Alternate Approaches

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Other approaches to the TMJ have been described and used clinically. The extended temporal and coronal incision can proceed inferiorly in the same fashion as for a Preauricular incision to expose the TMJ. The "extended" preauricular approach incision is similar to the preauricular approach, but an anterosuperior extension(hockey-stick) is made in the hair-bearing temporal skin (Fig. 12-17). Some surgeons choose to bring the preauricular incision behind the tragus (endaural incision) to hide a portion of it (Fig. 12-18). This choice may be especially useful in individuals, often young patients, who do not have a well-demarcated preauricular skin fold. A retroauricular skin incision further hides the incision and helps to protect the auriculotemporal nerve. This approach requires an arc-shaped incision behind the ear (Fig. 12-19). The external auditory canal must be transected at a wide portion to prevent stenosis, and the ear is reflected anteriorly to gain access to the joint. The same deeper dissection is effective for all of the approaches just described.

Endaural Incision
Figure 12 17. Preauricular incision with an oblique anterosuperior extension ("hockey stick").
Tmj Replacement Preauricular Incision

Figure 12 18 A and B. Preauricular incision with a retrotragal portion, hiding scar within the scar.

Figure 12 18 A and B. Preauricular incision with a retrotragal portion, hiding scar within the scar.

Temporal FasciaGillies Approach Temporalis Fascia

Figure 12 19 Retroauricular approach to the temporomandibular joint (TMJ). A, initial curvilinear incision in the retroauricular crease. B, Transection of the external auditory meatus. C, Retraction of the external ear anteriorly, exposing the TMJ capsule.

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  • kayden
    What is the difference between hockeystick inscion and question mark inscion in tmj approach?
    3 years ago

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