Dieffenbachs modification, weberfergussons approach, scarring, parasthesia. The weber ferguson approach allows wider exposure but may cause ectropion of the lower eyelid and risks injury to the infraorbital nerve. This incision is roughly parallel but posterior to the zygomaticomaxillary suture line. Jan 24, 2012 the approach through dieffenbachs modification of weberfergusons incision gave better visibility and accessibility to the lesions of maxilla. Versatility of dieffenbachs modification of weber fergussons. In addition, weak and thin tarsus was confirmed on surgery finding, it is predicted that the local vascularity is compromised.
The above described modification of incision for maxillectomy has many advantages over the classical weber ferguson incision and in the present times of aesthetic awareness among patients, it holds more relevance. Incision as noted above, a weber ferguson incision was used, and the incision was curved superiorly at the lateral canthus, and posteriorly along the supratemporal line to the temporal scalp fig. The external scar is minimal since it is located between the esthetic subunits of the face. Now it has been routinely applied in unmodified, modified or extended forms in maxillectomy procedures 15, 16. This is the horizontal component of weber fergusons incision made about 1 mm below the infraorbital rim otolaryngology online 21. Case report penetration of a wooden wedge into the. The lip splitting and lateral nasal component of the incision are placed opposite the side to which the nose is to be transposed and the infraorbital component of the incision is joined by a horizontal incision across the dorsum of the root of the nose fig. The incision is made from just above the medial canthus along. The lesion was completely excised enbloc with clear margins by using a weberferguson incision. We extended the weberfergusson incision to the temporal area to design the maxillafronttemporal mft approach. This modified approach avoids external facial incision and hence is cosmetically well accepted by the patient. Open surgical approaches to the anterior skull base and paranasal.
The first step in the weberfergussons incision is to mark the incision line on. Weberferguson incision is done for removal of lesions at the entry of the nasal passage. The juvenile nasopharyngeal angiofibroma is a benign neoplasm of the posterior. The medial end of the lower eyelid incision is not carried onto the nasal bone as would be the case for a weber ferguson incision that is made to follow the concept of.
The orbital limb of the incision could be placed below the eye, or both above and below the eye for orbital exenteration procedures. Lateral rhinotomy with inferior extension the line indicates skin incision. The authors describe in detail the key anatomic structures and the technical aspects of each approach, so that the surgeon can safely gain access to the region of the craniofacial skeleton requiring surgery. Picture of weberferguson incision otolaryngology houston. Although this type of incision is more frequently used in maxillectomies for the treatment of. The caldwellluc incision is most aesthetically pleasing but provides limited exposure and is thus reserved for small tumours. The medial end of the lower eyelid incision is not carried onto the nasal bone as would be the case for a weber ferguson incision that is made to follow the concept of facial subunits.
Weber ferguson incision, mostly the sublabial midfacial degloving incisions were employed to avoid any obvious scar or deformity. The modified weber ferguson incision used in total maxillectomy has three components. A patient with earlier history of excision was treated with repeat ergery employing the weberferguson incision followed by postop radiotherapy. The lesion was completely removed using a weberferguson facial incision and a transnasal transsphenoidal approach. Results the surgical approach depends on the type and staging of the tumour. Only one patient had transient epiphora as a result of ectropion. Unusually delayed recurrence of a low grade mucoepidermoid carcinoma of the maxillary sinus nitish virmani 1, jyoti p. Juvenile nasopharyngeal angiofibroma evaluation and workup return to. A patient with earlier history of excision was treated with repeat ergery employing the weber ferguson incision followed by postop radiotherapy. Itwas carried outeither by lateral rhinotomy or weber ferguson. Expansile keratocystic odontogenic tumor in the maxilla. Modifications of the craniotomy such as the osteoplastic frontal sinus or the supraorbital rim approach are posible as are extensions of the weber ferguson incision or use of the facial degloving approach. Curving incision from the medial canthus to the ala of the nose at the nasolabial sulcus. Complications are related with intracranial extension or extensive bleeding.
Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. Development of bleeding from the nose or nasal obstruction may raise the suspicion. Pdf modified weber ferguson incisiona rare traumatic. A 60yearold caucasian male presented with a medial canthal mass and epiphora. Pdf versatility of dieffenbachs modification of weber fergussons.
