Advances in surgical approaches to the upper facial skeleton

Surgical approaches to the upper facial skeleton comprise the coronal, lower eyelid and midface degloving approaches. These are routinely employed in both ablative and reconstructive craniofacial procedures. The ability to perform them in a well tolerated and predictable manner is predicated on knowledge of the indications and the exposure afforded by each approach, detailed appreciation of the anatomy and awareness of potential complications. This article reviews the literature for recent advancements and surgical refinements for each approach.

Multiple studies over the past 20 years have offered insight into many technical refinements in these surgical approaches. The choice of dissection plane in the lateral extension of the coronal approach affects the integrity of the frontal branch of the facial nerve and the temporal fat pad. A transcaruncular extension of the transconjunctival approach provides unprecedented access to the medial orbital wall and the midface degloving approach renders complex reconstructive procedures feasible.

These techniques continue to evolve and become more precise so that better results can be achieved and devastating complications can be avoided. This study reviews the literature and summarizes preferred options for craniofacial exposure, recent technical refinements, and our current preferred surgical approaches.