AN EXTENSIVE MAXILLARY AMELOBLASTOMA THROUGH A MIDFACIAL DEGLOVING APPROACH: A CASE REPORT

An 81-year-old male patient was referred to the stomatology service complaining of difficulty in prosthesis adapting. Clinically, a painless swelling was evident in the left maxilla. An incisional biopsy was performed and the specimen sent for histopathologic examination, revealing a final diagnosis of ameloblastoma. A computerized tomography (CT) scan was performed, revealing an extensive left maxillary lesion, involving the maxillary sinus and nasal cavity, crossing the midline and extending to the right side. During surgical planning, the use of the Weber-Ferguson-Diffenbach approach was raised, but it would not allow the recommended resection of the lesion since it exceeded past the midline. So, a midfacial degloving approach was chosen because this allows complete resection with safety margin and a better aesthetic result. The patient recovered well with good healing; no signs of recurrence were noted after 1 year of follow-up care. Thus, the degloving approach should be taken into account when treating extensive lesions in the midface. Support: FAPEMIG.

비중격에서 발생한 재발성 기저세포선암종 1예

Basal cell adenocarcinoma of the nasal cavity is a rare lesion of the head and neck, besides it is often misdiag-nosed as adenoid cystic carcinoma and other tumor disease. We encountered a 65-year-old patient with a recurred basal cell adenocarcinoma arising from the nasal septum and hard palate. This patient was treated with preoperative concurrent chemo-radiation therapy (CCRT), the tumor was radically removed through midfacial degloving approach and postoperative additional radiation therapy. We present this rare case with a review of related literatures. (J Clinical Otolaryngol 2019;30:261-265)

Versatile midfacial degloving approach in oral and maxillofacial surgery.

ObjectivesOral 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 MethodsThe 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.ResultsAccess 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.ConclusionThough 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.

Midfacial degloving approach to treat an extensive maxillary ameloblastoma: a case report

Midfacial degloving approach to treat an extensive maxillary ameloblastoma: a case report

Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa.

Selecting an appropriate surgical approach for resection of huge skull base tumors involving pterygopalatine and infratemporal fossa is challenging because of their rarity and high possibility of vital anatomical structure injuries. To suggest the guidance of selecting the appropriate approach by analyzing outcomes and satisfactions of known surgical approaches with our previous experience, the authors retrospectively analyzed skull base tumor cases experienced for 24 years, and condensed to 4 well-known surgical approaches: maxillary swing, infratemporal fossa type C, transzygomatic, and a combined transzygomatic-midfacial degloving approach: to review indications, advantages, and limitations of these approaches. Maxillary swing approach was useful in large-sized tumors as it provided wide surgical field; however, inevitable facial scar was the main drawbacks, especially in adolescents. Infratemporal fossa approach type C was helpful in the involvement of vital vascular structures; however, long incision scar with temporal area depression and permanent conductive hearing loss were the factors of patients' dissatisfaction. Transzygomatic approach could be the good alternative to the infratemporal fossa approach type C; however, en bloc tumor resection was impossible due to its limited operative space. To overcome limitations of these approaches, transzygomatic approach was combined with midfacial degloving approach, and it enabled lateral and anterior access without prominent facial scar and/or deformity while providing wide surgical space. Based on our 24 years of surgical experience in managing huge skull base tumors, the authors recommend the combined transzygomatic-midfacial degloving approach, which enables complete resection with short postoperative healing periods and no disfiguring facial incisions.

Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report

BackgroundFibrous 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 presentationThis 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.ConclusionsIn 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.

Proptosis in ENT Department: Presentation and Management

Objective: The main aim of this study was to manage proptosis caused by different nasal and paranasal sinus diseases. Study Design: This was a retrospective descriptive study. Settings: The study was carried out in department of otorhinolaryngology and Head & Neck surgery, Allied Hospital, Faisalabad Medical University, Faisalabad. Duration: Two years i.e; June 2014 to May 2016. Methodology: 30 patients with proptosis because of some nasal and paranasal sinus disease. Data Analysis: To analyze data SPSS software version 10 and Chi square test were employed. Results: 56.6% were males and 43.4% were females among a total of 30 patients. The age of these patients was ranging from 06 to 67 years with mean age of 34.3 years. In this study 70% patients had unilateral proptosis and 30% patients with bilateral proptosis. 53.3% patients had nasal polyposis causing proptosis; 23.3% unilateral and 30% being bilateral nasal polyposis. 90% of our patients were found to have nasal obstruction; unilateral nasal obstruction in 60% whereas bilateral in 30%. Nasal mass was seen in 23.3% and epistaxis was observed in 30% of the patients. 13.3% of our patients had facial swelling and 53.3% had tele canthus. 50% of the patients were found to have fungal disease either in the nose or paranasal sinuses causing proptosis. Among these 18 patients having proptosis due to fungal disease, 10 patients (55.5%) were immunocompetent. On the other hand, the remaining 08 patients (44.5%) were immunocompromised and metabolically moribund. Smokers were 16.6%, diabetes mellitus was seen in another 16.6% and 13.3% of the patients had hypertension. Different surgical procedures were used to treat the lesions responsible for unilateral or bilateral proptosis. The basic aim of the treatment was to clear the disease completely and orbital repositioning. Conclusion: Although endoscopic sinus surgery is considered the treatment of choice at present in experienced hands yet midfacial degloving approach is another excellent surgical option to treat majority of these sino-nasal diseases causing proptosis especially at those settings where FESS like modern facility is not available

