J Korean Assoc Oral Maxillofac Surg.  2019 Aug;45(4):192-198. 10.5125/jkaoms.2019.45.4.192.

Versatile midfacial degloving approach in oral and maxillofacial surgery

• Pangarikar A
• G U
• Parab P
• Kumar S
• M.V. D

• KMID: 2456037
• DOI: http://doi.org/10.5125/jkaoms.2019.45.4.192

Abstract

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.

Keyword

Surgical incision; Rhinoplasty; Aesthetics; Facial injury; Internal fracture fixation

MeSH Terms

Cicatrix
Congenital Abnormalities
Constriction, Pathologic
Esthetics
Facial Injuries
Facial Muscles
Fracture Fixation, Internal
Frontal Bone
Human Body
Incidence
Nose
Oral and Maxillofacial Surgeons
Osteotomy
Paresthesia
Rhinoplasty
Surgery, Oral*

Figure

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  Fig. 1 Connecting oral and nasal incisions through nasal sill incision.

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  Fig. 2 Complete midfacial degloving.

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  Fig. 3 Midfacial degloving (MFD) connecting to bicoronal flap. Asterisk: instrument connecting MFD and bicoronal flap, Arrow: supra-orbital neuro-vascular bundle.

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  Fig. 4 Preoperative depressed nasal bridge.

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  Fig. 5 Postoperative augmentation of nose.

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  Fig. 6 Preoperative computed tomography scan (three-dimensional reconstructed).

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  Fig. 7 Postoperative radiograph.

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