Quick Review #81 - #surgery #preauricular #plasticsurgery #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental #surgeon #doctor
The preauricular incision is a surgical technique primarily utilized in oral and maxillofacial surgery, especially for accessing the temporomandibular joint (TMJ) and surrounding structures. The specific indications and details of this approach are as follows:
Indications:
1. Upper Condylar Process and TMJ Compartments: The preauricular approach is ideally used for managing problems in these areas. It’s commonly employed in TMJ ankylosis cases.
2. High Condylar Fractures: This incision is also utilized in the treatment of high condylar fractures of the mandible.
3. Limited Exposure: It’s important to note that the exposure offered by the preauricular approach is limited to a portion of the condylar neck region.
Surgical Design:
• The incision is typically made in a preauricular skin crease, extending from the level of the helix above the tragus to the lobule. This placement is chosen for both functional and aesthetic reasons.
• The dissection involves navigating through neurovascular structures, including branches of the facial nerve and the superficial temporal artery and vein.
• The approach also involves dissecting down to the temporalis fascia and further to expose the capsule of the TMJ.
Pros:
• Aesthetic Considerations: One of the main advantages of a preauricular approach is the minimal visibility of scars.
• Access to the Superior Part of the TMJ: It provides good access to the superior portion of the TMJ and the anteromedially displaced mandibular condyle.
Cons:
• Limited Access to Lower Portion: The preauricular approach does not provide access to the lower portion of the condylar process.
• Difficulty in Rigid Fixation: Rigid fixation of mandibular condyle fractures can be challenging with this approach.
• Risk of Facial Nerve Damage: There’s a significant risk of damaging the facial nerve, which is a major concern in this surgical technique.
Additional Considerations:
• Careful planning and execution are essential to minimize risks, especially regarding nerve damage.
• The technique requires a thorough understanding of the anatomy and careful handling of the neurovascular structures.
References:
1. AO Foundation. (n.d.). Preauricular approach. AO Surgery Reference. https://lnkd.in/eeRnQve4.
2. Davies, R. O. H., Cascarini, L., Coombes, D., & Warburton, G. (2020). Two New Surgical Techniques to Refine Surgery Around the Ear: “The Inviscision” and the External Auditory Meatus Suture. Journal of Oral and Maxillofacial Surgery. https://lnkd.in/ettnH4cA.
3. ChatGPT. 2023.