Preauricular Approach Research Articles

Feasibility and safety of preauricular incision for extracapsular dissection in benign parotid tumors.

Parotidectomy techniques continuously evolve to improve outcomes while minimizing morbidity. This study investigates the rationale behind developing and evaluating the feasibility and safety of extracapsular dissection (ECD) via preauricular incision for benign parotid tumors in the anterior or superior part of the parotid gland. The preauricular approach is developed to address the increasing demand for minimally invasive techniques that prioritize both functional and aesthetic outcomes. Minimizing visible scarring and preserving facial nerve function offers a compelling solution for patients seeking optimal cosmetic results without compromising surgical efficacy. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. Eight patients underwent ECD via the preauricular approach, demonstrating favorable outcomes with preserved facial nerve function and minimal complications. This study highlights the potential of the preauricular approach as a preferred option for managing benign parotid tumors in the anterior or superior parotid region, emphasizing aesthetic outcomes and preserving gland function. IV.

Open management of condylar head fractures. The first 50 cases: What have we learnt and where are we going?

This study evaluates a single surgeon’s experience in the development of a practice in open treatment of intracapsular condylar fractures over three years at a tertiary maxillofacial trauma centre. An enhanced dynamic, peer-reviewed, longitudinal audit in keeping with the adoption of elements of new clinical practice was instituted. This aimed to record and analyse clinical and functional outcomes at both the surgeon and patient level. A retrospective review of patients treated for AO craniomaxillofacial (AOCMF)-classified intracapsular fractures was conducted, utilising an extended preauricular approach and positional screw fixation with an emphasis on early joint mobilisation and physiotherapy. The cohort consisted of 45 patients with 50 fractures, exhibiting a mean postoperative mouth opening of 32 mm, which increased over time and was noted to be statistically significant. Patient satisfaction was high, and the majority of radiological outcomes were deemed anatomical. No patients had permanent facial nerve injuries. Other postoperative complications were minimal, including one case of Frey syndrome and a 16% re-intervention rate, primarily for hardware removal. The findings suggest that open treatment can achieve satisfactory early function as part of the implementation of an in-part novel procedure. This paper provides insight into the establishment of a new technique in both experiential and governance domains, and looks at the lessons learned. The high levels of patient and surgeon satisfaction confirm increasing levels of evidence supporting open reduction and fixation in these challenging injuries, but the study’s limitations include the absence of a control group and potential non- generalisability due to the single-surgeon perspective. The study highlights the need to support colleagues providing this treatment and establish a national mentoring programme to achieve it. At this point, long-term studies and a multicentre trial are suggested for a comprehensive understanding of the treatment’s efficacy and the formal development of management protocols.

The ‘Manchester’ method of minimal access fixation of the zygomatic arch in zygomatic complex fractures: a case series

We have introduced a minimally invasive approach for the fixation of the zygomatic arch during the surgical management of zygomatic complex fractures. Access for this technique is provided by a preauricular approach and eyelid incisions with the addition of transcutaneous stab incisions overlying the arch. These stab incisions allow transcutaneous drilling and screw placement through a size CH 20 (5.0 mm) paediatric nasopharyngeal airway (NPA). We present a case series of seven patients. In all patients the arch component was successfully reduced and fixed, and no intraoperative or postoperative complications were observed. The use of an NPA is novel. It functions as a flexible self-irrigating sleeve and protects the skin from mechanical and thermal damage. The technique uses readily available equipment, is easy to learn, and simplifies surgery to the zygomatic arch.

The Variant type of Preauricular Sinus with Recurrent Postauricular Abscess: Excision by Single Incision Preauricular Approach

The Variant type of Preauricular Sinus with Recurrent Postauricular Abscess: Excision by Single Incision Preauricular Approach

Treatment of Sagittal Fracture of the Zygomatic Arch Root.

A sagittal fracture at the temporal root of the zygomatic arch (ZAR) often occurs as a component of zygomaticomaxillary complex (ZMC) fractures. However, this area is difficult to access, and anchorage is limited due to the unstable structure around it. Therefore, a preauricular approach using single-screw fixation is proposed, and this study reports its results and usefulness. Forty-four patients with sagittal fractures of ZAR occurring with ZMC fractures were evaluated from 2012 to 2021. Open reduction and internal fixation were performed on all patients with ZMC fractures. Closed reduction using Dingman incision and external finger pressure in group A (indirect approach; 30 patients) and single-screw fixation using a preauricular approach in group B (direct approach; 14 patients) were performed to address sagittal fractures in ZAR. For single-screw fixation, the additional mean operation time was 11.34±3.25 minutes. On postoperative 3-dimensional computed tomography and plain radiographs, group B showed more accurate reduction and less deformity and trismus ( P <0.05). Moreover, a normal diet was initiated more quickly in group B than in group A ( P <0.05). Some cases in group A showed nonunion or malunion. This study revealed that a direct approach (group B) toward sagittal fractures of ZAR is recommended due to more accurate results and fewer complications than those observed with the indirect approach (group A). Moreover, the total operation time and complications may be lesser than those with the bicoronal approach.

