title: Midfacial degloving approach for resectioning and reconstruction of extensive maxillary fibrous dysplasia.
abstract: OBJECTIVE
  The traditional unilateral or bilateral buccogingival or bicoronal approach often seems to impose limitations on achieving complete resection and reconstruction of the extensive midfacial fibrous dysplasia. Therefore, we hypothesized that the midfacial degloving approach could be used for the correction of maxillary fibrous dysplasia, which has been primarily used for paranasal sinus lesions or nasopharyngeal tumor.
  
  
  METHODS
  The study involved 5 maxillofacial fibrous dysplasia patients who underwent a midfacial degloving surgical procedure. There were 4 male patients and 1 female patient with a mean age of 16.8 years. The average, mean follow-up duration was 17.8 months. A wide, subperiosteal dissection was made along the anterior wall of the maxilla and pyriform aperture over the level of the infraorbital foramen. A bilateral, circumferential, nasal vestibular incision and dissection allowed for bilateral degloving of the middle third of the face over the infraorbital rim. Then total or subtotal resection, followed by reconstruction using an iliac bone graft, was performed.
  
  
  RESULTS
  The midface, degloving approach provided visualization of the medial maxillary wall, the pterygoid junction, nasofrontal suture, infraorbital rim, and laterally to the temporal process of the zygoma. Subtotal or total resection of the lesions and reconstruction with bone grafts was possible in all 5 patients, and there were no complications. There was also no visible facial scarring and all patients expressed satisfaction with the cosmetic outcome.
  
  
  CONCLUSIONS
  The midfacial, degloving approach was found to be safe and effective for maxillofacial fibrous dysplasia, and nearly total resection was possible. This approach allows for a wider dissection and resection compared with the traditional buccogingival approaches, and there was no visible facial scarring.
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Yang
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Choi
authors.forename: You Sam
authors.initials: YS
authors.lastname: Chung
authors.forename: Kang Min
authors.initials: KM
authors.lastname: Ahn
authors.forename: Joon Pio
authors.initials: JP
authors.lastname: Hong
authors.forename: Taik Jong
authors.initials: TJ
authors.lastname: Lee
authors.forename: Kyung S
authors.initials: KS
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult