• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.31 no.1
• /
• pp.74-81
• /
• 2005

In 1974, Casson et. al. reported midfacial degloving approach to repair the midfacial bone fracture. After then, this approach has been used frequently to treat the lesions on nasal cavity, nasopharynx, facial plastic surgery and midfacial trauma. Midfacial degloving approach consists of 1) bilateral sublabial incision 2) complete transfixion incision/ septocolumellar incision 3) bilateral intercartilaginous incision 4) bilateral pyriform aperature incision. This approach provides proper access for midfacial bone structure without facial scar but has post-operative complications such as transient epistaxis, infraorbital nerve paresthesia and nasal crust. We treated three patients using midfacial degloving approach to correct traumatic deformity in midface area. In two patients, rhinoplasty with autogenous rib graft was done simultaneously. So we report these cases with review of literatures.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.20 no.3
• /
• pp.214-216
• /
• 1998

In the treatment of maxillary lesion including a maxillary sinuses, most of oral and maxillofacial surgeons have used the vestibular incision or the Weber-Fergusson incision. However, the vestibular incision has disadvantage which it provides a rather limited exposure and the Weber-Fergusson incision leaves visible scar in the midface. Furthermore, because the scar is confined on unilateral side only, the technique is hesitated to apply especially in children, younger patients and women. Since Casson first introduced midfacial degloving technique, this approach has been used frequently to treat the lesion on nasal cavity, nasopharynx, skull base and paranasal sinuses by ENT surgeons. But, we think this technique can be used usefully in oral and maxillofacial regions. So, we experienced favorable results which it provided a proper exposure, no visible facial scar and it could be used on bilateral midfacial lesions.

• Journal of Korean Dental Science
• /
• v.15 no.1
• /
• pp.68-74
• /
• 2022

Organized hematoma of maxillary sinus is a rare pathologically benign mass in which pressure in the hematoma increases as it undergoes a process of organization, causing the deformation of the surrounding tissue, mimicking malignancies. The midfacial degloving approach can be used when extensive exposure is required in the treatment of lesions or traumas in the midfacial area with intranasal and intraoral incisions. We report a surgical excision case of organized hematoma of maxillary sinus using midfacial degloving approach without major complications and recurrence after one-year follow up.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.40
• /
• pp.38.1-38.9
• /
• 2018

Background: Fibrous 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 presentation: This 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. Conclusions: In 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.45 no.4
• /
• pp.192-198
• /
• 2019

Objectives: Oral 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 Methods: The 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. Results: Access 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. Conclusion: Though 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.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1991.06a
• /
• pp.43-43
• /
• 1991

부비동 점액낭종은 주로 전두동과 사골동에 발생하며 점차 커져서 인접 기관에 영향을 미치기도 한다. 저자들은 1985년 1월부터 1991년 3월까지 충남대학교병원 이비인후과에서 부비동 점액낭종으로 수술받았던 15예를 대상으로 임상분석을 실시하여 다음과 같은 결과를 얻었다. 성별은 남자 6예 여자 9예였고, 연령은 17세에서 79세까지였으며 50대에서 5예로 가장 많았다. 병변부위로는 사골동에 국한된 경우가 7예로 가장 많았고, 전두동과 사골동을 동시에 침범한 경우가 4예, 전두동에 국한된 경우가 2예, 사골동과 접형동을 침범한 경우가 1례였다. 안증상은 11예에서 있었으며 그중 안구돌출이 7예로 가장 많았고, 시력감퇴 6예, 안구운동장애 4예 등이었다. 5예에서 두개저 파괴로 인한 경막의 노출이 있었다. 치료는 사골동 비외수술법이 7예로 가장 많았고, Lynch operation 4예, 골성형 전두동수술 2예, Lateral rhinotomy를 통한 배액 1예, Midfacial degloving approach를 통한 배액이 1예였다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.41
• /
• pp.3.1-3.9
• /
• 2019

Background: The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. Methods: A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors' diverse clinical experiences. Results: We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. Conclusions: An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.