ABSTRACT
Appropriate access to the craniomaxillofacial region is an essential prerequisite to perform any procedure. The complex anatomy and adjacent vital and aesthetically sensitive areas make the design of access procedures important. In this chapter, the relevant anatomy and essential steps in various access procedures are described. The coronal flap provides access to the skull, anterior and middle cranial fossa, upper midface including the nasoethmoid region and orbits, temporal and infratemporal fossa. The hair along the incision line can be parted or a small strip shaved. A variety of approaches have been described to access the midface and can be broadly categorised into open and endoscopic approaches. The open approaches can be further subdivided into transfacial, transorbital, transnasal and transoral according to the site of access, and soft tissue and composite flaps based on the components of the mobilised tissue. The bone cuts are made with fine saws/a fissure bur/Sonopet and completed with osteotomes.
