Use of existing lacerations
Facial fractures are often associated with lacerations. These existing soft-tissue injuries can be used to access directly the facial bones for management of the fractures.
Approaches to the maxilla
Relevant to the required exposure in trauma of the midface two different approaches are possible: the maxillary vestibular approach (illustrated) and the midfacial degloving approach.
Lower eyelid - transconjunctival
Transconjunctival lower-eyelid approaches are performed in several ways.
The glabellar approach can be particularly advantageous in elderly patients who have developed horizontal glabellar furrows due to the action of the procerus muscle.
The coronal or bitemporal incision is used to approach the anterior cranial vault, the forehead, and the upper and middle regions of the facial skeleton.
The ethmoidal approach is generally not recommended.
Superolateral orbital rim
There are two periorbital approaches to the superolateral rim of the orbit: the lateral eyebrow approach (supraorbital eyebrow approach) or the upper-eyelid approach.
The preauricular approach can be used to access and treat fractures in the mandibular condylar head and neck region.
Endonasal approaches to the nasal skeleton can be used for primary treatment of traumatic injuries and for secondary procedures such as septorhinoplasty to correct posttraumatic secondary deformities.
External rhinoplasty approach
The external rhinoplasty approach to the nasal skeleton can be used for primary treatment of traumatic injuries and for secondary procedures such as septorhinoplasty to correct posttraumatic nasal deformities.
Extended glabellar approach
When wide visualization of the medial canthal area, lacrimal sac, and medial orbital wall is needed an extended glabellar approach is advantageous.
Zygomatic arch (indirect)
Common indirect approaches for reduction of the zygomatic arch include: the temporal (Gillies) approach and the transoral (Keen) approach.