Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Dec;7(4):323-6.
doi: 10.1055/s-0033-1364196. Epub 2014 Jun 3.

Component approach to the temporomandibular joint and coronoid process

Miles J Pfaff  1 , James Clune  1 , Derek Steinbacher  1
Affiliations
Review

Component approach to the temporomandibular joint and coronoid process

Miles J Pfaff et al. Craniomaxillofac Trauma Reconstr. 2014 Dec.

Abstract

Reconstruction of the temporomandibular joint (TMJ) region is challenging. The conventional direct preauricular incision permits only limited access to the TMJ and surrounding structures, therefore risking injury to the facial nerve during retraction. The ideal approach allows sufficient exposure, preservation of underlying neurovascular structures, and achieves an optimal aesthetic outcome. We describe a preauricular posttragal incision with a superficial musculoaponeurotic system flap to allow wide exposure of the zygomatic arch, TMJ, condyle, and coronoid process. We postulate that this approach improves access, lessens the amount of retraction required, and creates a more inconspicuous scar.

Keywords: posttragal incision; preauricular incision; rhytidectomy; superficial musculoaponeurotic system; temporomandibular joint.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosures The authors have no commercial associations or disclosures that may pose or create a conflict of interest with the information presented within this article.

Figures

Figure 1
Figure 1
(A) The skin incision extends from the anterior hairline to the root of the helix, then carried within the preauricular crease and terminated at the ear lobule-posterior cheek junction (note the posttragal extension of the incision). (B) The skin flap is elevated subcutaneously toward the malar region, exposing the frontal branch of the facial nerve. The trajectory of the frontal branch of the facial nerve is then outlined intraoperatively. (C and D) A deep SMAS flap is raised above the zygomatic arch and preauricularly to permit visualization of the zygomatic arch, condyle, and coronoid process. SMAS, superficial musculoaponeurotic system.
Figure 2
Figure 2
A 65-year-old woman presented with bilateral TMJ ankylosis and coronoid hypertrophy. Anterior hairline preauricular posttragal incisions with SMAS flaps were made bilaterally to perform condylectomies, coronoidectomies, and total TMJ alloplastic reconstruction. TMJ, temporomandibular joint; SMAS, superficial musculoaponeurotic system.
Figure 3
Figure 3
A 46-year-old man presented with multiple facial fractures affecting the left and right condyles and mandible. For open reduction and internal fixation of the left condylar fracture, a left-sided hairline preauricular posttragal incision with a SMAS flap was created. Pre- and postfixation computed tomographic images are presented (left and right, respectively).
Figure 4
Figure 4
A 65-year-old woman following bilateral reconstruction of the TMJ at 11 months postoperatively demonstrating intact function of the temporal branch of the facial nerve via furrowing of the brow (above) with preserved cosmesis and a well-concealed scar.
See this image and copyright information in PMC

References

    1. Ellis E. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. Surgical Approaches to the Facial Skeleton. 2nd ed; pp. 193–214.
    1. Kreutziger K L. Extended modified postauricular incision of the temporomandibular joint. Oral Surg Oral Med Oral Pathol. 1987;63(1):2–8. - PubMed
    1. Kreutziger K L. Surgery of the temporomandibular joint. I. Surgical anatomy and surgical incisions. Oral Surg Oral Med Oral Pathol. 1984;58(6):637–646. - PubMed
    1. Gulya A J Glasscock-Shambaugh Surgery of the Ear 6th ed. Shelton, CT: Peoples Medical Publishing House; 2010
    1. Frey M, Giovanoli P. The three-stage concept to optimize the results of microsurgical reanimation of the paralyzed face. Clin Plast Surg. 2002;29(4):461–482. - PubMed

LinkOut - more resources