ABSTRACT
The excellent blood supply of the craniofacial skeleton allows pedicled or free bone fragments to be moved so gaining access to the skull base and adjacent areas. Tooth bearing maxillary or mandibular bone segments must retain their blood supply and if post-operative radiotherapy is planned pedicled osteotomies are preferable. The maxilla is frequently mobile to a degree at the completion of surgery. The palatal cover plate can be left in situ for 6-8 weeks or until maxillary stability is achieved. The palatal incision is in the midline extended laterally at the junction of the hard and soft palate behind the maxillary tuberosity. A midline vertical incision in the periosteum aids exposure of the nasal bones and frontal process of the maxilla. The coronal flap provides access to the frontal bone, upper midface, anterior and middle cranial fossa, orbit, temporal and infratemporal fossae in a range of clinical situations.
