Deep Subfacial Approach for Temporomandibular Joint Ankylosis Patient with Evaluating Facial Nerve Injury by "Facial Nerve Grading System"
Authors/Creators
- 1. Senior Dental Officer, JP Hospital, Nauvast Rewa, M.P. - 486001
Description
Background: Preservation of the functional integrity of the facial nerve (FN) is a critical measure of success in temporomandibular joint (TMJ) surgery. In spite of the development of a myriad of surgical approaches to the TMJ, FN remains at risk. The deep subfascial approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the FN and thus, is the safest method to avoid FN injury. Objectives: To assess FN injury following TMJ surgery using deep subfascial approach and measuring it on House and Brackman facial nerve grading system (HBFNGS). Materials and Methods: Twenty TMJs in 18 patients were operated for TMJ ankylosis, using “the deep subfascial approach.” FN function was assessed postoperatively at 24 h, 1 week, 1 month, 3 months, 6 months using HBFNGS. Statistical analysis was done using SPSS 16.0. Results: Of 20 surgical sites 3 sites showed Grade III (moderate) FN injury and 17 sites showed Grade II (mild) FN injury at 24 h. The condition improved with time with full recovery of FN at all surgical sites at 6 months. Conclusion: The deep subfascial approach has a distinct advantage over the conventional approaches when dissecting the temporal region and is the safest method to avoid injury to FN.
Abstract (English)
Background: Preservation of the functional integrity of the facial nerve (FN) is a critical measure of success in temporomandibular joint (TMJ) surgery. In spite of the development of a myriad of surgical approaches to the TMJ, FN remains at risk. The deep subfascial approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the FN and thus, is the safest method to avoid FN injury. Objectives: To assess FN injury following TMJ surgery using deep subfascial approach and measuring it on House and Brackman facial nerve grading system (HBFNGS). Materials and Methods: Twenty TMJs in 18 patients were operated for TMJ ankylosis, using “the deep subfascial approach.” FN function was assessed postoperatively at 24 h, 1 week, 1 month, 3 months, 6 months using HBFNGS. Statistical analysis was done using SPSS 16.0. Results: Of 20 surgical sites 3 sites showed Grade III (moderate) FN injury and 17 sites showed Grade II (mild) FN injury at 24 h. The condition improved with time with full recovery of FN at all surgical sites at 6 months. Conclusion: The deep subfascial approach has a distinct advantage over the conventional approaches when dissecting the temporal region and is the safest method to avoid injury to FN.
Files
IJPCR,Vol15,Issue5,Article181.pdf
Files
(1.6 MB)
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Additional details
Dates
- Accepted
-
2023-05-24
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue5,Article181.pdf
- Development Status
- Active
References
- 1. Hall MB, Brown RW, Lebowitz MS. Facial nerve injury during surgery of the temporomandibular joint: A comparison of two dissectiontechniques. J Oral Maxillofac Surg.1985; 43:20–3. 2. Dolwick MF, Kretzschmar DP. Morbidity associated with the preauricular and perimeatal approaches to the temporomandibular joint. JOral MaxillofacSurg. 1982; 40:699–70 0. 3. Evans RA, Harries ML, Baguley DM, Moffat DA. Reliability of the House and Brackmann grading system for facial palsy. J Laryngol Otol. 1989; 103:1045–6. 4. Engströ m M, Jonsson L, Grindlund M, Stålberg E. House-Brackmann and Yanagihara grading scores in relation to electroneurographic results in the time course of Bell's palsy. Acta Otolaryngol. 1998; 118:783–9. 5. Satoh Y, Kanzaki J, Yoshihara S. A comparison and conversion table of 'the House-Brackmann facial nerve grading system' and 'the Yanagihara grading system' Auris Nasus Larynx. 2000; 27:207–12. 6. Mackinnon SE, Dellon AL. 1st ed. New York: Thieme Medical; Surgery of Peripheral Nerve; 1988; 638. 