Midfacial degloving: an alternative approach for traumatic corrections in the midface.

Midfacial degloving was used as an approach in 14 patients to correct post-traumatic deformities in the midface. In eight patients, deformities in the naso-orbito-ethmoid region were corrected by orbitonasal osteotomy, telecanthus correction, orbital grafting and nasal augmentation procedures. Zygomatic osteotomies were performed in five patients with orbitozygomatic deformity. In one patient, a midface fracture (Le Fort II/III) was reconstructed after midfacial degloving. By combination of transoral vestibular, intranasal and preseptal transconjunctival incisions a complete degloving of the midface up to the nasofrontal angle and the zygoma prominence was possible. All osteotomies could be completed after midfacial degloving. Additional coronal incisions were not required. Orbitonasal osteotomies for nasal lengthening as well as fixation of the medial canthal ligament by a miniplate could be performed under direct vision. There were no postoperative complications such as stenosis of the nasal aperture or disturbances of the mimic musculature. Midfacial degloving offers good exposure, specially of the central part of the midface, without leaving an external scar. It is useful for reconstructive procedures in patients after midface trauma.