Weber-Fergusson Incision Research Articles

Giant unicystic ameloblastoma of maxilla-successful endoscopic management

<p>This 32-year-old male patient presented with complaints of restricted mouth opening and gross facial asymmetry owing to the massive jaw swelling on the right side. After a thorough examination, a diagnosis of unicystic ameloblastoma of maxilla. Although, the standard of care surgical approach was through Weber-Fergusson incision, a concerted attempt to excise the tumour with the minimally invasive endoscopic route was made successfully. The patient was symptom free now with complete resolution of swelling on a regular follow up post operatively. This case report highlighted the modern day protocol of organ preservation concepts in surgical management of a rare tumour in otolaryngology practice</p>

Gain of exposure provided by extended incision in lateral rhinotomy approach: A cadaveric study

To assess the gain of exposure provided by extensions of the lateral rhinotomy (LR) incision, including subciliary extension, lip-splitting extension, or both (Weber-Fergusson incision), by comparing the surgical field obtained with every incision. The final goal is to better delineate the indications of each approach. Prospective study on fresh frozen specimens. A LR incision was first performed, and then extended by subciliary and/or lip-splitting incisions. The exposure of the anterior facial skeleton and of the deep retromaxillar spaces (pterygopalatine fossa and infratemporal fossa) were assessed. The distance between the nasal bone and the most lateral part of the exposure was measured. Dissection was performed on 4 specimens, with 7 LR. Three LR incisions were extended with subciliary incision, 3 with lip-splitting incision, and 4 with Weber-Fergusson incision. LR incision alone gave only limited access to the lateral orbital rim, the zygomatic arch and the maxillary tuberosity. Both subciliary and lip-splitting incisions gave access to the lateral orbital rim and to the zygomatic arch, but only upper lip incision provided a good access to the maxillary tuberosity. Weber-Fergusson did not significantly increase the surgical field obtained with lip-splitting extension alone. The exposure of the deep retromaxillar spaces was the same in all cases. LR incision with lip-splitting extension provided an optimal access to the anterior facial skeleton and to the maxillary tuberosity. In terms of exposure, it was equivalent to Weber-Fergusson approach. The exposure of deep spaces was the same regardless of the incision.

Subcranial craniotomy in surgical management of advanced oral cavity malignancies: a technical note

Craniofacial resection is the technique of choice for tumors of the oral cavity or paranasal sinus extending close to the skull base of middle cranial fossa. Here we would like to describe a new technique of approaching these tumors through the facial incision itself. All patients treated with this technique at our institute were included in this retrospectively analyzed case series. The pathological clearance margins, complications and outcomes were studied. A total of nine patients underwent resection of tumor with the subcranial approach. There were seven males and two female patients. Mean age was 50.66 years (22–72 years). The diagnosis was squamous cell carcinoma in five patients, adenoid cystic carcinoma in three patients and alveolar soft part sarcoma in one patient. A lip split incision and mandibulotomy/mandibulectomy was done in seven patients; a Weber–Fergusson incision was used in one patient and details were not available in one other patient. Reconstruction was done with anterolateral thigh flaps with or without titanium mesh for all the patients. One patient developed thalamic infarct and was managed conservatively. None of the other patients had complications related to the craniotomy. The infratemporal fossa margin was close/involved in two patients (22.22%). Eight patients received adjuvant therapy without delay. One patient, who had received radiation previously, did not receive adjuvant radiation. This technique aims to reduce morbidity without compromising on the oncological outcomes for tumors extending short of or up to the skull base.

Treatment Strategy of a Huge Ameloblastic Carcinoma

Ameloblastic carcinoma is a very rare malignant odontogenic tumor. We report a case of secondary-type ameloblastic carcinoma that extended transversally over almost half of the side of the face. Malignant transformation and identification of the malignant region in the large tumor were achieved using L-3-[F]fluoro-α-methyltyrosine (FAMT)-positron emission tomography (PET); FAMT is transported into cancer cells by L-type amino acid transporter 1 and shows high specificity for malignant tumors. The malignant region determined by microscopic evaluation of resected samples was similar to the region showing high FAMT uptake in PET. Using preoperative FAMT-PET and magnetic resonance imaging, we were able to achieve total resection of the very large tumor, while avoiding excessive resection that could cause severe functional loss or a poor aesthetic facial appearance. We used a modified Weber-Fergusson incision along the nasolabial fold to the labiajugal fold and reconstruction with a pectoralis major muscle flap, and this gave a good aesthetic outcome. Safe surgical resection was possible because preoperative three-dimensional computed tomography angiography was used to identify the position of the main trunk of the external carotid artery, which was closely aligned with the tumor in a posterior direction in the infratemporal fossa region.

Anatomical basis for modified infraorbital orbitotomy

The Weber-Fergusson incision is commonly used for the surgical exposure of the anterolateral maxilla. Infraorbital orbitotomy is a well-described technique which allows extended exposure during maxillary surgery. This paper presents a modification of infraorbital orbitotomy and is intended to make this simple modification familiar to surgeons involved in head and neck surgery.

The nasolabial approach: a potential alternative to the lip-splitting incision for maxillectomy

First described by Weber and later modified by Fergusson, the Weber–Fergusson incision has undergone numerous modifications, but the fundamental approach to maxillectomy has largely remained the same. We report the potential benefit of a nasolabial incision for partial maxillectomy. The incision is hidden within the nasolabial fold and obviates the need for division of the upper lip, which may undergo atrophy and shortening after radiotherapy.

