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Objective <p>This study aimed to evaluate a modified posteriorly based approach of superficial temporal neurovascular bundle for temporomandibular joint (TMJ) disc repositioning and suturing in patients with anterior disc displacement without reduction (ADDWoR), and to assess its immediate clinical outcomes.</p> Methods and materials <p>A retrospective analysis was conducted on 132 patients (218 joints) treated at the Affiliated Stomatology Hospital of Guangzhou Medical University between August 2023 and April 2024. All patients were diagnosed with ADDWoR corresponding to Wilkes–Bronstein stages III–V. Open TMJ disc repositioning and suturing were performed using either a posteriorly based or anteriorly based approach relative to the neurovascular bundle. Intraoperative parameters and immediate postoperative outcomes were compared between the two groups.</p> Results <p>Postoperative MRI confirmed successful disc reduction in 211 of 218 joints. Intraoperative bleeding was significantly higher in the posterior group (25.06 ± 8.00 mL) than in the anterior group (14.52 ± 4.83 mL). Operating duration was also longer in the posterior group (103.1 ±27.64 minvs.87.85 ± 23.93 min). No skin flap perforation occurred in the posterior group, whereas 5 cases were observed in the anterior group. The posterior group exhibited a higher postoperative infection rate (9.09%) than the anterior group, whereas transient facial nerve injury was more frequent in the anterior group (27.27% vs. 9.09%). Postoperative fever was more common in the posterior group (18.18% vs. 3.03%), and surgical site drainage was greater in the posterior group (13.87 ± 3.90 mL vs. 11.52 ± 3.52 mL). Perioperative inflammatory markers and hospitalization duration showed no significant differences between the two groups.</p> Conclusion <p>The modified posteriorly based approach for TMJ disc repositioning and suturing is a safe and effective technique for treating ADDWoR. Compared with the anteriorly based approach, it offers advantages in reducing facial nerve injury and minimizing flap complications, despite longer operative time and increased intraoperative bleeding.</p>

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Intraoperative and postoperative evaluation of temporomandibular joint disc repositioning and suturing via anteriorly based or posteriorly based approaches to the neurovascular bundle: a retrospective single-center cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Ying Zhang,
  • Zhenlong Liu,
  • Li Deng,
  • Wenchao Zhong,
  • Zhiqiang Song,
  • Qingbin Zhang,
  • Zixian Jiao,
  • Antong Wu,
  • Wei Cao

摘要

Objective

This study aimed to evaluate a modified posteriorly based approach of superficial temporal neurovascular bundle for temporomandibular joint (TMJ) disc repositioning and suturing in patients with anterior disc displacement without reduction (ADDWoR), and to assess its immediate clinical outcomes.

Methods and materials

A retrospective analysis was conducted on 132 patients (218 joints) treated at the Affiliated Stomatology Hospital of Guangzhou Medical University between August 2023 and April 2024. All patients were diagnosed with ADDWoR corresponding to Wilkes–Bronstein stages III–V. Open TMJ disc repositioning and suturing were performed using either a posteriorly based or anteriorly based approach relative to the neurovascular bundle. Intraoperative parameters and immediate postoperative outcomes were compared between the two groups.

Results

Postoperative MRI confirmed successful disc reduction in 211 of 218 joints. Intraoperative bleeding was significantly higher in the posterior group (25.06 ± 8.00 mL) than in the anterior group (14.52 ± 4.83 mL). Operating duration was also longer in the posterior group (103.1 ±27.64 minvs.87.85 ± 23.93 min). No skin flap perforation occurred in the posterior group, whereas 5 cases were observed in the anterior group. The posterior group exhibited a higher postoperative infection rate (9.09%) than the anterior group, whereas transient facial nerve injury was more frequent in the anterior group (27.27% vs. 9.09%). Postoperative fever was more common in the posterior group (18.18% vs. 3.03%), and surgical site drainage was greater in the posterior group (13.87 ± 3.90 mL vs. 11.52 ± 3.52 mL). Perioperative inflammatory markers and hospitalization duration showed no significant differences between the two groups.

Conclusion

The modified posteriorly based approach for TMJ disc repositioning and suturing is a safe and effective technique for treating ADDWoR. Compared with the anteriorly based approach, it offers advantages in reducing facial nerve injury and minimizing flap complications, despite longer operative time and increased intraoperative bleeding.