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maxilofacial operation technique
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  RHINOTOMI LATERALWEBER – FERGUSON TECHNIQUE  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 ando$er the nasal bone along the deepest portion o the nasomaxillary groo$e and ollo!ing thealar crease. A lip%splitting extension o the incision is not necessary. To expose the surgicalarea& the cheek lap is ele$ated subperiosteally o$er the maxilla and around the inraorbitalner$e. The periorbita is ele$ated o$er the lamina papyracea& and the rontoethmoid suture isidentiied and ollo!ed posteriorly until the anterior and posterior ethmoid arteries areidentiied. The anterior !all o the antrum is penetrated at the canine ossa by using a %mm SUMBER : HEAD – AND NECK SURGERY BAILEY 4 ED  chisel. The antrostomy is enlarged !ith a 'errison rongeur around the inraorbital ner$e andsuperiorly to!ard the inerior 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 openedand marsupiali)ed *+,. -: steotomies and remo$al o the specimen. The irst osteotomy in$ol$ed in theactual remo$al extends through the piriorm aperture at the le$el o the nasal loor& directed posteriorly until the osteotomy perorates the posterior !all o the antrum. The orbit isretracted laterally& and a second osteotomy is perormed at the rontoethmoid suture&extending posteriorly to a point / to  mm posterior to the posterior ethmoid artery *i.e.&anterior to the optic oramen,. : The thin bone o the medial loor o the orbit is sa!ed by ollo!ing a line that 2oinsthe lacrimal ossa !ith the superior osteotomy. The inal bone cut in$ol$es three steps. First&a /%mm osteotome is introduced through the anterior antrostomy and directed through themedial posterior antral !all. The osteotome is ad$anced superiorly to reach the le$el o thesuperior osteotome and is then pushed medially. 3econd& a !ide osteotome& introducedthrough the nose& is impacted into the anterior !all o the sphenoid sinus& and then pushedlaterally. 4ea$y right%angle scissors *e.g.& upper%lateral%cartilage scissors, are guided throughthe inerior 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$ity andthe other in the superior osteotomy& directed through or along the posterior attachments o theturbinates. The specimen is remo$ed by anterior and inerior traction. 4emostasis is achie$ed by direct clamping or cautery. The bony edges are smoothed !ith a rongeur. 5esidualethmoid mucosa is remo$ed !ith ethmoid orceps& and a !ide sphenoidotomy is opened !ith'errison rongeurs. The ca$ity is co$ered !ith absorbable gelatin *6eloam, or hemostasis.The medial canthal tendon is sutured to the periosteum o the nasal bones. The !ound isclosed by using a meticulous layered closure.

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Jul 23, 2017

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Jul 23, 2017
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