Midface Degloving Approach for Total Maxillectomy Without Orbital Exenteration: A Case Series.

Objective: Evaluate the feasibility of the midface degloving approach (MDA) in total maxillectomy without orbital exenteration (TMWOE) and reconstruction for sino-nasal neoplasms. Study Design: Retrospective case series. Setting: Tertiary referral center. Methods: This single-center series included 9 consecutive sino-nasal neoplasm patients who had TMWOE using MDA, free tissue reconstruction, and orbital floor implants (April 2018-Dec 2022) assessing tumor characteristics, margins, and complications. Results: There were 3 female and 6 male patients with a median age of 61 years. The median follow-up was 462 days. There were 7 malignant and 2 benign tumors. The median tumor size was 4.6 cm. There were 7 clear margins and 2 positive margins. Most patients underwent some combination of preoperative and or postoperative therapies. After resection, a variety of free tissue reconstruction was performed. Overall, there were no complications clearly attributable to the midface degloving approach. Flap debulking was required in one patient but no long-term complications were encountered. Conclusion: Midface degloving offers an alternative to the Weber-Ferguson for TMWOE and avoids facial incision while providing adequate exposure to the orbital rim. Patient selection is critical, as tumors extending laterally into the zygomatic arch and infratemporal fossa may not be accessible.