Abstract
A variety of transfacial surgical approaches to midline skull base lesions can be organized in a simple classification scheme of six techniques or levels. Three intracranial approaches use a subfrontal trajectory and variable amounts of transfacial exposure through the nasal and orbital bones. Surgical exposure increases with the amount of bone removed with the facial fragment: supraorbial bar (level 1), supraorbitonasal bar (level II), and orbitonasal bar (level III). Three extracranial approaches use a more inferior trajectory and variable amounts of transfacial exposure through the maxilla. The transnasomaxillary approach (level IV) requires a Le Fort II osteotomy with splitting of the maxillary fragment. The transmaxillary approach (level V) requires a Le Fort l osteotomy with splitting of the palate. The transpalatal approach (level VI) requires circumferential osteotomy and removal of the hard palate. These versatile transfacial approaches, used alone or in combination, have a distinct role in the armamentarium of the skull base surgeon who develops individualized treatment strategies for curative resection of midline skull base lesions.