Soft-tissue injuries can be used to directly access fracture sites for fracture management.
The coronal or bi-temporal approach is used to expose the anterior cranial vault, the forehead, and the upper and middle regions of the facial skeleton.
Lateral skull base approach
With the lateral skull base approach the lateral anterior and the middle cranial fossae can be reached.
Posterior skull base approach
When wide visualization of the medial canthal area, lacrimal sac, and medial orbital wall is needed an extended glabellar approach is advantageous.
The transmastoid approach is used for facial nerve decompression. A postauricular incision is commonly used to access the mastoid.
Endoscopic sinus surgery techniques can be used to open the frontal recess from below.
Endoscopy: Central skull base
The whole central compartment of the skull base, from the crista galli to the clivus and anterior craniocervical junction, can be accessed by means of the endonasal transsphenoidal endoscopic approach.
Endoscopy: Anterior table
Endoscopy has a variety of potential uses for frontal sinus fractures. Endoscopic access is most favorable in the upper portion of the frontal sinus.