Surgery of the temporomandibular joint. I. Surgical anatomy and surgical incisions.

Surgical anatomy is highly specific and correlates well with the surgical approaches to the temporomandibular joint (TMJ). The preauricular, endaural, and postauricular incisions are used for conventional surgery and microsurgery of the TMJ. Indications for the selection of the desired incision are given. The surgical technique of each incision is described in detail. Elevation of a continuous superoinferior flap of the temporalis fascia, the periosteum over the zygomatic arch, and the paratideomasseteric fascia lifts up and protects the branches of the facial nerve. Elevation in this fascia plane results in a skin-fascia flap with the branches of the facial nerve contained and protected within the tissues. This basic skin-fascia flap is developed in all three incisions--the preauricular, the endaural, and the postauricular.