hg

Others

Surgery

Trauma

GILLIES APPROACH

 

Indication

  • Access to Zygomatic Arch.
  • Access to Malar fractures.

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Consent

  • Scar
  • Localised hair loss around incision site.
  • Weakness of temporal branch of facial nerve.
  • Shaving hair from surgical incision area.
  • Failure of procedure (this is a closed procedure at a distance from the injury site).

 

Procedure

  • Temporal incision in scalp 2.5-3cm anterior to the helix.
  • Do at angle, right angles to direction the Rowe's goes into.
  • Cut down through temperoparietal fascia and down to temporalis fascia and bipolar diathermy- open tissue planes with scissors.
  • Cut through temporalis fascia and temporalis muscle will show through.
  • Hold medial end of fascia with a clip.
  • Slide Howarths under the fascia and under the zygoma.
  • Exchange Howarths for Rowe's elevator.
  • Lift zygoma while assistant holds the head of the patient.
  • Monitor intraoperative ECG during zygoma lift for sudden bradycardia. (See Oculocardiac Reflex)
  • Suture all layers of scalp as a whole unit with 3/0 vicryl.

 

Figure 1 - Demonstration of Rowe's elevator position. (Image courtesy of Mr Luis Bruzual)

 

Author: Johno Breeze

Last Update: 1/5/2015