Modified Preauricular Transparotid Approach for Treating Mandibular Condylar Fractures.

We introduce a technical variant of the standard preauricular approach to treat intracapsular and condylar neck fractures: the modified preauricular transparotid approach (MPTA). The main modification, when compared with the conventional submandibular approach, is that the incision of the superficial musculoaponeurotic system is performed directly above the parotid gland, and the buccal branch of the facial nerve is dissected in a retrograde way within the parotid gland. Between January 2019 and December 2020 at the Maxillofacial Departments of "Ospedale Maggiore" of Parma and "Policlinico San Martino" of Genoa 6 patients affected by intracapsular and condylar neck fractures underwent open reduction and internal with MPTA. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 85 minutes, ranging from 75 to 115 minutes. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible. MPTA is particularly suited for intracapsular and condylar neck fractures. Morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and esthetic deformity.

The learning curve of transoral condylectomy; a retrospective analysis of 100 consecutive cases of unilateral condylar hyperplasia

In this study, 100 consecutive scheduled transoral condylectomies for unilateral condylar hyperplasia were included. The safety and surgical performances were assessed, using the operating time, conversion rate and complication rate. The conversion rate learning curve was evaluated with a learning curve cumulative summation (LC-CUSUM).The total conversion rate was 8.0%. The LC-CUSUM for conversion signaled at the 53th procedure, indicating sufficient evidence had accumulated that the surgeon had achieved competence. For procedures 54–100, the conversion rate was 4.0%. The operating time for the transoral condylectomy was 41.5 ± 15.3 min; when a conversion was necessary, the operating time was 101.4 ± 28.3 min (p < 0.05). The estimated operating time in the post-learning phase was 37 min, this was reached after approximately 47 procedures. There was 1 major complication of a permanent inferior alveolar nerve hypoesthesia. The complication rate was not significantly decreased after the learning curve.Within the limitations of the study, it seems that transoral condylectomy for UCH is a safe procedure with several advantages over the traditional preauricular approach. Surgeons starting this procedure should be aware of the potential complications and of the learning curve of approximately 53 procedures.

Surgical approaches of condylar fracture management - A Mini Review

Mandibular condylar neck and subcondylar fractures are common in maxillofacial surgery. The justification for surgical treatment of these fractures has varied over time, to avoid the most concerning side event, namely facial nerve injury. We offer a new approach that combines intraoral and cutaneous pre-auricular access, allowing for quick and safe access to the surgical site while avoiding facial nerve injury and surgical scars in high-impact aesthetic areas of the neck. Five patients with condylar neck or subcondylar fractures were treated at the same hospital using a combined intraoral and pre-auricular approach. Three months following surgery, the results were assessed in terms of mandibular mobility, complications, and patient satisfaction All five patients had a positive outcome, with complete fracture healing and no sequelae, including no facial nerve palsy. The safe reduction of the two mandibular pieces achieved by a combined intraoral and cutaneous pre-auricular surgical access is a major element of the approach. The periosteal plan of the ramus can be broadly and safely elevated using the intraoral approach and connected to the condylar bone plane with the pre-auricular cutaneous approach, avoiding facial nerve damage. The wide ramus periosteum elevation generates an "optical space" that allows fragment reduction and fixation in direct oblique view without the requirement for endoscopic intervention. Our findings strongly imply that with our technique, it is possible to treat sub-condyle and condylar neck fractures safely while avoiding facial nerve injury, which is an undesirable consequence due to its severe impact on quality of life.

Burr hole microsurgical subtemporal selective amygdalohippocampectomy.

