Inviscision: A Futuristic Alternative to Endaural Incision for TMJ Surgeries.

Abstract

As TMJ surgery incisions have evolved, there has been a decrease in facial deformity and adequate surgical access. Even though the traditional preauricular and endaural incisions offer great exposure, they heal with a noticeable scar; in contrast, the Inviscision becomes invisible. To compare and evaluate both the approaches for TMJ surgeries in terms of surgical exposure, VII nerve injury and postoperative aesthetics. 60 TMJ surgery cases were randomly divided into two groups: Group A-30 Inviscision and Group B-30 Endaural incision and assessed for the amount of time from the incision to the exposure, ample access for surgery and postoperative nerve injury, scarring, cartilage injury/necrosis and ear deformity. All the patients were followed up for an average of sixmonths. Surgical exposure time was average 12 and 10min via Inviscision and endaural incision, respectively. In Inviscision, scar becomes invisible after 40days and in endaural incision, scar becomes a thin but visible line after 35days. No cases of hypertrophic scar, keloid formation, cartilage injury/necrosis/ear deformity in either group. Transient temporal branch of VII nerve weakness seen in 33% of Inviscision and 40% of endaural cases which improved after average 3 and 3.4months, respectively. Likert's patient satisfaction score was average 4 and 2, and POSAS score for scarring was 1.5 and 3, in Inviscision and endaural incision, respectively. Inviscision gives adequate exposure, avoids all related anatomic structures, other than causing transient retraction neuropraxia, along with outstanding aesthetic outcomes by hiding the scar in the anatomical folds of the ear auricle. Although, endaural incision provides better surgical time management and equivalent surgical exposure, Inviscision proves to be a better alternative for TMJ surgeries through all other parameters.