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.
The surgical indication is usually cosmetic and therefore minimally invasive approaches should be considered.
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.
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.
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.
The subcranial access osteotomy is used to access the central compartment of the anterior cranial fossa.
Lower eyelid - transconjunctival
Transconjunctival lower-eyelid approaches are performed in several ways.
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.
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.
Le Fort I level (orthognathic)
The Le Fort I level is approached through a buccal sulcus approach.
The submental approach is used to treat fractures of the anterior mandibular body and symphysis.
Transoral approach to symphysis
The transoral approach is the usual access for simple fractures of the body, symphysis, and angular regions.
This approach is selected for fractures of the mandibular body and angle regions unsuitable for intraoral treatment.
The retromandibular approaches expose the entire ramus from behind the posterior border. They therefore may be useful for procedures involving the area on or near the condylar process/head, or the ramus itself.
The preauricular approach can be used to access and treat fractures in the mandibular condylar head and neck region.
Intraoral approach to condyle
The ramus and condyle region can be exposed via an intraoral approach by extending the standard vestibular incision in a superior direction up the ascending ramus.
Facelift (rhytidectomy) approach
The facelift approach provides the same exposure as the retromandibular and preauricular accesses combined. The only difference is that the skin incision is placed in a more cosmetically acceptable location.
Transoral approach to the angle
The transoral approach is used for the majority of simple angle fractures.