At present, selective amygdalohippocampectomy (SAH) has become popular in the treatment of drug-resistant mesial temporal lobe epilepsy (TLE). However, there is still an ongoing discussion about the advantages and disadvantages of this approach. The study included a consecutive series of 43 adult patients with drug-resistant TLE, involving 24 women and 19 men (1.8/1). Surgeries were performed at the Burdenko Neurosurgery Center from 2016 to 2019. To perform subtemporal SAH through the burr hole with the diameter of 14mm, we used two types of approaches: preauricular, 25 cases, and supra-auricular, 18 cases. The follow-up ranged from 36 to 78months (median 59months). One patient died 16months after surgery (accident). By the third year after surgery, Engel I outcome was achieved in 80.9% (34 cases) of cases and Engel II in 4 (9.5%) and Engel III and Engel IV in 4 (9.6%) cases. Among the patients with Engel I outcomes, anticonvulsant therapy was completed in 15 (44.1%), and doses were reduced in 17 (50%) cases. Verbal and delayed verbal memory decreased after surgery in 38.5% and 46.1%, respectively. Verbal memory was mainly affected by preauricular approach in comparison with supra-auricular (p = 0.041). In 15 (51.7%) cases, minimal visual field defects were detected in the upper quadrant. At the same time, visual field defects did not extend into the lower quadrant and inside the 20° of the upper affected quadrant in any case. Burr hole microsurgical subtemporal SAH is an effective surgical procedure for drug-resistant TLE. It involves minimal risks of loss of visual field within the 20° of the upper quadrant. Supra-auricular approach, compared to preauricular, results in a reduction in the incidence of upper quadrant hemianopia and is associated with a lower risk of verbal memory impairment.

Preauricular Incision Approach as a Management of Zygomaticomaxillary Complex Fracture Reduction: A Case Report

Introduction: A zygomatico maxillary complex fracture is a facial bone fracture that commonly occurs as a centrally and laterally protruding zygomatic area. The effective surgical approach and exact reduction of the displaced fracture is the most important task in the treatment of a zygomatic fracture, from the aesthetic point of view. Determination of surgical approach and the fixation point of zygomatic arch fracture is one of the most challenging procedure. The purpose of this case report is to find out that the preauricular incison approach is one of the effective methods for reduction of zygomaticomaxillary complex fracture. Case Report: A 53 years old male patient presented with right zygomatico maxillary complex fractures. Diagnosis of right side tetrapod zygomatico maxillary complex fracture deformity was done by clinical examination and confirmed by computed tomography which included 3-D reconstruction view. The authors performed 4-point fixation using the preauricular approach to counter the disadvantages of the coronal approach. The results and usefulness of preauricular approach with 4-point fixation are reported in this study. Conclusion: Preauricular incision is an effective surgical approach for the reduction of zygomatic arch fracture. 4-point fixation using the easier-to-manipulate preauricular approach would be more useful than the conventional method that uses the coronal approach. Satisfactory reduction that showed exact correction was observed. In an outpatient follow-up, no complication such as nonunion or malunion was found, and facial symmetry was also shown. In addition, the preauricular scar was hardly observed. Keywords: zygomaticomaxillary complex fracture, preauricular incision, reduction, fixation

Management of chronic long standing condyle dislocation

Condyle dislocation accounts for 3% of all the dislocations of different joints in the body. They are basically classified based on duration as acute, chronic and recurrent, the most difficult to manage being chronic longstanding. This study of case series was carried out to enunciate and discuss optimal treatment protocols to enhance the postoperative result and functionally rehabilitate the patient. Data were recorded of patients of chronic long standing condyle dislocation (CLSCD) between 2012 to 2019. Predictor variables were drawn from demographics age, gender, aetiology, duration of dislocation status. The outcome variables were surgical success rate and complications. Surgical treatment included endaural pre auricular approach, high condylar shave with eminoplasty, elastic traction for a period of 5-7 days and mouth opening exercises. 15 patients with CLSCD of more than a month duration were identified out of 65 reported with other forms of acute and recurrent dislocation. The 12 (80%) were bilateral and 3 (20%) were unilateral. Three (20%) were of interpersonal violence, 3 (20%) had cerebrovascular accident, 3 (20%) following RTA with other major injuries, and 1 patient (6.6%) very rare unusual history of dislocation during labor pain reporting after six months. All patients had unsuccessful attempted conservative management. Surgical intervention and outcome were excellent. Complications recorded were 3 patients (20%) had transient facial nerve weakness, 2 (13.3%) infection. Conservative manipulation has definitive role in acute and recurrent cases but surgical approach or open procedure in chronic long-standing cases is the choice with duration of condylar dislocation being the decisive factor for difficulty index.

