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Chapter 114Although the masseteric and auriculotemporal nerve provide innervation to respectively the anterolateral and lateral area of the articular capsule, the main nerve to keep in mind during surgical treatment of the TMJ is the facial nerve. After exiting the skull, the seventh cranial nerve divides into the cervicofacial and temporofacial branch, with the latter being most at risk during a surgical procedure. As the superior limit of the nerve is situated below the line connecting the tragus and lateral palpebral commissure, this nerve could be easily damaged or even sectioned by a novice surgeon. (13–15) Secondly, when making use of a submandibular approach, the marginal ramus has to be kept in mind as well. (16)Surgical indications and approach for a TMJ replacementKeeping in mind that only 5-10% of patients with TMD need an invasive treatment, the amount of patients that needs to be subjected to a TMJ TJR is considerably less. (4,5) Indications for a TMJ TJR were well outlined by both the American Association of Oral and Maxillofacial Surgeons (AAOMS) (17) and the National Institute for Health and Care Excellence (NICE) (18) guideline. These indications include TMJ ankylosis and end-stage joint disease resulting from trauma, infection, degenerative arthrosis, cancer, developmental/inherited craniofacial anomalies affecting the mandible and TMJ, failed/failing temporomandibular joint replacement (TMJR) devices or failed prior invasive surgery. When a surgical replacement of the TMJ is indicated, there are several surgical approaches to the joint, each with its own advantages and disadvantages. Firstly, an extraoral approach is preferred over an intraoral, arthroscopic, or endoscopy-assisted approach, as these techniques provides only limited access to the joint. When opting for an extraoral approach, a general distinction can be made between a preauricular, endaural and postauricular technique. The preauricular approach, developed by Blair and first reported on by Risdon, is relatively easy to use, allows for good exposure and can easily be modified to allow for larger exposure of the TMJ and the peri-articular area.(19) Since then, several popular modifications have found their way into the TMJ-surgeon’s ‘bag of tricks’.Nikolas de Meurechy NW.indd 14 05-06-2024 10:14