The Midface Degloving Approach in Management of Sinonasal and Anterior Skull Base Lesions

The concept of a midfacial degloving procedure was first introduced by Portmann and Retrouvey and later popularized by Conley and Maniglia.

The advantage of this technique is the wide exposure of the maxilla, the paranasal sinuses, the nasopharynx, the ethmoid labyrinth, the clivus, the pterygomaxillary fossa, and the infratemporal fossa without facial incisions. It can be used successfully in children and in adults.

This approach is quite easy to do and requires bilateral intercartilaginous incisions, a circumvestibular incision, a complete transfixion incision, and a bilateral sublabial incision.

With these incisions the nasal soft tissues and the cheek can be elevated over the nasal and maxillary bones in a subperiosteal plane to the level of the medial canthus on each side.

A portion of lateral maxilla can be removed temporarily with an oscillating saw to allow greater exposure of the tumor.

Modifications in the traditional approach have been described that combined temporary resection of portions of the pyriform aperture with elevation of the cartilaginous septum and anterior nasal spine with the soft tissue to increase exposure.

The most common complications from a midfacial degloving approach are intranasal crusting, prolonged but transitory infraorbital nerve hypesthesia, nasal vestibular stenosis, oral-antral fistula, and leak of cerebrospinal fluid.

Between 1992 and 2006, 85 patients were operated on in our Department of Otolaryngology Head and Neck Surgery at the Ospedali Riuniti di Bergamo with midfacial degloving approach for the treatment of benign and malignant neoplasm of the sinonasal tract and the anterior skull base. In our hands midface degloving always allows good control of the nasal and paranasal sinuses, the pterygomaxillary fossa, the infratemporal fossa, and the vertical segment of the internal carotid artery. This approach allows dural repair with an underlay technique in case of leak of cerebrospinal fluid. The cosmetic results with this technique are excellent.