96. Pseudoaneurysm of the Superficial Temporal Artery: A previously unreported complication of the pre-auricular approach

Pseudoaneurysms of the superficial temporal artery (STA) are reported as a rare complication of blunt craniofacial trauma and neurosurgical procedures. Classically they present with a pulsatile temporal swelling and are usually treated by surgical resection plus ligature of the proximal and distal vessel ends. We report the management of an unusual presentation of a pseudoaneurysm of the STA following open reduction and internal fixation (ORIF) of a high condylar neck fracture via pre-auricular approach.

An Alternative Location for Fixation of Subcondylar Fractures With 2 Resorbable Plates.

Mandibular subcondylar fractures can be fixed with 2 titanium plates or 2 resorbable plates. However, when a wider resorbable plate is used, there might be insufficient space on subcondylar region. The authors have tested the back of the condyle as an alternative location for the wide resorbable plate. The fractured condyle was accessed through the preauricular approach. The first resorbable plate (4 hole plate, extended; 2mm Inion OTPSTM) was contoured around the posterior edge of the mandibular ramus. The upper and lower parts of the very resorbable plate were twisted into 2 different planes. The upper part was adapted and then fixed on the back of the condylar neck. And the lower part was fixed on the lateral surface of the posterior edge of the mandibular ramus. The second plate (4 hole plate; 2mm Inion OTPSTM) was put below the mandibular notch as usual. Postoperative computed tomography confirmed a stable anatomical reduction of condyle. One-year follow-up showed good fracture healing. The authors believe that the back of the condyle is particularly suitable for wider resorbable plate. And this alternative site on the back of the condyle is also feasible in cases where the conventional site is not available.

Zygomatic Implants through a Face-Lift Approach: Analysis of 30 Years' Experience.

The use of zygomatic implants has been mostly replaced by fat grafting in rhytidectomy procedures. Furthermore, surgeons using implants prefer the intraoral approach. The authors aimed to describe and emphasize the usefulness of the preauricular approach as the best approach for this operation and underline the value of cheek implants as an alternative and/or as an adjunct to fat grafting during face-lift procedures for midfacial rejuvenation. A retrospective study of 350 patients who underwent face-lift procedures with silicone malar implant placement through a preauricular approach was conducted. Postoperative photographs of all patients were examined by two physicians for postoperative volume adequacy, naturalness of appearance, and improvement in asymmetry. Patient satisfaction was evaluated using a questionnaire with an ordinal scale. The large majority of patients [338 of 350 (96.5 percent)] were completely satisfied or satisfied with the aesthetic outcome. The complication rate was very low and comparable to data reported in current literature. The application of cheek implants proved to be a great tool for midfacial volume rejuvenation with or without associated fat grafting. This conclusion was drawn from the answers reported in the questionnaires completed by the two examiners. The main challenge in this operation was the choice of the type, shape, and size of the implant. The preauricular approach should be given preference during this procedure because, compared to the other approaches, it is easier, faster, and more comfortable for both the patient and the surgeon. Therapeutic, IV.

Modified Preauricular Cervico-facial Approach for Oral Cancers: an Analysis of Oncological and Functional Outcomes.

The quest for a more cosmetic and functionally better approach to oral cancer continues unabated. The modified facelift and preauricular approaches have been a common approach in trauma and cosmetic surgery. In the current study, we evaluate the feasibility and functional outcomes of a preauricular cervico-facial approach for compartmental resection of complex gingiva-buccal complex tumours with concurrent neck dissection. This was a prospective single-centre study and recruited patients of biopsy-proven operable advanced oral cavity tumours. These patients underwent compartmental tumour resections with neck dissection using the modified preauricular approach. Patients were followed up and advised adjuvant treatment when mandated. At 3rd month and 6th month follow-up, QoL was assessed using the self-administered University of Washington Quality of Life scale (UW-QOL). A total of 20 patients met the inclusion criteria and were recruited for the approach. All patients had surgically clear margins on histopathological analysis. Oral swallow was initiated on the 10th postoperative day and the average duration of nasogastric tube dependence was 13days. All patients had reasonably good oral commissure competence and none had drooling of saliva at 6th month follow-up. Modified preauricular cervico-facial approach tolocally advanced gingiva-buccal complex tumours is a safe and holds the possibility of a functionally superior approach.

