Extended modified postauricular incision of the temporomandibular joint.

The traditional postauricular approach to the temporomandibular joint has excellent cosmetic results since the entire incision is concealed in the postauricular flexure. Excellent posterior joint exposure, good lateral joint exposure, and fair anterior joint exposure are obtained. The risk of injury to the facial nerve is decreased. An extended modification of the postauricular incision was developed to overcome some of the disadvantages of the postauricular incision while maintaining its advantages. The incision begins inferiorly in a curvilinear manner, over the mastoid tip and progresses superiorly 3 mm posterior to the postauricular flexure. As it ascends superiorly above the level of the external auditory canal, it progresses posteriorly from the flexure. It then progresses superiorly in a curvilinear fashion in the temporal area slightly superior to the customary superior aspect of the preauricular incision. The dissection is carried to and through the temporalis fascia and periosteum, over the root of the zygomatic arch, and anteriorly after crosscut of the external auditory canal to the parotideomasseteric fascia. Dissection anteriorly deep to these fused structures allows a single flap to the skin. With this anterior dissection, the temporal and zygomatic branches of the facial nerve are protected and contained within the skin-fascia flap. The capsule is thus exposed and further dissection into the joint is described. A representative case presentation demonstrates the extended modified postauricular incision.