Surgical Approaches to the Facial Skeleton – highly regarded by oral and maxillofacial surgeons, plastic surgeons, otolaryngologists, and trainees in these fields
There are many reasons for exposing the facial skeleton. Treatment of facial fractures, management of paranasal sinus disease, esthetic onlay and recontouring procedures, elective osteotomies, treatment of secondary traumatic deformities such as enophthalmos, placement of endosteal implants, and a host of other reconstructive procedures require approaches to the facial framework. Many approaches to a given skeletal region are possible. The choice is made usually on the basis of the surgeon’s training, experience, and bias. This book does not advocate one approach over another, although the advantages and disadvantages of each approach will be listed. We maintain the age-old belief that “many roads lead to Rome.” Therefore, the purpose of Surgical Approaches to the Facial Skeleton is to describe in detail the anatomical and technical aspects of most of the commonly used surgical approaches to the facial skeleton. We have deliberately not presented every approach, because many of them are not universally used, or are so simple that nothing needs to be said. However, the approaches presented in this book will allow the surgeon complete access to the craniofacial skeleton for whatever skeletal procedure is being performed.
We have attempted, from the beginning, to make Surgical Approaches to the Facial Skeleton different from the other books that touch on this subject. Most books that discuss surgical approaches do so in the context of the surgical procedure that is being presented. For instance, a book on facial fractures will usually present surgical approaches to a particular facial fracture. However, the surgical approach is not generally given much consideration or is it presented in sufficient detail for the novice. The reader is often left with the question, “How did the author get from the skin to that point on the skeleton?” We instead avoid consideration of why one is exposing the skeleton and describe the approaches in great detail so that even the novice can safely approach the facial skeleton by following the step-by-step description we have provided.
Surgical Approaches to the Facial Skeleton assumes that the reader has some basic understanding of regional anatomy, especially osteology. However, the anatomic structures 8 of greatest interest will still be discussed for each surgical approach. This book also assumes that the reader has developed skills for the careful handling of soft tissues. We have suggested the use of those instruments that we have found useful for incising, retracting, and manipulating the tissues involved with each surgical approach, recognizing that others are also appropriate. The book also assumes that the reader is skilled in facial soft tissue closure. We have not discussed skin closure techniques associated with the approaches unless they differ from routine skin closures.
The first edition of Surgical Approaches to the Facial Skeleton became a hit with surgeons from several specialties when it was published in 1995. Oral and maxillofacial surgeons, plastic surgeons, and otolaryngologists all wanted this book for their collections. The book was most popular, however, among residents-in training from these specialties. The third edition of Surgical Approaches to the Facial Skeleton, like the first two editions, contains 14 chapters, 13 of which describe a specific surgical approach. The first chapter discusses basic principles involved in surgical approaches. The remaining 13 chapters are organized into sections, predominantly on the basis of the region of the face being exposed. There will often be more than one surgical approach presented for each region, with the choice left to the surgeon. We attempt to point out the advantages and disadvantages of each as they are presented.