Even with advent of endoscopic assisted surgeries the access osteotomy plays an important role for accessing the pathological lesions of anterior skull base since beginning of the era of surgery. This report introduces the orbito–rhino–antral access osteotomy for the removal of juvenile nasio angio fiboma extending in to the cranial base. This osteotomy provides good access to the lesion with lesser morbidity and without hampering the occlusion as in lefort osteotomies. It is safe, easy and faster to perform. Osteotomised segment is easy to replace and gives ease for the surgeon to access without any hindrance. The osteotomised segment act as free graft and there are no complications postoperatively even after 48 mnth of follow-up.
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