Midface Degloving Approach for Total Maxillectomy Without Orbital Exenteration: A Case Series

Area of Science:

• Head and Neck Surgery
• Otolaryngology
• Surgical Oncology

Background:

• Sino-nasal neoplasms often require extensive surgical resection, including total maxillectomy without orbital exenteration (TMWOE).
• The choice of surgical approach impacts oncologic outcomes, functional results, and cosmetic appearance.

Purpose of the Study:

• To evaluate the feasibility and outcomes of the midface degloving approach (MDA) for TMWOE in patients with sino-nasal neoplasms.
• To assess tumor characteristics, surgical margins, and complications associated with MDA in this patient cohort.

Main Methods:

• A retrospective case series of 9 consecutive patients undergoing TMWOE using MDA for sino-nasal neoplasms.
• Procedures included MDA, free tissue reconstruction, and orbital floor implants.
• Data collected included tumor characteristics, margin status, and postoperative complications.

Main Results:

• Seven malignant and two benign tumors were resected, with a median follow-up of 462 days.
• Seven patients achieved clear surgical margins; two had positive margins.
• No complications were directly attributed to the MDA technique; one patient required flap debulking without long-term issues.

Conclusions:

• Midface degloving provides an effective alternative to the Weber-Ferguson incision for TMWOE, offering excellent exposure of the orbital rim without external facial scarring.
• Careful patient selection is essential, as laterally extending tumors may not be fully accessible with this approach.
• MDA is a viable surgical option for selected sino-nasal neoplasms requiring TMWOE.