“Bat Wing Surgical Approach for the Temporomandibular Joint”

Abstract

Introduction The temporomandibular joint (TMJ) is anatomically complex; with its close proximity to neurovascular structures, including the facial nerve that gives a high degree of difficulty during surgical exposure. When the first description on TMJ surgery by Orlow in 1913 was published it gave an account describing the basic retroauricular, preauricular, endoaural and submandibular approaches, on treatment of articular pathologies as used today. The proposed study of the 'Bat Wing' approach, first described in 1993 by Garcia y Sanchez J.M. as a surgical alternative, offers great advantages is that it avoids the section of the ear canal and provides a wide surgical field. The management of the proposed technique has wide application with multiple joints addressed, achieving major objectives such as avoiding facial nerve damage, as well as avoiding the section of the external auditory canal with an optimum visibility of the operative field. Material and methods The Department of Maxillofacial Surgery National Medical Center XXI Century records over a period of approximately 18 months have completed twenty TMJ surgeries using the 'Bat Wing', approach. Conclusions The bat wing approach is a surgical alternative that offers broad exposure of the surgical field in TMJ, it is effective and meets the goal of exposing the area to intervene safely, good visibility and access to the site to intervene. It perfectly fulfills the above described.

Variants and Modifications of the Retroauricular Approach Using in Temporomandibular Joint Surgery: A Systematic Review

“…An extended access described by Blythe is termed “the temporal RA extension” in the further contents of this discussion [ 15 ]. In the case of the bat wing approach, the original nomenclature was retained [ 14 ]. In the course of an extensive ablation surgery described by Yokoyama et al, RA was only a fragment of the approach, and the temporomandibular joint constituted only a part of the resected tissues, so this case will not be analyzed any further [ 21 ].…”

“…The essential shape of the incision in RA runs almost the full length of the sulcus of the retroauricular crease [ 8 , 11 ]. According to the publications which underwent full-text analysis in the course of this review, the incision can be extended in three directions: (a) upper-anterior; (b) lower-anterior; and (c) posterior [ 14 , 26 , 27 ]. Out of these, only the first, upper-anterior extension is used for a wider exposure of the temporomandibular joint [ 14 , 15 ].…”

“…According to the publications which underwent full-text analysis in the course of this review, the incision can be extended in three directions: (a) upper-anterior; (b) lower-anterior; and (c) posterior [ 14 , 26 , 27 ]. Out of these, only the first, upper-anterior extension is used for a wider exposure of the temporomandibular joint [ 14 , 15 ]. The next two, i.e., the lower-anterior and posterior modifications of RA, assume the shortening of the main incision by its upper part corresponding to approximately half the length of the original preparation [ 26 , 27 ].…”

“…The original RA is primarily exerted in the open reposition and internal fixation of mandibular head and neck fractures [ 8 , 9 , 10 , 11 ]. However, indications for surgery within the temporomandibular joint are more numerous [ 5 , 14 , 15 ]. The classic course of RA enables an effective treatment in certain cases of the temporomandibular joint ankylosis [ 5 ].…”

“…The classic course of RA enables an effective treatment in certain cases of the temporomandibular joint ankylosis [ 5 ]. Consecutively, among the indications for the use of modified versions of RA, apart from fractures and ankylosis, there are pathologies that require arthroplasty, eminoplasty, and joint disc surgery [ 14 ].…”