Authors of section

Authors

Brian Burkey, Neal Futran

Executive Editors

Gregorio Sánchez Aniceto, Marcelo Figari

General Editor

Daniel Buchbinder

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Weber Ferguson approach

1. Introduction

The Weber Ferguson approach is indicated for access for tumors involving the maxilla extending superiorly to the infraorbital nerve and into or involving the orbit. It provides a wide access to all areas of the maxilla and orbital floor.

weber ferguson approach

2. Positioning

The patient is placed in a supine position with the entire face prepared and draped into the surgical field. Tarsorrhaphy sutures are placed in the eyelids.

weber ferguson approach

3. Incision line

The incision line is drawn through the vermillion border, along the filtrum of the lip, extending around the base of the nose (or entering the nostril floor for a better esthetic result) and along the facial nasal groove (In the border of both esthetic units). It then extends infraorbitally 3-4 mm below the cilium to the lateral canthus.

weber ferguson approach

The incision can be extended laterally or superiorly as necessary for tumor removal.

weber ferguson approach

4. Anaesthesia

The tissue is infiltrated with local anaesthetic containing vasoconstrictor (eg. 1 % Xylocaine with 1/100 000 epinephrine).

5. Incision

The incision is made through skin and subcutaneous tissue along the nose. The full thickness upper lip is transected and the labial artery ligated or coagulated.

weber ferguson approach

It then extends sub labially along the mucobuccal fold preserving as much mucosa as possible, up to the maxillary tuberosity.

weber ferguson approach

The subciliary component extends through the orbicularis oculi muscle and then down to bone in the preseptal plane.

weber ferguson approach

The cheek flap is elevated off the maxilla to its lateral border in a subperiosteal plane with electrocautery. A supraperiosteal dissection plane will be necessary in the subcutaneous tissues if there is tumor invasion of the antero lateral maxillary wall. In most cases the infraorbital nerve is sacrificed to facilitate tumor removal.

weber ferguson approach

6. Closure

After tumor removal, the orbicularis oculi muscle is approximated with absorbable sutures. The subcutaneous tissues are also closed with absorbable sutures, as is the orbicularis oris muscle. The vermillion border is reapproximated accurately and the skin is closed with fine nylon sutures.