Incision utilized for a classical weber ferguson with extension along the inferior orbital lid, often required for a total maxillectomy. Pdf modified weber ferguson incisiona rare traumatic serendipity. The leeds modified weberfergusson incision the journal. Weber ferguson incision closure with preserved facial aesthetic.
The leeds modified weberfergusson incision volume 101 issue 5 j. Featuring over 400 fullcolor surgical photographs and drawings, this textatlas is a stepbystep guide to the surgical approaches used to expose the facial skeleton. Ferguson incision to expose the tumor adequately and remove it completely. Osteoid osteoma is a benign bone neoplasm which is seen in the long bones of appendicular skeleton. This incision is rounded inferiorly along the upper border of upper lip till the center of the lip is reached.
Lateral rhinotomy,weberferguson, lynch, sub cilliary, mid cilliary, dieffenbach, are presented. As a result, we think that ectropion is caused by 1 contracture and weight of grafted flaps, 2 contracture by weberferguson incision and 3 dysfunction of orbicularis oculi muscle. Clinical alikeness of such incision is a rare entity, and the importance of early esthetic primary closure of this ugly injury is an important treatment aspect for the. The weberferguson approach allows wider exposure but may cause ectropion of the lower eyelid and risks injury to the infraorbital nerve. The weberferguson incision was first described by gensoul in 1827 and was developed by weber and ferguson afterwards.
Other systemic examination was under normal limit and no associated medical signs and symptoms were present. Skull base osteoid osteoma is extremely rare and has been anecdotally reported. In this patient, the incision ended at the insertion of the ala nasi. An uncommon resemblance of a traumatic laceration with wellknown weber ferguson incision and its management has been discussed in this report. Incision weber fergusons incision is used lateral rhinotomy incision with horizontal infraorbital component and midline lip split otolaryngology online 19. Caldwellluc incision or the weber ferguson incision. Our case report presented a 24yearold woman, which is in conformity with the typical demographics 8. Approach weber ferguson ao surgery reference the weber. Transconjunctival incision for total maxillectomyan. Apr 29, 2017 a modified weber ferguson incision is used. Do you want to use the redesigned ao sr like an app.
Inverted papilloma of lacrimal sac invading into the orbit. Modified weber ferguson incisiona rare traumatic serendipity. The incision is made from just above the medial canthus along the lateral aspect of the nose into the alar crease. Discussion oms are rare tumours of the jaws with female predilection, and generally occur in the second to fourth decades of life. Like the midface degloving approach, the lateral rhinotomy incision provides adequate exposure for medial maxillectomy with or without ethmoidectomy. Because there is direct access to the pathology, the inadvertent resection of the uninvolved structures is prevented thus minimizing the morbidity. Modified weber ferguson incision a rare traumatic serendipity. The weberferguson incision used in the present case can be made in parts or can even be extended, if necessary, through additional incisions and dissections. Pedicled mandibular osteomuscular flap for zygomatic reconstruction through a modified weberferguson incision. The authors report a case of a large osteoid osteoma of the ethmoid with intraorbital and intracranial extension in a 33 year old male patient.
Ethmoidal osteoid osteoma with orbital and intracranial. Incision as noted above, a weberferguson incision was used, and the incision was curved superiorly at the lateral canthus, and posteriorly along the supratemporal line to the temporal scalp fig. Sep 24, 2019 incision utilized for a lateral rhinotomy approach where a straight incision is made at the nasomaxillary junction followed by a curvilinear incision around the nasal ala. Jun 27, 2015 approach weber ferguson ao surgery reference the weber ferguson approach is indicated for access for tumors involving the maxilla extending superiorly to the infraorbital nerve and into or involving the orbit. The incision is extended onto the nasal bone and maxilla. Modified weberfergusson incision with borles extension.
