Surgery of the temporomandibular joint: facial nerve injury with modified dissection technique.

This paper describes a modified preauricular surgical approach to the TMJ used in more than 272 joint surgeries since October 1984. During this time, only four surgical procedures have resulted in postsurgical paresis of the frontal branch of the facial nerve. The technique is a modification of the preauricular approaches described by Al Kayat, Bramley, and Dolwick. Relevant anatomic studies that relate to the frontal branch of the facial nerve and associated fascial layers are discussed. From findings of current anatomic dissections, a safe preauricular approach to the TMJ is described, with emphasis on following certain landmarks.