Modified Weber–Fergusson incision with Borle's extension

The Weber–Fergusson maxillectomy incision was first described by Weber in German and later modified by Fergusson 1 Fergusson W. Operation on the upper jaw. A System Of Practical Surgery. J Churchill & Co, London1842 Google Scholar in English. It is one of the most commonly used transfacial approaches to the midface for the resection of maxillary tumours.

Osteoplastic maxillotomy approach for infraorbital nerve schwannoma, a case report

Extracranial schwannomas can readily occur in the head and neck region and rarely involve the trigeminal nerve. As a rule, their treatment is surgical and dictated by the location of the tumor and nerve of origin. We describe a case of a 14-year-old boy with a mass invading right nasal fossa, maxillary sinus, orbital floor, pterygopalatine fossa, and infratemporal fossa. The diagnosis of a nerve sheath tumor was evoked after angiography showed no vascular blush. The tumor was removed through a Weber-Fergusson incision with subciliary extension followed by maxillozygomatic osteotomy. This approach showed the tumor to be coming from the infraorbital nerve and allowed complete tumor exposure and removal. Pathology confirmed the diagnosis of a schwannoma. We describe the osteoplastic maxillotomy approach which we felt most appropriate for removal of the infraorbital schwannoma and discuss other possible surgical options for this type of tumor.

Osteoplastic Maxillotomy for Treatment of Neoplasms of the Nasopharynx and Infratemporal Fossa

Approaches to the infratemporal fossa and nasopharynx are difficult because of the anatomic complexity of these regions. We describe our experience with osteoplastic maxillotomy, with our own modifications, and evaluate oncological outcomes and postoperative quality of life. Ten patients underwent osteoplastic maxillotomy, 3 of whom had a diagnosis of malignancy, and 7 of whom had nasopharyngeal angiofibromas (NPAs). A Weber-Fergusson incision was made to develop facial flaps and preserve the vascularity of the maxilla. Osteotomies were performed through the facial aspects of the maxilla, on the orbital rims, and on the malar eminence for the medial variant of the procedure. The anterolateral variant involved descent of the temporalis muscle with preservation of the facial nerve, and a zygomatic osteotomy. Four craniotomies were done. Two patients had the medial variant of the procedure, and 8 had the anterolateral variant. The complications were transient and mild. The patients who had malignancies are alive with no disease, and there was 1 recurrence among the 7 patients with NPAs. We found excellent aesthetic results in 8 of the 10 patients, and no change in basic functions in 8 patients. Osteoplastic maxillotomy allows resection of massive NPAs with no significant bleeding. Resection of malignant lesions with good results is feasible.

High-pressure grease injury of the face

We describe a rare case of high-pressure grease injury of the face in a 48-year-old man with severe facial edema, soft palate swelling, and bleeding from the nose and mouth. Preoperative computed tomography (CT) revealed multiple low-density areas in nasal cavity, subcutaneous tissue of the cheek, soft palate, right maxillary sinus, and right infratemporal fossa. The patient complained of a dyspnea feeling, and immediate tracheostomy was performed. The grease was removed by the Caldwell-Luc incision approach but was partially left in the infratemporal fossa. After the operation, the patient still complained cheek and temporal pain. CT and magnetic resonance imaging were useful to diagnose the remaining grease, and the remnant of the grease was completely removed by the Weber-Fergusson incision approach.

Extended lateral rhinotomy incision for total maxillectomy

An extended lateral rhinotomy incision for total maxillectomy, which avoids postoperative lower eyelid complications, is described. Advantages of the extended lateral rhinotomy incision for total maxillectomy are discussed in comparison with the classic Weber-Fergusson incision. (Otolaryngol Head Neck Surg 2000;123:512-3.)

Extended Osteoplastic Maxillotomy: A Versatile New Procedure for Wide Access to the Central Skull Base and Infratemporal Fossa

Extended osteoplastic maxillotomy provides wide, direct exposure of the lateral and/or central skull base. This procedure, developed in cadavers, has been used successfully in six patients. Briefly, the maxillofacial skeleton is partially exposed via a Weber-Fergusson incision. Osteotomies in the maxilla and zygoma completely disengage the maxilla from the facial skeleton. The maxilla is mobilized on the skin and soft tissues of the ipsilateral cheek, maintaining its vascularity. Medial positioning of the anterior osteotomy through the face of the maxilla determines the extent of exposure to the nasopharynx. The lateral osteotomy can be placed anteriorly at the malar eminence or posteriorly to include the glenoid fossa, thus determining the extent of exposure to the infratemporal fossa. Concurrent use of a pterional or temporal craniotomy provides corresponding access to the cranial cavity. Miniplate fixation of the maxilla and zygoma reestablishes skeletal contour. This new, versatile procedure can be used for benign and malignant lesions of the nasopharynx and infratemporal fossa, particularly in those patients requiring preoperative or postoperative adjuvant therapy.

Excision of obstructing retropharyngeal tumor in an infant; excision by sagittal jawsplitting approach.

The choice of a surgical approach to the pharynx depends upon the location and size of the lesion under consideration. If primarily located in the oropharynx, a direct transoral approach is usually adequate. The nasopharynx may also be reached through an intraoral approach with or without a softpalate-splitting incision or removal of part of the posterior bony palate. 1 If this is not adequate, a lateral pharyngotomy with or without a transection at about the angle of the mandible 2 may yield a good exposure of the nasopharynx. In certain instances a transantral approach through a Caldwell-Luc or Weber-Fergusson incision may be elected. The hypopharynx may be reached by suspension laryngoscopy or through an anterior 3 or lateral pharyngotomy exposure. Very extensive lesions in these areas, especially those that require complete extirpation with a maximum of safety, challenge the effectiveness of any of these surgical approaches. A situation of this