Deep subfascial approach to the temporal area.

ABSTRACT

PURPOSE: Surgical access to the temporomandibular joint (TMJ) and zygomatic arch is a challenge even to the experienced maxillofacial surgeon. The conventional subfascial approach to these structures carries the potential risk of transient paralysis of the frontalis and orbicularis oculi muscles. This article discusses the use of a deep subfascial approach to access the TMJ and zygomatic arch. This surgical technique provides a safe operating field without jeopardizing the branches of the facial nerve. PATIENTS AND METHODS: A study was carried out on 12 patients, wherein 15 surgical exposures were made, to access the TMJ and zygomatic arch. A deep subfascial approach was used that preserved the structural and functional integrity of the temporal and zygomatic branches. RESULTS: Postoperatively, no functional deficit was noted in either the temporal or zygomatic branches of the facial nerve as ascertained by clinical examination. CONCLUSIONS: The deep subfascial approach preserves and protects the branches of the facial nerve. It relies on distinct anatomic planes that are easily identified during surgery; and hence, the technique becomes relatively simple and easy to use.