The bicoronal flap (craniofacial access): an audit of morbidity and a proposed surgical modification in male pattern baldness

Maxillofacial surgeons have used the bicoronal flap for nearly three decade s to gain access to the craniofacial skeleton. A retrospective analysis of 68 bicoronal flaps done over a five-year period showed that our incidence o f permanent morbidity was low. Although 24 patients (35%) experienced some form of sensory abnormality immediately after the operation, this persisted for longer than two years in only one. Complete motor recovery occurred by one year in all 15 patients (22%) who developed postoperative frontalis we akness. Three patients developed male pattern baldness postoperatively, which resul ted in exposure of the scar and poor cosmesis. This prompted a cadaveric st udy in which we assessed the feasibility of modifying the position of the s tandard bicoronal incision in people who are prone to hair loss. The pivota l point of the bicoronal flap was found to lie at its most inferior aspect. By extending the incision into the skin crease in front of the lobe of the ear it was possible to adjust the anteroposterior position of the bicorona l incision without limiting access to the facial skeleton. We therefore adv ocate occipitally placed incisions with preauricular extensions in patients who are prone to male pattern baldness. (C) 2000 The British Association o f Oral and Maxillofacial Surgeons.