The authors present a method of gaining access to the temporomandibular joint that improves visibility and surgical access. It should reduce operating times and improve results.
New methods of gaining access to the temporomandibular joint (TMJ) are required that will improve visibility and surgical access, reduce surgeon and assistant fatigue, reduce operating times and improve results. The authors present a method that attempts to fulfill these criteria.
After pre-auricular exposure of the TMJ, two 1.5 mm or 1.6 mm Kirschner wires (K-wires) are selected ( Fig. 1 ). The K-wires can be plain or threaded. Using an SS White 701 carbide bur, two holes are made, one at the neck of the condyle (low enough on the condylar neck to not interfere with the lateral capsule reinforcement) angled at 45° and the other, approximately 1 cm from the zygomaticotemporal prominence, also at an angle of 45° ( Fig. 2 ). This should be accomplished after subperiosteal dissection under direct vision. As per operator choice, The K-wires are then tapped or threaded into these holes, such that they converge towards each other ( Fig. 3 ). The K-wires are then cut to an equal height and stretched in the direction opposite to their angles of convergence. Self-retaining retractors ( Fig. 1 ) are inserted and torqued open as desired ( Fig. 4 ).