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    Approaches To The Facial Skeleton

    Uploaded by

    Mugdha Francis
    The document discusses different surgical approaches to the facial skeleton. It outlines general guidelines for selecting an approach and considerations like exposure, access and aesthetics. It then describes specific approaches for different areas, highlighting relevant anatomy.

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    Approaches To The Facial Skeleton

    Uploaded by

    Mugdha Francis
    19 views117 pages
    The document discusses different surgical approaches to the facial skeleton. It outlines general guidelines for selecting an approach and considerations like exposure, access and aesthetics. It then describes specific approaches for different areas, highlighting relevant anatomy.

    Original Title

    Approaches to the facial skeleton

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    The document discusses different surgical approaches to the facial skeleton. It outlines general guidelines for selecting an approach and considerations like exposure, access and aesthetics. It then describes specific approaches for different areas, highlighting relevant anatomy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    19 views117 pages

    Approaches To The Facial Skeleton

    Uploaded by

    Mugdha Francis
    The document discusses different surgical approaches to the facial skeleton. It outlines general guidelines for selecting an approach and considerations like exposure, access and aesthetics. It then describes specific approaches for different areas, highlighting relevant anatomy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 117

    APPROACHES TO THE

    FACIAL SKELETON
    Dr S Sooraj MDS MOS RCS (ED) DNB
    Remit of this presentation
    • Help understand different approaches to the facial
    skeleton
    • General guidelines for selecting the approach
    • Anatomical obstacles in the selected approach
    • Functional consequences
    • Aesthetic implications
    Approaches
    Trans oral Transcutaneous

    Combination
    Transconjunctival
    General guidelines
    maximize exposure and access

    Exposure Access

    • Ability to maneuver and


    • Visual appreciation of the perform instrumentation
    site
    • Direct visual Exposure • Direct

    • Endoscopic • Remote
    General Guidelines
    • Surgical convenience SHOULD NOT contravene Facial
    Aesthetics
    • Incisions to be hidden or to blend in with skin creases
    • Respect neurovascular structures
    • Transected muscles to be repaired
    Surgical Anatomy
    Neuro Skeleton Visceroskeleton

    • Frontal (U) • Inferior choncha (P)


    • Sphenoid (U) • Zygomatic (P)
    • Ethmoid (U) • Nasal (P)
    • Occipital (U) • Maxilla(P)
    • Parietal (P) • Palatine (P)
    • Temporal (P) • Lacrimal (P)
    • Vomer(U)
    • Mandible(U)
    Applied anatomy
    APPROACHES TO
    SPECIFIC AREAS
    Approaches around the eye
    • UPER LID

    • LOWER LID

    • TRANSCONJUNCTIVAL
    Upper Lid Incision Applied Anatomy
    Approaches to the orbital floor
    • Cutaneous incisions
    •
    • Transconjunctival
    Applied anatomy
    Cutaneous Incisions
    Marking the incision
    Lower lid incision
    Identify the fracture and the inferior orbital
    fissure
    Floor ascends as we go back
    Find the posterior limit of the fracture
    Renconstruction spanning the defect
    Transconjunctival approach
    Lower lid retraction sutures
    Vasoconstrictor inj. into the fornix
    Lateral canthotomy

    Lateral canthotomy
    Inf.limb of LCL identified
    Inf limb of LCL transected
    Increased exposure after sectioning LCL
    Inf Fornix incised
    Periosteum incised
    Floor defect reconstructed
    Coronal approach
    • Regions Accessed
    • Upper and middle
    1/3rds of facial
    skeleton
    • Zygomatic arch
    • Skin ,sub cutaneous
    tissue and galea move
    as a single layer

    • Subgaleal fascia is the


    cleavage plane
    Temporoparietal fascia
    • Temporo parietal
    fascia
    • Lateral extension of
    Galea
    subgalea • Superficial temporal
    l
    artery
    Temporo
    parietal • Facial nerve
    fascia
    Temporal approaches
    • Gillies temporal approach
    • Al Khayat-Bramley Approach
    • Approaches for harvesting temporal fascia-temporalis
    muscle
    Applied anatomy
    Preauricular Approach
    • Temporomandibular
    joint surgeries
    • Condylar head injuries
    RETRO MANDIBULAR APPROACH
    • Exposes the entire
    ramus from behind the
    posterior border
    Applied Anatomy
    • Main anatomical
    structures at risk are :
    • Facial nerve
    • Retromandibular vein
    incision
    Parotid gland exposed
    Trans Massetric Antero Parotid
    Submandibular Approach
    Indications
    • Accesing the angle –
    ramus region
    • Submandibular gland
    • E/O Ramus
    osteotomies
    Applied Anatomy
    • Marginal Mandibular N
    • Facial Artery
    • Facial vein
    The facial vessels cross the inferior border of the mandible
    at the anterior margin
    of the masseter.

    The facial artery is always located anterior to the vein


    Dingman & Grabb (1962)

    19% - upto 1 cm below the inf. border

    Zairah & Atkinson (1981)

    1.2 cm
    Vestibular Approach-Mandible
    • Access symphysis,
    para symphysis ,body
    and angle regions of
    the mandible
    Applied Anatomy
    • Mentalis muscle

    • Mental nerve

    • Facial vessels
    Anterior mandible
    Mandibular body
    Posterior mandible
    Trans buccal access

    Transbuccal Approach
    Vestibular Approach-Maxilla
    Applied Anatomy
    • Infraorbital nerve
    Nasolabial musculature
    Closure
    Nasal Cinch suture V-Y closure
    Existing lacerations

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