During temporomandibular joint (TMJ) surgeries, the facial nerve is at risk. Therefore, surgical approaches are thoughtfully designed to eliminate damage to these vital structures. The aim of this systemic review (SR) was to compare the deep subfascial approach (DSFA) to the subfascial approach (SFA) in terms of the rate of transient facial nerve injury (FNI) when accessing the TMJ. This systematic review was performed with PubMed, EBSCOhost, Cochrane, and Google Scholar databases (2002–2024). The inclusion criteria were all randomized controlled trials (RCTs) and prospective cohort studies that assessed the rate of FNI. The primary outcome was the incidence of FNI (House–Brackmann Grade > I). Raw count data from two studies (Rastogi et al . and Li et al .) were pooled to perform an analysis calculating the pooled risk ratio (RR) and risk difference (RD). In total, 66 articles were identified, and four studies were included in this SR. The quantitative pooling of binary data from two RCTs ( N = 136 patients) showed total FNI events of 1 out of 76 (1.32%) in the DSFA group and 14 out of 60 (23.33%) in the SFA group. The pooled analysis yielded a RR of 0.057, indicating a 94.3% reduction in the relative risk of FNI with the DSFA. The RD was –0.2201, demonstrating a 22.01% absolute risk reduction (number needed to treat (NNT) ≈5). The qualitative findings from the remaining studies corroborated the superior short-term safety of the DSFA. Based on the synthesis of available RCT data, the DSFA may be associated with a statistically significant reduced risk of transient FNI compared to the SFA.
Bagade et al. (Thu,) studied this question.