Nose and Paranasal Sinuses Surgery
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The modified transpalatal approach is used to excise smaller juvenile angiofibroma. In this way, palatal bone is preserved and function of the palate is maintained. A total maxillary swing is needed for bigger angiofibroma around the maxilla with intracranial extension. Partial resections are needed for smaller tumors which can be removed completely without damaging normal vital structures. These tumors used to occupy the inferior part of the sinonasal complex. Moure’s lateral rhinotomy is used for localized tumors in the ethmoid, nasal cavity, floor of the maxillary antrum, and alveolus. Midfacial degloving is used for bigger or bilateral tumors; moreover this approach is cosmetically acceptable as it does not produce any facial scar. Weber–Fergusson incision is used for total maxillectomy when the tumor is much bigger and involved walls of the maxillary sinus. More extensive tumor involves the orbit. In such case orbit has to be removed by Weber–Dieffenbach incisions. Involvement of the orbital apex and adjoining middle cranial fossa is dealt by frontotemporal craniotomy. Oronasal separation is achieved by placing temporalis muscle flap in the cavity following the resection of the tumor.