The upper lip is ideally split right in the midline. Radical maxillectomy has usually been done by the classical weber ferguson incision since age old times and still is being used widely due to. Figure 1 facial incisions for resection of craniofacial neoplasms. Desmoid tumor or aggressive fibromatosis is rarely seen in the nasal cavity and are prone to recurrences. Weber ferguson provides a wide access to all areas of the maxilla and orbital floor. As a result, we think that ectropion is caused by 1 contracture and weight of grafted flaps, 2 contracture by weber ferguson incision and 3 dysfunction of orbicularis oculi muscle. Lateral rhinotomy and the weber fergusson approach. Juvenile angiofibroma rads see also with virtual slide. Juvenile nasopharyngeal angiofibroma iowa head and neck. The facial incision starts as a lateral rhinotomy incision, and is.
Anterior skull base reconstruction with the pericranial. Pdf objective the aim of the study is to evaluate the usage of dieffenbachs modification of. A rare case report in maxillary sinus with weberferguson approach marcelo domingues pinto, felipe lage da rocha, viviane bento cupello, gustavo gaffree braz, roberto gomes santos and fabio ramoa. Orthopedic trauma incl pediatrics your digital gateway to expertise, education, and innovation.
Adequate surgical excision with longterm followup should be the treatment of choice for managing a giant cell lesion of the maxilla. Lymphangioma of the clivus neurosurgery oxford academic. A gently curved incision lessens the chances of ectropion and sagging of the medial canthus. The traumatic injury caused due to such accidents hampers. The study included 3 male patients and 2 female patients with an average age of 46 years. You need to keep contact with your surgeon in case of recurrence. The lesion was completely excised enbloc with clear margins by using a weber ferguson incision. A bold surgical approach is detailed using a lateral rhinotomy incision or a modified weber. Composite auricular chondrocutaneous graft is useful for. Though rare, giant cell tumor should be considered as one of the differential diagnosis in cases of maxillary swelling. It provides a wide access to all areas of the maxilla and orbital floor. This incision allows exposure of the superior and inferior aspects of the maxilla and its complete en bloc resection. Juvenile nasopharyngeal angiofibroma symptoms diagnosis. Pedicled mandibular osteomuscular flap for zygomatic.
It is indicated for access for tumors involving the maxilla. It was bright on both t1 and t2weighted magnetic resonance imaging scans. To characterize this tumor, specimens were immunostained with bcl2, bax, ki67. Incisional biopsy confirmed a transitional neoplasm. The aim of this study was to evaluate the use of a pedicled mandibular osteomuscular flap for zygoma reconstruction through a modified weberferguson incision. Unlike the weber ferguson incision that follows the concept of facial subunits, the medial end of the lower eyelid incision is not carried onto the nasal bone, but instead avoids the epicanthal fold and so turns inferiorly just before the vertical or parasagittal plane at the medial canthus to follow the junction of the cheek and the. If weber confirms the defect and approves the claim, weber will elect to replace such parts without charge. A classical weberferguson incision would continue toward the columella and then slit the lip in the midline. The leeds modified weber fergusson incision volume 101 issue 5 j. Road traffic accident has become a menace in todays expanding era. This incision gives great visualization for surgeon and causes very little deformity 4. Lateral rhinotomy with superior extension the line indicates skin incision.
Total maxillectomy and orbital exenteration vula university of. Medial maxillectomy was the most common procedure 35% followed by total maxillectomy 24% figure 2. Modified weber ferguson incision international journal of. Weberferguson incision with lateral subciliary extension. Feb 23, 2011 the above described modification of incision for maxillectomy has many advantages over the classical weber ferguson incision and in the present times of aesthetic awareness among patients, it holds more relevance. The aim of this study was to evaluate the use of a pedicled mandibular osteomuscular flap for zygoma reconstruction through a modified weber ferguson incision. Varia tions to the standard approach depend on the location and extent of the tumor. Interdisciplinary surgical management of orbital and. Ademarcation of the incision at weberferguson access, bsurgical exposure of the lesion, caspiration puncture, evidencing net intra. The weber ferguson is used for better accessibility for the maxillary and orbital lesions. No patient had ugly scarring, severe ectropion from eversion of the lower lid, or depression, that are usually seen after a classic weberferguson incision. The weber ferguson incision used in the present case can be made in parts or can even be extended, if necessary, through additional incisions and dissections. We extended the weber fergusson incision to the temporal area to design the maxillafronttemporal mft approach.
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