Total Maxillary swing approach
Introduction:
Total maxillary swing approach is utilized to approach nasopharynx inorder to remove benign tumors of nasopharynx like nasopharyngeal angiofibroma. This procedure involves disarticulation of maxilla, and swinging it away laterally with its attached facial skin exposing the nasopharynx.
Steps of total maxillary swing approach:
Anesthesia – General
Position – Rose position (tonsillectomy position)
Incision – Weber Ferguson incision without gingivolabial component
Bilateral tarsorraphy should be performed
Inverted “U” shaped incision is marked out on the hard palate
After deepening the facial incision the lacrimal sac should be skeletonized and sectioned at its lower end.
Infra orbital nerve should be sectioned as it comes out of infraorbital foramen.
Periosteum of the inferior orbital wall should be elevated. Appropriate sized miniplates should be used to drill out holes in the area for future anchorage of the maxilla.
Osteotomies should be performed on the frontal process of maxilla and at the maxillo zygomatic suture.
The maxillo ethmoidal junction should be separated using a straight osteotome.
The mucoperiosteum over the hard palate should be elevated based on the contralateral greater palatine vessels. The ipsilateral greater palatine vessels were cauterized and sectioned.
A straight osteotome should be placed between the arms of a v shaped notch located on the anterior nasal spine and hammered in order to separate the maxilla down the middle.
A curved osteotome is used to disarticulate the maxilla from the pterygoid process.
Now the whole maxilla with its attached cheek tissue can be swung like a door laterally exposing the whole of nasopharynx.
Mass in the naso pharynx can now be removed under direct vision.
Maxilla can be repositioned after surgery and secured in position by using miniplate and screws.
Occlusal wafer and palatal splints can be used to secure the mucoperiosteal lining of the palate in place.
Complications:
1. Palatalnecrosis
2. Floatingpalate
3. Rhinolaliaaperta
4. Nasalregurgitation of fluids
5. Palatalfistula – could be temporary
