The deep subfascial approach to the temporomandibular joint.
OBJECTIVE
The aim of the present study was to improve safety and visibility in the surgical approach to the temporomandibular joint (TMJ). In spite of the development of a myriad of surgical approaches to the TMJ, the facial nerve remains at risk for damage. For this reason the authors present an additional, safe, surgical approach to avoid injuries of the facial nerve during TMJ surgery, termed "the deep subfascial approach."


METHODS
Two resident surgeons, under supervision of the Department Chief, made 29 surgical exposures of the condyle, safely using the deep subfascial approach. This surgical approach is carried out by means of a modified preauricular incision followed by the subfascial dissection. Dissection passes under both layers of the deep temporalis fascia.


RESULTS
Neither permanent nor temporary motor loss of the frontal branch of the facial nerve was observed after surgery. It has not been necessary to ligate the superficial temporal vessels except the posterior branch of the superficial temporal artery. Aesthetic results were excellent in all cases.


CONCLUSIONS
The operation is technically facile, surgically uncomplicated, and clinically effective. It is our opinion that the deep subfascial approach to the TMJ represents a safe method to avoid injury of the facial nerve. We suggest this surgical procedure as a routine and safe approach to the TMJ and to the zygomatic arch, especially in second procedures or in delayed treatments.
Politi
Massimo
M
Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, Italy. m.politi@med.uniud.it
Toro
Corrado
C
Cian
Roberto
R
Costa
Fabio
F
Robiony
Massimo
M
D000293:Adolescent; D000328:Adult; D000844:Ankylosis / Q000601:surgery; D002102:Cadaver; D004210:Dissection / Q000379:methods; D020220:Facial Nerve Injuries / Q000517:prevention & control; D005158:Facial Paralysis / Q000517:prevention & control; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D004204:Joint Dislocations / Q000601:surgery; D008026:Ligation; D008297:Male; D008335:Mandibular Condyle / Q000601:surgery; D008875:Middle Aged; D012449:Safety; D013699:Temporal Arteries / Q000601:surgery; D013703:Temporal Muscle / Q000601:surgery; D013704:Temporomandibular Joint / Q000294:innervation / Q000601:surgery*; D019224:Temporomandibular Joint Disc / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000601:surgery