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British Journal of Oral and Maxillofacial Surgery 48 (2010) e23–e24
Technical note
Modified Weber–Fergusson incision with Borle’s extension
Anshul Rai ∗ , Nitin bhola, Abhay datarkar, Rajeev borle
Sharad Pawar Dental College Wardha, MH India
Accepted 31 March 2010
Keyword: Weber–Fergusson incision with temporal extension
The Weber–Fergusson maxillectomy incision was first
described by Weber in German and later modified by
Fergusson1 in English. It is one of the most commonly used
transfacial approaches to the midface for the resection of
maxillary tumours.
The modified incision is required for the exposure of
diseases of the maxilla. When the primary tumour that
involves the maxilla and maxillary sinus is large, then the
Weber–Fergusson incision is required with a Lynch, Diffen-
Fig. 1. Weber–Fergusson incision with temporal extension.
∗ Corresponding author. Tel.: +91 9766320242.
E-mail address: anshulrai007@yahoo.co.in (A. Rai).
0266-4356/$ – see front matter © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2010.03.011
bach, or subciliary extension. To expose the ethmoid sinus, a
Lynch extension is required, and for a total maxillectomy a
subciliary extension.2
For better postoperative cosmesis Hernandes Altemir3
suggested a modification to the incision, in which the straight
line incision in the lip is moved from the midline and placed
on the philtrum. This incision allows for improved access
to the maxilla, and for unimpeded resection of tumours of
the anterior and superior aspects of the maxilla. It may also
be used to aid in swinging the maxilla laterally while it is
pedicled to the cheek flap.
We recommend the extension of the incision (Borle’s
extension) from the lateral canthus of the eye to the tem-
poral region in the shape of a question mark (Fig. 1) when
the reconstruction of the maxillectomy defect is planned with
a temporalis muscle flap. No second incision is required to
harvest the temporalis flap (Fig. 2), which is an advantage of
Fig. 2. Operative photograph showing harvesting of a temporalis muscle
flap.
e24 A. Rai et al. / British Journal of Oral and Maxillofacial Surgery 48 (2010) e23–e24

this modification. There is no periorbital oedema, injury

to the facial nerve, or ectropion postoperatively (Fig. 3).
When the large defect is to be covered by a temporalis
flap, the question mark part of the incision can be extended
superiorly.

References

1. Fergusson W. Operation on the upper jaw. In: A System Of Practical

Surgery. London: J Churchill & Co; 1842, 484.
2. Shah JP, Johnson NW, Batsakis JG, editors. Head And Neck Surgery. 3rd
ed. London: Mosby-Wolfe; 2003.
3. Hernandes Altemir FH. Transfacial access to the retromaxillary area. J
Maxillofac Surg 1986;14:165–70.

Fig. 3. Postoperative photograph (published with the patient’s permission).