Post-traumatic superolateral temporo-mandibular dislocation with intact condyle: case series and literature review

Introduction: Supero-lateral temporomandibular dislocations with intact condyles are very rare, particularly in countries of sub-Saharan Africa where they are poorly documented. Materials and method: This was a retrospective study that included all patients received for superolateral temporomandibular dislocation with intact condyle following a maxillofacial trauma. The period covered by the study was from January 2011 to July 2021. Results: 3 patients were studied. According the classification of temporomandibular superolateral dislocation with intact condyle, the first patient had a Type II A, the second and the third patient, type II B. The manual reduction of the first patient luxation was unstable requiring an osteosynthesis of mandibular symphysis to stabilise the reduction of the temporomandibular dislocation. The second patient manual reduction was unsuccessful requiring an open reduction by preauricular approach. The third left against medical advice. Discussion: The occurrence of temporomandibular superolateral dislocation with intact condyle in an underdeveloped city like Bouaké, is not related to the density of road traffic but to the indiscipline of the many motorcyclists who do not wear helmets. Early reduction of the dislocation, early mobilisation of the joint and mechanotherapy positively influence the postoperative outcome.

Reduction Malarplasty Using Customized Surgical Stent Based on 3D Virtual Surgery, CAD/CAM, and 3D Printing Technology: Case Series.

The zygomatic bone is a structure that protrudes symmetrically on both sides of the midface and plays an important role in the overall aesthetic appearance of the face. Unlike Caucasians, the mesocephalic facial shape is predominant in Asians, and therefore, many people have a relatively laterally developed zygomatic bone. In Asians, when the zygomatic bone is excessively developed, it gives a strong and stubborn image, and aesthetically, many people want to reduce the zygomatic bone because they prefer an oval and slim face.To reduce the excessive zygomatic bone, a reduction malar- plasty through an intraoral and preauricular approach has been performed. Although reducing the zygomatic bone is not a big problem in most cases of symmetric reduction malarplasty, it is not easy to produce surgical results as intended by the surgeon in asymmetric malar patients or patients requiring a three-dimensional (3D) change of zygoma. In addition, because of the mobility of the zygoma segment, it may be difficult to drill holes and fix plate after osteotomy. Moreover, these factors can increase the possibility of malunion or nonunion.In this study, cutting guides made with the aid of 3D virtual surgery, 3D printing, and customized titanium plates manufactured with the computer-aided design/computer-aided manufacturing technology are used for 8 patients to maximize the recovery of 3D symmetry and minimize complications through accurate fixation after surgery. During the surgical procedures, screw hole drilling and osteotomy were performed using a cutting guide, and then, the malar segment was fixed by matching the premade customized plates with the predrilled holes. As a result of checking the accuracy of the surgery by superimposing the postoperative 3D cone beam computed tomography image and virtual surgery data based on the skull base, the 2 images almost overlapped and no significant differences were observed, so it was confirmed that the operation was performed exactly as planned.When using the 3D technology, it is possible to perform a more accurate surgery in patients with asymmetry due to congenital anomalies or trauma as well as simple asymmetry, so it can be concluded that using the 3D technology can overcome the limitations and disadvantages of the conventional method as in the cases in this study. The accurate prediction of soft tissue is still insufficient, and further research is needed to overcome this limitation.

Incidence of Facial Nerve Injury and Sialocele Formation Following Mandibular Condylar and Sub-condylar Fracture Fixation.

To study the incidence of sialocele formation in the parotid gland and to study the incidence of facial nerve affliction following treatment of mandibular condylar and sub-condylar fractures. The present study is a retrospective study conducted on a total of 82 patients with 107 sub-condylar and condylar fractures treated in this centre from August 2008 to August 2020. The surgical approaches used to treat the fractures were considered, and the occurrence of sialocele, salivary fistula and facial nerve paralysis was noted. The facial nerve function was analysed using House-Brackmann system of classification. The incidence of sialocele formation was seen in 15.87% of cases, and the incidence was seen more commonly during a preauricular approach (52.94%) followed by retromandibular (41.17%) followed by anterior parotid transmassetric approach (11.76%). The incidence of facial nerve affliction was seen in 17.57% of cases with majority of them showing temporal branch involvement in 21.05% of cases. During the treatment of condylar and sub-condylar fractures, the facial nerve is at considerable risk of damage; however, understanding the anatomy of the nerve is of importance to avoid such complications. Sialocele formation is also an undesirable complication of such surgeries, a prompt diagnosis and early treatment is mandatory to overcome further unwanted sequel.

