A transfacial approach to the nasal-paranasal cavities and anterior skull base

Large lesions of the nasal and paranasal cavities present a particularly difficult problem of surgical approach. The direct transnasal, Denker's, Weber-Fergusson, lateral rhinotomy, and facial degloving approaches have all been used with varying degrees of success. Nevertheless, these approaches fail to provide adequate exposure of the midfacial and interorbital spaces. In 1979, we developed a method called the transfacial approach in which two large midfacial flaps, one containing the entire external nose, are raised, exposing the maxillae, both medial orbital walls, and the nasal and paranasal cavities. Through this panoramic approach, one can easily expose the anterior skull base to the clivus and operate on this area under direct visual and manual control. The technique of this approach is described and our experience with 16 patients in whom it was applied is reviewed.