7. Nellestam P, Eriksson L. Preauricular approach to the temporomandibular joint: A postoperative follow-up on nerve function, haemorrhage and esthetics. Swed Dent J. 1997; 21: 19–24. 8. Alsén B, Svensson B, Adell R. Facial nerve injuries in temporomandibular joint surgery. Tandlakarti dningen. 1994; 18:1157. 9. Politi M, Toro C, Cian R, Costa F, Robiony M. The deep subfascial approach to the temporomandibular joint. J Oral Maxillofac Surg. 2004; 62:1097–102. 10. Gosain AK, Sewall SR, Yousif NJ. The temporal branch of the facial nerve: How reliably can we predict its path? Plast Reconstr Surg. 1997;99: 1224–33. 11. Al-Kayat A, Bramley P. A modi ied pre-auricular approach to the temporomandibular joint and malar arch. Br J Oral Surg. 1979;17: 91– 103. 12. Rowe NL. Surgery of the temporomandibular joint. Proc R Soc Med. 1972; 65:383–8. 13. Toscano P. The Temporo-frontal Fascio-cutaneous Flap in Orbitomalarzygomatic Surgical Approach. Proceedings of the VIII Annual Meeting of the Italian Society of Maxillofacial Surgery. 1993:4–9. 14. Hochberg J, Kaufman H, Ardenghy M. Saving the frontal branch during a low front-orbital approach. Aesthetic Plast Surg. 1995; 19:161–3. 15. Kenkere D, Srinath KS, Reddy M. Deep subfascial approach to the temporal area. J Oral Maxillofac Surg. 2013; 71: 382–8. 16. Candirli C, Celik S. Efficacy of deep subfascial approach to the temporomandibular joint. J Craniofac Surg. 2012;23: e126–9. 17. Gokkulakrishnan S, Singh S, Sharma A, Singh AK, Borah R. Facial nerve injury following surgery for temporomandibular joint ankylosis: A prospective clinical study. Indian J Dent Res. 2013; 24:521. 18. do Egito Vasconcelos BC, BessaNogueira RV, da Silva LC. Prospective study of facial nerve function after surgical procedures for the treatment of temporomandibular pathology. J Oral MaxillofacSurg. 2007; 65:972–8. 19. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985; 93:146–7. 20. House JW. Facial nerve grading systems. Laryngoscope.1983;93:1056– 69. 21. Risdon F. Ankylosis of temporom andibular joint. J Am Dent Assoc. 1934; 21:1933–7. 22. Bellinger DH. Temporomandibular joint ankylosis and its surgical correction. J Am Dent Assoc. 1940;27:1563.[Google Scholar] 23. Milch H. Bayonet incision for temporomandibular joint arthrotomy.Am J Orthodont Oral Surg. 1938;24: 287. 24. Mccann CF, Mallett SP, Houghton JD, Atwood DA. Bilateral subcondylar osteotomy: Report of case. J Oral Surg. 1965; 23:240–4. 25. Rowe NL, Killey HC. Fracture of the Facial Skeleton. 2nd ed. Baltimore: William & Wilkins; 1968. 26. Giles HV. A useful incision to the parotid gland and fractures of the mandible. Int Surg. 1969; 51:76–7. 27. Thoma KH. Oral Surgery. I. St Louis: Mosby; 1969. p. 88. [Google Scholar] 28. Benech A, Arcuri F, Baragiotta N, Nicolotti M, Brucoli M. Retroauricular transmeatal approach to manage mandibular condylar head fractures. J Craniofac Surg. 2011; 002022:641–7. 29. Weinberg S, Kryshtalskyj B. Facial nerve function following temporoma ndibular joint surgery using the preauricular approach. J Oral MaxillofacSurg. 1992; 50:104 8–51. 30. Bansal V, Kumar S, Mowar A, Yadav A, Khare G. The post-auricular approach for gap arthroplasty – A clinical investigation. J Craniomaxi llofac Surg. 2012; 40:500–5. 31. Vasconcelos BC, Bessa-Nogueira RV, Cypriano RV. Treatment of temporomandibular joint ankylosis by gap arthroplasty. Med Oral Patol Oral Cir Bucal. 2006;11: E66 –9. 32. Narayanan V, Kannan R, Sreekumar K. Retromandibular approach for reduction and ixation of mandibular condylar fractures: A clinical experience. Int J Oral Maxillofac Surg. 2009; 38:835–9. 33. Arcuri F, Brucoli M, Benech A. Analysis of the retroauricular transmeatel approach: A novel transfacial access to the mandibular skeleton. Br J OralSurg. 2012; 50:22– 6. 34. Nogueira RV, Vasconcelos BC. Facial nerve injury following surgery for the treatment of ankylosis of the temporomandibular joint. Med Oral Patol Oral Cir Bucal. 2007 12: E160–5.