Modified Midfacial Degloving Approach for Sinonasal Tumors

Abstract

A perfect surgical approach to nasal cavity and paranasal sinus tumors should provide a broad exposition preserving the important structures with no cosmetic defect. Midfacial degloving (MD) technique provides good exposure without incisions and scars in the face. Classic MD technique includes rhinoplasty incisions. However, combination of the facial plastic skills of the rhinoplasty techniques with an oncologic approach limits its popularity. We modified the classic technique, which is performed without classic rhinoplasty incisions. The surgical approaches to 55 patients with benign and malignant sinonasal neoplasms are reviewed, and the modification of MD technique performed without rhinoplasty incisions is described. The study includes 41 male and 13 female patients with both benign and malignant sinonasal neoplasms. The ages of the patients were between 9 and 78 years with a mean age of 41.15 years. Follow-up of the patients ranged from 2 to 96 months with a mean of 31.7 months. Most of the cases were angiofibroma and inverted papilloma. Modified MD approach was used for all patients, and in 6 cases, the technique was combined with subcranial approach. We successfully resected the tumors in all of the patients. The most frequently encountered complaint in the postoperative period was temporary nasal crusting and epistaxis. An important complication was the rupture of subpetrous part of the internal carotid artery in one patient and also a temporary facial palsy in another one. Palatal dysfunction, oroantral fistula, or vestibular stenosis, which are significant complications of MD, were not observed in any of our cases. In this modified technique, rhinoplasty incisions are not used; therefore, the duration of operation is shortened, the technique becomes easier, and the incisions of the rhinoplasty procedure, which could cause circular stenosis, are avoided.

Skull Base Inverted Papilloma: A Comprehensive Review

“…Traditionally, surgical resection has been the primary treatment modality for the management of sinonasal tumors involving the maxillary or ethmoid sinuses that are centrally located in the nose and sinuses [45, 348]; however, resection is often limited by critical structures such as eyes, brain, and the cranial nerves. A perfect surgical approach to nasal cavity and paranasal sinus tumors should provide a broad exposition preserving the important structures with no cosmetic defect [349]. Surgical advances are allowing more patients to enjoy functional reconstructions and better quality of life [350–352].…”

“…Common complications related to midfacial degloving are temporary infraorbital anesthesia, hypoesthesia, temporary asymptomatic nasal vestibular stenosis, temporary nasal crusting and epistaxis, palatal dysfunction, oroantral fistula, rupture of subpetrous part of the internal carotid artery in one patient, and temporary facial palsy in another one [349, 443]. Radical sinus surgery with resection of the turbinates by means of midfacial degloving seems to disturb the climatization of the inspiratory air in the nasal cavity.…”

A modified midfacial degloving approach for the treatment of unilateral paranasal sinus tumours

“…Previous modifications of the classic MFDA have utilized lateral osteotomy or nasal bone fracture to gain better exposure to the upper nasal cavity (Krause and Jafek,1999;Jeon et al, 2003;Cansiz et al, 2008). In our modified approach, we separated the upper lateral cartilage from the nasal bone on the lesion side instead of using a lateral osteotomy or nasal bone fracture.…”

Clinical Presentations, Surgical Management and Outcome of Sinonasal Inverted Papilloma

“…However, the lateral rhinotomy approach leaves permanent facial scars, which is one of the reasons why many surgeons consider it to be too invasive for the treatment of benign neoplasm. Besides the lateral rhinotomy approach, the mid facial degloving approach is a relatively uncomplicated alternative option for managing IP even when it has presented at an advance stage [15,16]. Furthermore, in the early 1990s, the endoscopic surgical approach was introduced for the treatment of inverted papilloma which shown comparable or even superior outcome than the conventional external approaches [17][18][19].…”