Comparison Of Facial Nerve Function After Different Surgical Approach For The Temporomandibular Joint

Objective: Comparison between anterior approach through superfacial temporal vessel of ear-temple incision and posterior approach through superfacial temporal vessel of preauricular incision to treatment of temporomandibular joint intracapsular disease and offer maximum protection for facial nerve,for carrying out the corresponding clinical work to provide some guidance.Methods:1 Case materials: outpatients at TMJ clinic of our hospital from February 2014 to June 2015 were randomly included in this study,all the patients who were successfully treated with arthrocentesis were dignosed as temporomandibular joint intracapsular disease by clinical examination and MRI or CT findings and patients receiving surgery included in the study.The patients consist of 12 males and 73 females,aged from 14 to 60 years with the mean age of 26.6 years,including: temporomandibular joint disorder(Wilkes Ⅲ ~ Ⅴ stage)74 patients(78 sides),displaced condylar fractures in patients 7(7 sides),temporomandibular joint synovial osteochondroma 4 patients(4 side).The left side of 32 cases,the right side of 49,bilateral in 4 cases.All patients were first underwent surgery,and exclusion of the facial nerve and ear temporal nerve related diseases.Depending on the surgical incision and approach into A,B groups.Group A of 47 cases(49 sides)were used the anterior approach through superfacial temporal vessel of preauricular and temporal incision,group B 38 cases(40 sides)were used posterior approach through superfacial temporal vessel of preauricular incision.2 surgical treatment2.1 Anterior approach through superfacial temporal vessel of preauricular and temporal incision: Cut the skin before subcutaneous 1: 100,000 epinephrine saline,according to Shen Ning reported improved temporal incision ear skin incision Bag design only the lower,open ear front flap,exposing the superficial temporal artery and its branches,and then along the front edge of the ear into the temporal neurovascular bundles,open temporal fascia above the zygomatic arch 2cm to stop the flap at the surface of the deep temporal fascia was the root of the zygomatic arch 45 ° angle cut between two deep temporal fascia and fat pad to reach the surface of the temporalis muscle,which is deep temporal fascia plane,along the plane down to the inner side of the zygomatic arch,deep temporal fascia incision in the side attachment,forward flap open along the cut down before the separation vessel,in turn attached to the surface of the joint capsule of the parotid gland to expose the joint capsule.2.2 Posterior approach through superfacial temporal vessel of preauricular incision: before the skin incision subcutaneous injection with 1: 100,000 epinephrine saline,from among the tragus tragus notch along the medial edge to the front line drawing ear notch,and then in front of the ear notch forward on about a 45 °angle toward the temporal direction extending 1 ~ 1.5cm.Press cut the skin incision,after subcutaneous tissue,revealing the superficial temporal vascular bundle.In the rear of the vascular bundle,cut to deep temporal fascia,cartilage,following along the leading edge of the external auditory canal,close to the external auditory canal cartilage and parotid gland capsule to be blunt bony external auditory canal separating the outer edge,pulled forward to open the superficial temporal vascular bundle,in the middle temporal the roots of the zygomatic arch vein rear,cut to the periosteum,and to extend a little below the root of the zygomatic arch periosteum flap flips up,forward and downward to the bottom of the separation before the articular eminence,and to expose the joint capsule.2.3 With temporomandibular joint disorder(WilkesⅢ~Ⅲstage)in patients underwent a anchor technique for internal derangement of TMJ and condylar high cut planing operation;With condylar fractures in patients were used the rigid internal fixation;The patients which had got synovial chondrosarcoma underwent a surgery to remove it.3 Postoperative facial nerve function: When after the surgery,we used the facial nerve grading 2.0 to evaluation(Table 1)all patients facial nerve function and record it and leave image data by 24 hours,one week,one month,three months,six months.4 Statistical Methods: Statistical analysis was done by SPSS20.0 software and used Mean-Whitney U to test the data,which studied and compared with two surgical methods after the results of the evaluation of facial nerve grading by 24 hours,one week,one month,three months,six months..Results:After surgery,in group A of 47 patients,28 People had got facial nerve dysfunction,the occurrence rate of facial nerve dysfunction was 59.57%.In group B of 38 patients,4 cases had got facial nerve dysfunction,the occurrence rate of facial nerve dysfunction was 10.52%.No one had permanent facial paralysis;The facial nerve function at 24 hours postoperatively,group A compared with group B,P = 0.003,statistically significant.Using posterior approach through superfacial temporal vessel of preauricular incision can significantly reduce the incidence of facial nerve function damage,and the incision is more smaller,the bleeding is less.Conclusions:The posterior approach through superfacial temporal vessel of preauricular incision,easy to operate,facial nerve injury probability is small,a small incision scar hidden,is worthy of a safe and effective surgical incision.