Advantages of an additional subcranial approach in the correction of craniofacial deformities

The subject of this paper are the advantages conferred by the subcranial and extracranial approach for the performance of fronto-orbital osteotomy and advancement. In contrast to the usual intracranial approach the resection of the ethmoidal and medial aspect of the orbital roof can be achieved by the subcranial and transethmoidal approach, thus avoiding any damage to the olfactory filaments. The resulting subcranial compartment, after radical resection of the ethmoidal cells, enables optimal visualization of the optic nerve and decompression from this access. Frontal lobe retraction is only necessary at the lateral fronto-temporal region in order to complete the lateral osteotomy. Thus the morbidity rate related to the intracranial procedure can be reduced. Further advantages are the watertight repair of the skull base with fascia lata and the drainage of the intercranial region avoiding the postoperative development of the Orbital Apex Syndrome.