Atlas of Surgical Approaches to Paranasal Sinuses and the Skull Base by Dan M. Fliss & Ziv Gil

Author:Dan M. Fliss & Ziv Gil
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Fig. 4.39Elevation of the cheek flap and maxillectomy

Fig. 4.40Combined maxillectomy and preauricular infratemporal approach

4.2.8 Maxillary Swing Approach

A maxillary swing has been routinely used for recurrent nasopharyngeal carcinomas, but since the development of endoscopic and robotic approaches, this approach is used in selected cases with paranasopharyngeal space invasion. The procedure is performed through a Weber-Ferguson incision and extended subciliary incision (Fig. 4.41). A full upper cheek flap is not elevated, to prevent devascularization of the anterior wall of the maxilla. Only the lines of the osteotomies are exposed, allowing pre-banding of titanium plates, which are placed along the osteotomy lines. This procedure allows repositioning of the maxillary bone flaps after tumor resection (Fig. 4.42). The palatal incision is performed along the medial border of the hard palate circumferentially, preserving the blood supply from the greater palatine arteries (Fig. 4.43). The coronal palatal mucosal flap is elevated, exposing the hard palate. The osteotomies are performed along the midline at the hard palate and upper gingival sulcus, below the inferior orbital rim, and laterally along the malar eminence. The bone flap is left attached to the upper cheek flap, and the maxilla is swung laterally with the aid of fine osteotomes (Fig. 4.44). After the tumor is removed, the maxilla is swung back and secured in place with pre-bent titanium plates (Fig. 4.45).

Fig. 4.41Development of an upper cheek flap for a maxillary swing approach

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