Transmaxillary approach [Neurosurgery Wiki]

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====== Transmaxillary approach ======

The Weber Ferguson [[approach]] is indicated for access for [[tumor]]s 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]].

===== Positioning =====

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.

===== Incision line =====

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).

===== 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.

It then extends sub labially along the mucobuccal fold preserving as much mucosa as possible, up to the maxillary tuberosity.

The subciliary component extends through the orbicularis oculi muscle and then down to bone in the preseptal plane.

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 reapproximated accurately and the skin is closed with fine nylon sutures.