[The coronal approach in maxillofacial surgery. Notes on the surgical anatomy]

In the light of personal experience and of the modern advances in surgical anatomy, the surgical approach and practice in coronal access is described. For a long time this approach has been considered unusual owing to the risk of damaging the frontal branch of the facial nerve.

The SMAS includes the galea capitis which in temporal region is named superficial temporal fascia; under the galea there are the subaponeurotic avascular plane by Merkel and the periosteum. In the temporal space the periosteum (named temporal fascia) is composed of the superficial fold and deep fold. The frontal branch of the facial nerve lies under the superficial temporal fascia, and where it crosses the zygomatic arch is separated only by the superficial fold of the temporal fascia and by areolar tissue.

The incision is made deeply to the subaponeurotic areolar tissue following, about 4 cm posterior to the hairline. The periosteum is incised at 2 cm above the superior orbital margin. Four cm above the bony lateral canthus and at 7 cm on the tangential to the zygomatic arch, the incision is made deeply to the superficial fold of the temporal fascia and the interfascial vascular fat.

If the approach is correct, the coronal access is considered an easy and very safe way. In personal experience important complications have not been observed, while the esthetic results have been remarkable and with no visible scars.