1588 A Rare Case of Arteriovenous Malformation Following TMJ Arthroscopy: A Case Report and Review of The Literature

Abstract Patients undergo temporo-mandibular joint (TMJ) arthroscopy as part of the diagnosis and management of chronic pain in the TMJ. Known complications of the procedure include bleeding within the joint spaces, lacerations of the external auditory canal and local nerve damage. We present the case of a 25-year-old woman who developed an arteriovenous fistula in the right pre-auricular region secondary to TMJ arthroscopic examination. She had presented with ongoing TMJ pain necessitating further investigation with arthroscopy. Following her procedure her TMJ symptoms improved, however she developed right pre-auricular swelling of gradual onset, right-sided headaches, and pulsatile tinnitus. Due to her pregnancy of around 16 weeks this was originally linked to expansion in plasma volume and hyperdynamic circulation; however, this was later diagnosed as an extremely rare, post-operative complication of TMJ arthroscopy. Her examination revealed a pre-auricular pulsatile swelling measuring approximately 1.5 cm. Blood tests including ESR and CRP were within normal limits excluding temporal arteritis. An ultrasound scan revealed an AV fistula of the right superficial temporal artery; Her MRI confirmed single vessel supply. Following discussion in the vascular anomalies MDT, she underwent embolisation with PHIL and surgical excision via a preauricular approach. The procedure was successful, and the patient made a full recovery. The literature reports very few cases of iatrogenic arterio-venous fistulas resulting from TMJ arthroscopic surgery. Our case emphasises the importance of a multidisciplinary approach in combining embolisation with surgical excision resulting in the successful management of a rare post-operative complication.

Deep Subfascial Approach as an Alternative to Explore Temporomandibular Joint: A Pilot Study

Statement of the problemThe study aimed to compare the efficacy of superficial, subfascial, and deep subfascial approaches in patients with temporomandibular joint (TMJ) disorders and to correlate its effect on facial nerve function and quality of the surgical field. Materials and methodsThe study comprised of 15 cases indicated for TMJ surgery divided randomly into 3 study groups: Groups I, II, and III based on the surgical approach used (Figure 1). In Group I patients, the superficial approach was used and dissection was limited to the superficial layer of temporalis fascia. In Group II, a subfascial approach was used where dissection was carried between the 2 layers of the fascia. In Group III, a deep subfascial approach was used where dissection was kept between the deep layer of fascia and muscle. Intraoperatively, the quality of surgical field was assessed using Fromme, et al. Scale and intraoperative blood loss were calculated for each group. The dissection time was measured as the time elapsed from the skin incision to reach the dissection plane. All patients were evaluated for pain and swelling on the first, third, and seventh postoperative day. The facial nerve function test was performed post-surgically after 24 hours, 1 week and 1, 3, and 6 months using the House-Brackman scale. Methods of data analysisStatistical analysis was performed using SPSS software (IBM Corp, Armonk, NY). Data were presented as mean and appropriate. Statistical tests were applied. ResultsThe inter-group comparison showed that the outcomes of all intraoperative parameter were superior in Group II in comparison to the other groups (Table 1), whereas postoperative pain and swelling and facial nerve function were better in Group III (Table 2). Outcomes dataThe mean time required for exposure of TMJ was least in Group I as compared to the other groups (mean score for Groups I, II, and III, respectively, 20.8 ±1.36;19.0±3.3.17; and 29.2±4 minutes). The quantity of blood loss was minimum in Group II (mean score for Groups I, II, and III, respectively, 311.8±5.15; 244.4 ±6.19; and 249.6±10.58). Similarly, the quality of the surgical field was highest in Group II (mean score for Groups I, II, and III, respectively, 2.2±0.87;1.00±0.44; and 1.04±0.33). Mean pain scores were generally better for Group III when compared to Groups I and II on all days. Highest mean score observed on the first postoperative day was 5.2±1.33; 6.2±1.17; and 4.8±1.16 for Group I, Group II and Group III, respectively. It was also observed that deep subfascial approach resulted in lesser postoperative swelling as compared to the other groups (mean score for Group I, Group II, and Group III, respectively, at seventh postoperative day was 27.2±1.13;22.1±0.86; and 20.14±2.09). At 6 months, all surgical sites in Group III had normal facial nerve function, whereas total palsy of temporal branch was seen in 1 case for Group I and mild dysfunction was noted in 1 case of Group II (Figure 1). ConclusionThe deep subfascial approach is the safest approach among the preauricular approaches to avoid injury of the facial nerve and yielded better postoperative result for pain and swelling. However, the traditional subfascial technique provided a quicker and blood-less field of dissection. Thus, either of the 2 approaches could be used depending on the surgeon's preference and training.