Root of Helix Inter Tragus Notch Incision (RHITNI) for open temporomandibular joint surgery: A five-year...

Open temporomandibular joint (TMJ) surgery must balance exposure, facial nerve preservation, and cosmesis. The Root of Helix Inter Tragus Notch Incision (RHITNI), an endaural modification with promising aesthetics and low morbidity, lacks systematic outcome data. A single-center retrospective cohort study of consecutive primary open TMJ procedures using RHITNI over five years was performed. Primary endpoint: branch-specific facial nerve dysfunction (temporary or permanent). Secondary endpoints: auriculotemporal sensory change, salivary complications, hematoma, infection, wound problems, and scar concerns. Outcomes were stratified by procedure type and calculated per surgical site (joint). Thirty-seven patients underwent surgery, for a total of 46 operated joints. Follow-up was completed for all patients over a five-year period. Temporary complications occurred in 6/46 joints (13.0 %). Specific events included: transient facial nerve weakness in 2/46 (4.3 %); auriculotemporal hypoesthesia/paresthesia in 2/46 (4.3 %); ear canal blood clot in 1/46 (2.2 %); and preauricular edema in 1/46 (2.2 %). All transient events resolved (median facial nerve recovery 322 days, range 300-344). No infections, salivary issues, dehiscence, or scar-related complaints were recorded. No permanent complications (>12 months persistence) were observed (0 %). RHITNI provided safe access for open TMJ surgery, with 4.3 %transient facial nerve weakness, no permanent deficits, and minimal locoregional morbidity regardless of the intra-articular procedure performed. Findings compare favorably with benchmarks and support RHITNI as an aesthetic, nerve-sparing option.