Comparative Evaluation of Post-Operative Facial Nerve Injury in Conventional 45º Incision V/S Modified 90º Incision in Al-Kayat Bramley and Hemi-Coronal Approach

Abstract

Introduction: The facial nerve is considered the “Queen of The Face” as it innervates the muscles of facial expression. Al-Kayat and Bramley a modified preauricular approach to TMJ and malar arch in an effort to protect temporal and zygomatic branches. They insisted upon placing a 45⁰ incision in superficial temporalis fascia. However temporal and zygomatic branches involvement were still noted following Al-Kayat Bramley approach. Hence, we believed a necessity to revisit this conventional 45⁰ incision.

Methods: The present study was meticulously planned and executed, involving patient who sought consultation at outpatient department. The sample consisted of 34 patients operated by the same surgical team using Al-Kayat Bramley and Hemi-coronal approach. Patients were divided randomly into two groups. Group 1 included patients operated using the conventional 45⁰ incision and group 2 included patients operated using the modified 90⁰ incision. All patients were examined using the House Brackmann Facial Nerve Grading System scale at regular intervals to assess the degree of improvement or deterioration.

Results: The incidence of temporal and zygomatic nerve injuries was less in modified 90⁰ incisions than conventional 45⁰ incision

Conclusion: Facial nerve impairment was shown to be of a temporary nature. This study shows that the modified 90º incision is associated with reduced incidence of facial nerve injury post operatively when compared to conventional 45⁰ incision.