Transfacial and Craniofacial Approaches for Resection of Sinonasal and Ventral Skull Base Malignancies Elizabeth L. Perkins, MD a , Bryan M. Brandon, MD a , Satyan B. Sreenath, MD a , Dipan D. Desai, BS a , Brian D. Thorp, MD a , Charles S. Ebert, MD, MPH a , Adam M. Zanation, MD a,b, * a Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician’s Office Building Room G-190, Chapel Hill, NC 27599, USA; b Department of Neurosurgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician’s Office Building Room G-190, Chapel Hill, NC 27599, USA * Corresponding author. Department of Otolaryngology—Head & Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician’s Office Building Room G-190, Chapel Hill, NC 27599. E-mail address: adam_zanation@med.unc.edu KEYWORDS  Ventral skull base surgery  Craniofacial approach  Transfacial approach  Sinonasal malignancy  Skull base  Open resection KEY POINTS  A transfacial or craniofacial approach allows for wide, potentially en bloc resection and is ideal for tumors that involve surrounding soft tissue, the palate, anterolateral frontal sinus, and dura.  Regardless of an open versus combined approach, a complete resection with negative margins should be the primary goal.  The transfacial approach can be gradual and stepwise depending on the extent of the dis- ease and often begins with a lateral rhinotomy to gain access to facial and orbital regions.  Craniofacial approaches combine the traditional transfacial approaches with a bifrontal or subfrontal craniotomy to provide greater exposure to the ventral skull base.  Transfacial and craniofacial approaches have been greatly refined since their initial de- scriptions, but now are mostly reserved for advanced lesions not amenable to endoscopic removal. Otolaryngol Clin N Am - (2016) -–- http://dx.doi.org/10.1016/j.otc.2016.12.006 oto.theclinics.com 0030-6665/16/ª 2016 Elsevier Inc. All rights reserved.