Anesthesia/facial pain
Can a Novel Surgical Approach to the Temporomandibular Joint Improve Access and Reduce Complications?

https://doi.org/10.1016/j.joms.2016.01.039Get rights and content

Purpose

This clinical study investigated whether the vascular-guided multilayer preauricular approach (VMPA) to the temporomandibular joint (TMJ) could improve access and decrease complications.

Patients and Methods

This retrospective evaluation consisted of a consecutive series of patients who underwent TMJ surgeries through the VMPA from January through December 2013. Patients with a history of TMJ surgery were excluded. Clinical data, including operating times, subjective complaints of incision scars, functional conditions of the auriculotemporal nerve and facial nerve, and other complications, were recorded and analyzed. All patients in this study were followed for at least 6 months.

Results

All patients (606 joints) had successful TMJ surgeries through the VMPA. All incisions healed favorably with an uneventful recovery. No patient developed permanent weakness of the facial nerve or other severe complications.

Conclusion

The VMPA can provide direct access and favorable visibility to the TMJ region and yield good esthetic and functional results. The VMPA can be considered the approach of choice for common TMJ surgeries.

Section snippets

Patients and Methods

This retrospective evaluation consisted of a consecutive series of patients who underwent TMJ surgeries through the VMPA at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine (Shanghai, China) from January through December 2013. To be included in the study sample, the patient must have undergone TMJ surgery only through the VMPA and had no history of TMJ surgery. Those patients who underwent TMJ surgeries through a

Results

All 475 patients (606 joints) had successful TMJ surgeries only through the VMPA, including open disc repositioning and anchorage fixation (n = 392 joints), disc replacement with a temporalis myofascial flap (n = 55 joints), resection of tumorous or tumorlike lesions (n = 45 joints), open reduction and fixation of condylar fractures (n = 42 joints), ankylotic bone resection and arthroplasty (n = 31 joints), condylar replacement with a costochondral graft (n = 26 joints), eminence augmentation

Discussion

According to the results of this study, different TMJ surgeries were performed successfully through the VMPA and there was no permanent weakness of the facial nerve or other severe complications. This indicates that the VMPA can produce appreciable improvement in access to the TMJ region by developing multilayer flaps while leaving the auriculotemporal nerve and superficial temporal artery and vein in situ and can provide a safe and efficient way to locate and protect the facial nerve using the

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This study was supported by grants from Science and Technology Commission of the Shanghai Municipality Science Research Project (14DZ2294300) and the Shanghai Municipal Commission of Health and Family Planning of China (201440548).

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