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Kevin A. Shumrick, MD; Robert C. Kersten, MD; Dwight R. Kulwin, MD; Pradeep K. Sinha, MD; Timothy L. Smith, MD

Arch Otolaryngol Head Neck Surg. 1992;118(10):1105-1112.

Abstract
• The two most significant recent developments in the treatment of facial trauma are the introduction of plating systems, which provide rigid internal fixation and the development of surgical approaches that allow wide exposure of the entire facial skeleton while minimizing external incisions. These approaches (referred to as extended access/internal approaches) are hemicoronal and coronal flaps, the sublabial approach to the midface, the transconjunctival approach to the orbital floor and orbital rim, and the intraoral management of mandibular fractures. These approaches work well, and have become standard techniques for managing facial trauma; however, each one has definite technical points that need to be adhered to to assure their success. Additionally, there are situations where these approaches are not appropriate and, in fact, may even be detrimental. This article outlines our approach to facial trauma using these extended access/internal approaches and discusses the important technical factors of each approach. Our experience in treating 113 patients with 119 fractures and 161 approaches over the last 2 years is presented and the role extended access/internal approaches have played is reviewed. The indications, limitations, and possible complications associated with each approach are outlined.

(Arch Otolaryngol Head Neck Surg. 1992;118:1105-1112)

Author Affiliations
From the Departments of Otolaryngology (Dr Shumrick), Ophthalmology (Drs Kersten and Kulwin), and College of Medicine (Drs Shumrick, Sinha, and Smith), University of Cincinnati (Ohio).

Footnotes
Accepted for publication June 2, 1992.

Presented at the fall meeting of the American Academy of Facial Plastic and Reconstructive Surgery, San Diego, Calif, September 7, 1990.

Reprint requests to the Department of Otolaryngology, University of Cincinnati, 231 Bethesda Ave, Cincinnati, OH 45267 (Dr Shumrick).

Arch Otolaryngol Head Neck Surg—Vol 118, October 1992

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