Weber Edit Fix

8/10/2019 Weber Edit Fix

1/12

RHINOTOMI LATERAL

WEBER FERGUSON TECHNIQUE


2/12

Figure 107.1 Medial maxillectomy. Lateral rhinotomy :A: The skin incision begins beneaththe medial aspect o the eyebro! and continues " to # mm anterior to the medial canthus and

o$er the nasal bone along the deepest portion o the nasomaxillary groo$e and ollo!ing the

alar crease. A lip%splitting extension o the incision is not necessary. To expose the surgical

area& the cheek lap is ele$ated subperiosteally o$er the maxilla and around the inraorbital

ner$e.

The periorbita is ele$ated o$er the lamina papyracea& and the rontoethmoid suture is

identiied and ollo!ed posteriorly until the anterior and posterior ethmoid arteries are

identiied. The anterior !all o the antrum is penetrated at the canine ossa by using a "%mm

SUMBER : HEAD AND NECK SURGERY BAILEY

4 ED


3/12

chisel. The antrostomy is enlarged !ith a 'errison rongeur around the inraorbital ner$e and

superiorly to!ard the inerior orbital rim. (: (one is remo$ed across the orbital rim&

including the lacrimal ossa. The nasolacrimal duct is di$ided& and the lacrimal sac is opened

and marsupiali)ed *+,.

-: steotomies and remo$al o the specimen. The irst osteotomy in$ol$ed in the

actual remo$al extends through the piriorm aperture at the le$el o the nasal loor& directed

posteriorly until the osteotomy perorates the posterior !all o the antrum. The orbit is

retracted laterally& and a second osteotomy is perormed at the rontoethmoid suture&

extending posteriorly to a point / to mm posterior to the posterior ethmoid artery *i.e.&

anterior to the optic oramen,.

: The thin bone o the medial loor o the orbit is sa!ed by ollo!ing a line that 2oins

the lacrimal ossa !ith the superior osteotomy. The inal bone cut in$ol$es three steps. First&

a /%mm osteotome is introduced through the anterior antrostomy and directed through the

medial posterior antral !all. The osteotome is ad$anced superiorly to reach the le$el o the

superior osteotome and is then pushed medially. 3econd& a !ide osteotome& introduced

through the nose& is impacted into the anterior !all o the sphenoid sinus& and then pushed

laterally. 4ea$y right%angle scissors *e.g.& upper%lateral%cartilage scissors, are guided through

the inerior osteotomy !ith one blade in the nose and the other in the antrum to start the

posterior cut& behind the turbinates.

F: 4ea$y cur$ed scissors are then introduced !ith one blade in the nasal ca$ity and

the other in the superior osteotomy& directed through or along the posterior attachments o the

turbinates. The specimen is remo$ed by anterior and inerior traction. 4emostasis is achie$ed

by direct clamping or cautery. The bony edges are smoothed !ith a rongeur. 5esidual

ethmoid mucosa is remo$ed !ith ethmoid orceps& and a !ide sphenoidotomy is opened !ith

'errison rongeurs. The ca$ity is co$ered !ith absorbable gelatin *6eloam, or hemostasis.

The medial canthal tendon is sutured to the periosteum o the nasal bones. The !ound is

closed by using a meticulous layered closure.


4/12


5/12

1.

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. It provides a wide access to all areas

of the maxilla and orbital floor.


6/12

/.

The patient is placed in a supine position with the entire face

prepared and draped into the surgical field. Tarsorrhaphy

sutures are placed in the eyelids.


7/12

.

The incision line is drawn through the vermillion border, along

the filtrum of the lip, extending around the base of the nose

(or entering the nostril floor for a better esthetic result) and

along the facial nasal groove (In the border of both esthetic

units). It then extends infraorbitally 3-4 mm below the cilium

to the lateral canthus.

The incision can be extended laterally or superiorly as

necessary for tumor removal.Anaesthesia :

The tissue is infiltrated with local anaesthetic containing

vasoconstrictor (eg. 1 % Xylocaine with 1/100 000

epinephrine).


8/12

5.

Incision : The incision is made through skin and

subcutaneous tissue along the nose. The full thickness upper

lip is transected and the labial artery ligated or coagulated.


9/12

6.

7.

It then extends sub labially along the mucobuccal fold

preserving as much mucosa as possible, up to the maxillary

tuberosity.


10/12

8.

The subciliary component extends through the orbicularis oculi

muscle and then down to bone in the preseptal plane.


11/12

9.

The cheek flap is elevated off the maxilla to its lateral border

in a subperiosteal plane with electrocautery. A supraperiosteal

dissection plane will be necessary in the subcutaneous

tissues if there is tumor invasion of the antero lateral maxillary

wall. In most cases the infraorbital nerve is sacrificed to

facilitate tumor removal.

Closure

After tumor removal, the orbicularis oculi muscle is

approximated with absorbable sutures. The subcutaneous

tissues are also closed with absorbable sutures, as is the

orbicularis oris muscle. The vermillion border is rea roximated


12/12

accurately and the skin is closed with fine nylon sutures.

Weber Edit Fix

Documents

Transcript of Weber Edit Fix