Division of Facial and Plastic Reconstructive Surgery
University of Michigan Hospital
1500 E Medical Center Dr, TC 1904
Ann Arbor, MI 48109-0312
In this issue of the ARCHIVES, Cultrara et al1 demonstrate the usefulness of the midfacial degloving (MFD) approach for the reduction of naso-orbital-ethmoid (NOE) and midface fractures. As they state, the "open-sky" approach provides excellent exposure of NOE fractures; however, it involves the use of facial incisions which, in the region of the medial canthal ligaments, may lead to scar contracture and webbing. Because the mechanism of trauma resulting in such fractures is a crushing type of injury, the "open sky" approach may be more prone to scar contracture and webbing than the standard Lynch incision used for external ethmoidectomy. The authors describe in excellent detail the steps required to successfully expose the midfacial skeleton via the MFD approach and state that the complications of the MFD approach can include nasal obstruction, nasal deformity, and temporary infraorbital nerve anesthesia. In addition to these complications, nasal vestibular stenosis can occur as a result of the circumvestibular incisions, andspecial caution should be taken when considering using this approach in a patient known to be prone to keloids. Additionally, excessive retraction of the midfacial soft tissues may result in temporary midfacial muscular weakness; however, this will resolve over time.
Marentette LJ. Craniofacial Approaches to Midfacial Fractures. Arch Facial Plast Surg. 2004;6(2):136. doi:10.1001/archfaci.6.2.136