Midfacial degloving approach for malignant maxillary tumors.

Purpose: The aim of this work is to study the use of this technique in extirpation of malignant tumors of the maxillary sinus. This includes the exposure for adequate tumor resection and the preservation of as much as possible functional tissue integrity. This approach will be evaluated including the advantages and disadvantages as regards the physiological function, aesthetic outcome and the complications related to the procedure.

Methods: Fourteen patients underwent the midfacial degloving technique for excision of malignant maxillary sinus tumors during the period from 1999 to 2003 at the National Cancer Institute, Cairo University. This procedure uses 4 basic incisions; sublabial incision, bilateral intercartilaginous incision, septocolumellar-complete transfixion incisions, and bilateral pyriform aperture incisions extending to the vestibule. Immediate reconstruction of the palatal defect was done in all cases by prosthetic obturator.

Results: All patients successfully underwent the planned procedures through the midfacial degloving approach for the treatment of malignant lesions of the maxilla without significant complications. Fifty of the patients had immediate postoperative face edema which resolved within a week. Oral infection occurred in 4% of patients. Other sequelae were nasal crusting and infraorbital hypoesthesia, both of which resolved within 2 to 3 months.

Conclusions: The midfacial degloving approach offers a good exposure of the mid third of the face with excellent cosmetic results. This approach may be combined with down fracture of the maxilla for access to expose and resect sinonasal malignancies. The midfacial degloving technique can be considered as a valuable procedure with low mortality and excellent cosmetic outcome.