Combined Median Mandibulotomy and Weber-Fergusson Maxillectomy

Abstract

Monoblock surgical resection in combination with radiotherapy remains the most effective method of treatment for advanced carcinoma of the maxillary sinus. Extension of antral carcinoma into the infratemporal and pterygopalatine fossae decreases the probability of achieving an all-encompassing resection via the classic anterolateral Weber-Fergusson approach because of limited posterior access. Temporal and lateral infratemporal fossa approaches have been described and involve either mobilization of the zygomatic arch or a lateral mandibular osteotomy, respectively. We report the use of a median labiomandibulotomy combined with the Weber-Fergusson approach for lesions extending posteriorly. The labiomandibulotomy with paralingual extension along the floor of the mouth allows rotation of the coronoid process laterally and exposes the infratemporal fossa to its posterior margin. We present two cases in which this approach was used to extirpate lesions that had extended posteriorly. Relevant anatomy, operative technique, potential complications, and limitations, as well as a comparison with other methods of exposure, are discussed.

Factors in the Pathogenesis of Tumors of the Sphenoid and Maxillary Sinuses: A Comparative Study

“…Tables I through IV summarize the collective published experience with maxillary and sphenoid benign and malignant tumors according to histopathology and incidence. 7–50 , 51–100 , 101–150 , 151–200 , 201–250 , 251–300 , 301–350 , 351–400 , 401–450 , …”

Pilot Study: Reimagining Facial Tumor Resection by Introducing the Tau Incision in Head and Neck Surgery

“…In 1826, Lizars performed one of the earliest recorded maxillectomies, setting the stage for the landmark procedure by Fergusson in 1842, which used an incision extending from the inner eyelid to the upper lip. 1 – 5 This early innovation became the foundation for the Weber–Fergusson incision, which remains widely used.…”

“… 6 – 8 Postoperative radiotherapy exacerbates these issues by causing soft-tissue fibrosis and contractures, particularly in edentulous patients. 4 , 5 Although modifications such as Z-plasties and nasolabial approaches have aimed to mitigate these complications, achieving a balance between oncological efficacy and aesthetic outcomes has proven challenging, especially in younger patients. 4 , 5 …”

“… 4 , 5 Although modifications such as Z-plasties and nasolabial approaches have aimed to mitigate these complications, achieving a balance between oncological efficacy and aesthetic outcomes has proven challenging, especially in younger patients. 4 , 5 …”