Frontobasal approach for trauma and tumor.

The potential for remediation of a host of varied disease processes afflicting the skull base has been increasingly realized over the past two decades. Advances in medical technology, the development of new approaches, and most importantly the close cooperation of the head and neck surgeon and the neurological surgeon have made this possible. Surgeons are attempting to diminish the injury to normal un-involved structures while at the same time maximizing exposure and enabling rectification of the disease or disorder. This is especially pertinent in a number of frontobasal approaches used in anterior craniofacial surgery. The osteoplastic flap approach to the posterior wall of the frontal sinus to repair small cerebrospinal fluid leaks and manage posterior wall fractures saves the patient a larger anterior craniotomy and brain retraction. Cranialization of the frontal sinus in comminuted through-and-through fractures allows for removal of devitalized brain, dural repair, and safe management of the frontal sinus. The lateral rhinotomy medial maxillectomy-ethmosphenoidectomy approach coupled with either an osteoplastic flap of the frontal sinus or a low limited craniotomy is an excellent approach for resection of tumors encroaching on the anterior skull base. Even malignancies of this region can be completely excised with adequate margins, yet produce minimal to no facial aesthetic distortion. Moreover, larger tumors requiring a more extensive lip-splitting incision and total maxillectomy with orbital exenteration can often anticipate minimal deformity, especially with good prosthetic rehabilitation. In the resection of aggressive malignancies, techniques of ocular preservation and facial bone sparing have been developed with encouraging cosmetic results.