Mid-face lift with Endotine midface B device
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Transcript
This is Richard Allen at the University of Iowa.
This video demonstrates a mid-face lift using an Endotine Midface B device.
A lateral canthotomy is performed followed by an inferior cantholysis. A 4-0 silk suture is place through the lower lid margin to provide traction during the case. A transconjunctival incision is made with the monopolar cautery inferior to the inferior border of the tarsus, extending from the punctum medially to the lateral canthotomy incision laterally. Dissection is then carried out between the orbicularis muscle and the orbital septum inferiorly. The cut end of the conjunctiva and lower lid retractors are engaged with a 4-0 silk suture to provide traction. Dissection then continues to the inferior orbital rim. The inferior orbital rim is identified and incised with the monopolar cautery. A Freer periosteal elevator is then used to elevate the periosteum from the inferior orbital rim. The periosteum will then be elevated along the face of the maxilla and zygoma. This subperiosteal dissection will continue to the gingival-buccal sulcus. An incision is made through the periosteum inferiorly to release the midface. The area of the infraorbital nerve is identified and dissection is carried around the infraorbital neurovascular bundle. The midface is demonstrated to be fully mobile.
Attention is the directed to the other side where the same procedure is performed. A transconjunctival incision is made followed by dissection between the orbicularis muscle and the orbital septum. This proceeds inferiorly. The cut end of the conjunctiva and retractors are engaged with a 4-0 silk suture to provide traction during the case. The inferior orbital rim can be identified using cotton tip applicators for blunt dissection. The periosteum of the inferior orbital rim is then incised with the needle tip cautery. The Freer periosteal elevator is then used to elevate the periosteum from the inferior orbital rim. This subperiosteal dissection proceeds inferiorly along the face of the maxilla and zygoma to the gingival-buccal sulcus. The infraorbital neurovascular bundle is identified and dissection is carried out around it. An incision is then made through the periosteum inferiorly to fully release the midface. The midface is now completely mobile.
The Endotine drill is the used to make a hole in the central portion of the inferior orbital rim. A tap is then used to tap the hole. The Endotine midface B device is then introduced into the subperiosteal pocket. The device is placed as far inferior as possible with the Freer. The device then engages the cheek and is pulled superiorly using the leash of the device. The hole in the leash is then fixated to the inferior orbital rim with the absorbable screw. The top of the screw is then clipped. The redundant portion of the leash is then clipped. This results in elevation of the cheek.
Attention is then directed to the other side where the same process is performed. The Endotine drill is used to make a hole in the central portion of the inferior orbital rim. The tap is used to tap the hole. The Endotine device is then introduced into the subperiosteal pocket and placed as far inferior as possible. The soft tissue of the cheek is engaged with the device and upward traction is performed with the leash. The hole of the leash is then engaged with the absorbable screw and fixated to the inferior orbital rim. The top of the screw is clipped, followed by the redundant portion of the leash.
The transconjunctival incision is then closed with interrupted 7-0 vicryl sutures. A lateral tarsal strip will then be performed. Dissection is carried out between the anterior and posterior lamella. The mucocutaneous junction is excised with the Westcott scissors. The posterior surface of the strip is scraped. The strip is then shortened and engaged with a double armed 4-0 mersilene suture, placing the sutures posterior to anterior. The needles are then placed through the periosteum of the lateral orbital rim at the level of Whitnalls tubercle. The lateral upper mucocutaneous junction is excised and sutured to the lateral tarsal strip with a 5-0 Vicryl suture. The mersilene sutures are then tied. The lashes laterally on the anterior lamella are excised. The lateral canthotomy incision is then closed with interrupted 7-0 Vicryl sutures. The patient will use antibiotic ointment over the area three times per day and follow up in one week for reevaluation.
