Abstract
Introduction: The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery. Aim: The aim of this study is to systematically review the currently used variants and modifications of RA. Materials and Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review. Results: Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis. Discussion: All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material. Conclusions: In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis.
Highlights
The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar
In the title of the first known description of the RA, Bockenheimer indicates that the aim of developing this approach was to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar [13]
The original RA technique is primarily used in the mandibular head fracture surgery but can be applied in the treatment of initial stages of ankylosis
Summary
The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. In the course of RA it is possible to reach the mandibular condyle, the zygomatic arch and a very complex temporomandibular joint [5,6,7,8,9] This joint, apart from a complex system of ligaments, is surrounded by very delicate branches of the facial nerve, which makes it difficult to safely access anteriorly from the auricle [5,10,11,12]. In the title of the first known description of the RA, Bockenheimer indicates that the aim of developing this approach was to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar [13]. The above-mentioned still-valid assumptions are expressed in the results of research works
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