Một số phương pháp tiếp cận KỸ THUẬT đến TMJ đã được đề xuất và được sử dụng trên lâm sàng. Các tiêu chuẩn và cơ bản nhất là phương pháp tiếp cận Preauricular. Các cách tiếp cận khác khác nhau trong nhiệm kỳ của vị trí của vết rạch da cũng như truy cập vào khớp. | TPF SMAS Figure 12 5 Coronal section of the temporomandibular joint TMJ region. SMAS superficial musculoaponeurotic system TF temporalis fascia note that it splits inferior to this point into superficial and deep layers TPF temporoparietal fascia VII temporal branch of the facial nerve. TECHNIQUE Several approaches to the TMJ have been proposed and are used clinically. The standard and most basic is the Preauricular approach. Other approaches differ in term of placement of the skin incision as well as access to the joint. The dissection down to the TMJ however is similar in all approaches. In this discussion the standard Preauricular approach is described first. Later variants are briefly presented. Step 1. Preparation of the Surgical Site Preparation and draping should expose the entire ear and lateral canthus of the eye. Shaving the Preauricular hair is optional. A sterile plastic drape can be used to keep the hair out of the surgical field. Cotton soaked in mineral oil or antibiotic ointment may be placed into the external auditory canal. 168 Step 2. Marking the Incision The incision is outlined at the junction of the facial skin with helix of the ear. A natural skin fold along the entire length of the junction of the incision can be used. If none is present posterior digital pressure on the Preauricular skin usually creates a skin fold that can be marked. The incision extends superiorly to the top of the helix and may include an anterior hockeystick extension. Step 3. Infiltration of Vasoconstrictor The Preauricular area is quite vascular. A vasoconstrictor can be injected subcutaneously in the area of the incision to decrease incisional bleeding. If a local anesthetic is also being injected however it should not be injected deeply because it may be necessary to use a nerve stimulator on exposed facial nerve branches. Step 4. Skin Incision The incision is made through skin and subcutaneous connective tissues including temporoparietal fascia to the depth of the
