During surgical treatment of condylar fractures, there are various surgical approaches to access the fractures site . each approaches , has a specific inscions and dissection under skin, dose an incision can cause facial injury more than dissection do ?
Incision results in higher rates of permanent facial nerve injuries than dissection. At dissection chances are good that nerve-branches are just "squeezed" away without permanent injury.
The temporal branches of facial nerve cross the lateral surface of the zygomatic arch and they course along the undersurface of the superficial temporalis fascia and not, as showed by the authors in Fig. 2, under the superficial layer of deep temporal fascia.
The deep temporal fascia splits in two layers approximately 2 to 3 cm above the zygomatic arch. Continuing inferiorly to the zygomatic arch, these 2 fascial layers are separated from each other by a fat pad.
The risk of significant temporal branch injury has been attributed to the dense fusion of the deep fascial layers as the nerve crosses over the zygomatic arch, therefore it is essential to have a proper dissection of the periosteum of the zygomatic arch.
The necessity of obtaining a safe plane of dissection in the temporal area is crucial to preserve the integrity of the frontal branch of the facial nerve.
The traditional subfascial approach to the TMJ, when properly performed, minimizes the damage to the frontal branch of the facial nerve and it provides to dissect the layers below the superficial layer of the deep temporal fascia that is the temporal fat pad, which provides a natural plane of dissection.
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