|MIDFACIAL DEGLOVING APPROACH
Tumors involving the midface which require surgical excision usually involve a Lateral Rhinotomy or a Weber Fergusson approach. The disadvantage of these approaches is the prominent scar they produce over the face. This can be done away with the technique of Midfacial Degloving, which gives almost the same amount of exposure the other approaches give. This amounts to a 'No Stich No Scar Technique' as there is no external scar visible.
This picture shows the endoscopic view of an Inverted Papilloma, which is a benign but locally invasive tumor. The tumor is seen arising inferior to the middle turbinate.
The exposure involves a Sublabial incision combined with a Complete Transfixion incision of the septum and Intercartillagenous incision of the nose. In this picture, the anterior wall of right maxilla is exposed and Osteotomy cuts are taken. Osteotomy is completed with a high powered Fissure burr and sharp stout scissors. The osteotomy for this case passes along the floor of Nasal cavity into the maxillary sinus, another cut passes along the attachment of the middle turbinate and a posterior cut connecting the two.
This picture shows the tumor after removal of the anterior wall of maxilla. The tumor involves the nasal cavity and the right maxilla.
The tumor is being excised in this picture. Care should be taken to ensure that complete removal is accomplished. The endoscope plays a vital role in this aspect. Cessation of bleeding is not a reliable indicator for completeness of evacuation.
This is the profile view of the patient showing the skin over the anterior part of the face being retracted superiorly over the nose. The upper extent of exposure is upto the Glabella which is as good as any other approach.
This is the post op view showing a clean cavity with crusts and no recurrence.The patient has to be periodically followed up as this tumor is notorious for recurrence.