Osteomyelitis of maxilla - a rare presentation: case report and review of literature

Osteomyelitis involving the maxillofacial skeleton is a rare entity today. In maxillofacial region mandible is more commonly involved as compared to maxilla. It continues to remain one of the most difficult to treat infections with considerable morbidity and costs to the healthcare system. Hallmark of osteomyelitis are progressive bony destruction and formation of sequestrum. When present, the possibility of underlying malignancy or granulomatous diseases should be kept in mind and ruled out. We present a rare case of osteomyelitis involving the maxilla in a 64 year old male diabetic. The patient was managed with sequestrectomy and debridement by infrastructure maxillectomy via a midfacial degloving approach, appropriate parentral antibiotic therapy and glycemic control. The patient had an uneventful recovery. <p> </p>

Sino-nasal nodular fasciitis in a child: Case report and review of literature

Abstract Nodular fasciitis (NF) is a benign reactive fibroblastic process which belongs to pseudosarcomatous proliferative lesions of soft tissues. Its occurrence is uncommon in the pediatrics with only a handful of cases reported in the sino-nasal area. We report a 14-month old boy, presented with right facial swelling caused by a 5 cm tumor involving the sino-nasal area with erosion of the floor of the orbit and extension into the pterygopalatine fossa. The lesion was completely excised through a midfacial degloving approach. Histological examination revealed the diganosis of NF. The postoperative period was uneventful with no evidence of recurrence 24-months postoperatively.

Midfacial Degloving Approach for Bilateral Giant Cell Reparative Granuloma

Reparative giant cell granuloma is a rare benign tumor. Mandible is the most common site. The case is reported for its rarity in maxilla and difficulty in differentiating it from other giant cell lesions. Differentiation is only based on the clinical test and histopathological examination. Midfacial degloving approach popularized by Caisson et al and Conley in 1974 is best suited for bilateral facial lesions. This approach gives a wide exposure with no facial scar or deformity. The advantages of the degloving technique in exposure of the midface, maxilla, mandible, nasal cavities, and paranasal sinuses, have led to its increasing importance in the otorhinolaryngology. J Curr Surg. 2016;6(3-4):78-80 doi: https://doi.org/10.14740/jcs304e

Mid Facial Degloving Procedure: Managing A Case of Multiple Mid Face Fractures with Significant External Deformity

Purpose: The midfacial degloving approach (MFDA) is the primary option for surgical treatment of midface lesion. Usually most benign and malignant paranasal sinus (PNS) tumours are unilateral. So the classic MFDA does not fit for every case. Modifications of the classical MFDA are then tailored accordingly for surgical field exposure to achieve the goal. MFDA was first suggested by Portmann in 1927, but the modern technique had its origin in 1974 with the report by Casson and colleagues. It was not until Conley and Price first suggested that the technique be used for the excision of neoplastic disease in 1979 that its use was fully realized. It can be of great benefit for the management of various lesions, mainly tumors, of the facial cavities, paranasal sinuses, nasopharynx, orbits, and central compartment of the anterior and middle cranial fossae, allowing adequate bilateral maxillary and lower nasal cavity exposure without cosmetic dysfunction.Patients: A male patient of 20 years was admitted with history of faciomaxillary trauma having significant external deformity. Under GA open rhinoplasty and reduction & immobilization of fractured segments were done with adequate exposure of midface using midfacial degloving procedure.Result: We have performed MFDA in one case only for the first time. Utilizing sublabial gingivobuccal incision, a complete transfixion incision, intercartilaginous incision with mucosal detachment of the pyriform aperture nasomaxillary skeleton along with zygoma were exposed adequately. No technical problems and no intraoperative complications related to the surgical procedure were encountered. Cosmetic outcome was also satisfactory.Conclusion: Midfacial degloving can be considered as an excellent, useful, and safe approach for many lesions of the midface that has a low complication rate with excellent cosmetic outcomes. It provides excellent exposure to the midportion of the craniofacial skeleton, yet avoids external incisions and should be in every head and neck surgeon’s armamentarium.Bangladesh J Otorhinolaryngol; April 2015; 21(1): 51-56

A Case of Pyogenic Granuloma of the Nasal Cavity Excised via the Midfacial Degloving Approach

A Case of Pyogenic Granuloma of the Nasal Cavity Excised via the Midfacial Degloving Approach

巨大な鼻中隔多形腺腫例

An 83-year-old woman was referred with right-side nasal obstruction. The CT scan showed a 60×45×43 mm mass arising from the nasal septum. MRI imaging indicated a smooth and encapsulated mass partial cystic formation involving 30×30×24 mm. A pre-operative definitive diagnosis could not be made despite two biopsies. We performed an endoscopic intranasal operation in combination with a midfacial degloving approach. The post-operative final diagnosis was pleomorphic adenoma (PA) of the nasal septum. Nasal septal PA is exceedingly rare, and only a few cases of giant PA tumor have been reported previously. In this case, we could achieve complete en bloc excision via minimal invasive surgery without facial skin incision. Intranasal PAs have a pathologic feature which seems to be composed of higher epithelial and lower stromal components than PAs of the major salivary glands. The possibility of PA should be kept in mind when assessing nasal cavity tumors that are rich in epithelial constituents. Sometimes small cysts are formed in PAs, while a cyst large enough to be recognized macroscopically is rare. This is the first case report of a nasal septum PA accompanied with cyst formation.