A modified pre-auricular approach to the temporomandibular joint and malar arch

In an attempt to improve visibility and safety in the surgical approach to the malar arch and jaw joint, anatomical dissections of 56 facial halves were undertaken. Observations are made on the relationship of the facial nerve bifurcation and its temporal branch to bony landmarks. Attention is drawn to the dangerous area of fusion of the superficial fascia, the superficial layer of temporal fascia and the periosteum of the malar arch. The safety of approaching the malar arch through the pocket formed by the splitting of the lower part of the temporal fascia is emphasised. Minor modifications to the established pre-auricular approach were made and applied successfully to six sides in five patients.