Arthroplasty and Discectomy of the Temporomandibular Joint

Surgery to correct disorders of the temporomandibular joint (TMJ) has been performed and documented since the mid-nineteenth century. Although earlier mentions may be found, Annandale’s brief 1888 Lancet article reports a remarkably modern surgical approach to the TMJ and procedure for disc repositioning and is often cited as the first description of TMJ disc surgery. In the decades to follow, pioneering surgeons published a variety of approaches to the TMJ, traversing the preauricular area vertically, horizontally, and by various L-shaped incisions. By the mid-twentieth century, most surgeons were trained in a standard vertical preauricular approach with an anteriorly directed hockey-stick curve at the superior margin. This skin incision is often modified by extending it posteriorly so that much of its length is hidden behind the tragus (endaural approach). A less commonly used approach is to make the incision behind the ear and, reflecting the ear anteriorly and sharply transecting the external auditory canal, access the TMJ from a well-hidden postauricular approach. This article does not describe indications for open TMJ surgery and discectomy or the relative role of this treatment among others, but focuses on the surgical technique used. Once the lateral capsule is reached, any of the open joint procedures described in this text may proceed, but this article describes a conservative discectomy without disc reconstruction. The following description uses a standard preauricular incision and dissection as performed by the author based on the collective experience and wisdom of many surgeons before him.