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Qaisi M, Al Azzawi T, Joseph F, Shah B, Murphy J. Osteo-cutaneous microvascular free-flaps are a viable option for reconstructing the temporomandibular joint. Heliyon 2024; 10:e28201. [PMID: 38571615 PMCID: PMC10987928 DOI: 10.1016/j.heliyon.2024.e28201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
Background There are multiple reconstructive options after mandibular resection and disarticulation of the condyle. The purpose of this study was to assess the clinical outcomes and functionality of osteocutaneous free flaps in the reconstruction of mandibular defects that involve the Temporo-Mandibular Joint (TMJ). Methods Our study is a retrospective cohort study involving subjects who underwent mandibular resection and needed TMJ reconstruction with vascularized bony-free flaps from February 2016 to June 2018. Data gathered included patient demographics, post-operative function, maximum interincisal opening (MIO), occlusion status, deviation on opening, and TMJ symptoms. Data points collected from postoperative CT imaging included the following: position of the flap in relation to the glenoid fossa and articular eminence, and closest point of contact. Results Eight out of the nine patients who underwent free flap reconstruction of mandibular defects involving the TMJ qualified for the study. The mean age was 39.7 years old. In all 8 cases, virtual surgical planning (VSP) was used. The mean follow-up time was 18.75 months. The flap success rate was 100%. The mean MIO was 37.37 mm. Six patients resumed their premorbid diet, and one patient developed dysphagia and was peg tube dependent. In seven cases the occlusion was intact and reproducible, one case was without sufficient teeth for occlusion. On imaging, the mean distance from the neo-condyle to the glenoid fossa was 14 mm and to the articular eminence 8.68 mm. The point of closest contact in all cases appeared to be the articular eminence. Conclusion Vascularized Osteocutaneous-flaps such as FFFs and DCIA flaps provide a good option for the reconstruction of mandibular defects that involve the TMJ. Ipsilateral deviation on opening does not negatively affect clinical outcomes or function. Placing patients in Maxillomandibular fixation for 4-6 weeks may help to prevent condylar sag and provide stable post-operative occlusion.
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Affiliation(s)
- Mohammed Qaisi
- Oral & Maxillofacial Surgery, USA
- Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, 1950 W Polk Street, Suite 8302, Chicago, IL 60612, USA
| | - Thaer Al Azzawi
- Division of Oral and Maxillofacial Surgery Cook County Health 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
| | - Fanti Joseph
- Oral & Maxillofacial Surgery Resident, Division of Oral and Maxillofacial Surgery, Cook County Health, 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
| | - Biraj Shah
- Attending Physician Division of Oral and Maxillofacial Surgery Cook County Health 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
| | - James Murphy
- Attending Physician Division of Oral and Maxillofacial Surgery Cook County Health 1950 W Polk Street, Suite 8302 Chicago, IL 60612, USA
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Hijazi KM, Dixon SJ, Armstrong JE, Rizkalla AS. Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction. MATERIALS (BASEL, SWITZERLAND) 2023; 17:140. [PMID: 38203994 PMCID: PMC10779528 DOI: 10.3390/ma17010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.
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Affiliation(s)
- Khaled M. Hijazi
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
| | - S. Jeffrey Dixon
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - Jerrold E. Armstrong
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Amin S. Rizkalla
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
- Chemical and Biochemical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
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Hidaka T, Tanaka K, Mori H. An Artificial Intelligence-Based Cosmesis Evaluation for Temporomandibular Joint Reconstruction. Laryngoscope 2023; 133:841-848. [PMID: 35662031 DOI: 10.1002/lary.30239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Management of the temporomandibular joint (TMJ) following condylar resection remains challenging in the field of mandibular reconstruction. A simple reconstruction of the TMJ with a contoured end of a fibular graft placed into the joint space is a potential option, but its efficacy is unknown partly because there are only few objective assessment systems for aesthetic outcome. This study aimed to develop an artificial intelligence (AI)-based aesthetic outcome evaluation system for the simple TMJ reconstruction method and evaluate its functional outcomes. METHODS Patients who underwent segmental mandibular resection and reconstruction with fibular flaps at our institution between 2011 and 2020 were retrospectively reviewed. The mandibular asymmetry value was introduced as a primary aesthetic outcome measure, calculated for each patient's photograph using facial recognition AI. The outcomes of the simple TMJ reconstruction method were compared with those of cases in which the native condyle was preserved. RESULTS Ten patients underwent condylar resection followed by simple TMJ reconstruction, while the native condyle was preserved in 18 patients. No significant difference was observed in the postoperative mandibular asymmetry value between the two treatment groups. No significant differences were found in the functional outcomes of deglutition and speech. CONCLUSION The AI-based asymmetry evaluation system was useful as an aesthetic outcome measure in mandibular reconstruction. Simple TMJ reconstruction with a fibular end seemed to be a promising option, as there were no significant differences in both aesthetic and functional outcomes between this method and those cases in which the native condyle was preserved. Laryngoscope, 133:841-848, 2023.
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Affiliation(s)
- Takeaki Hidaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Tanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Yu Y, Zhang WB, Liu XJ, Guo CB, Yu GY, Peng X. Regeneration of the Neocondyle After Free Fibular Flap Reconstruction of the Mandibular Condyle. J Oral Maxillofac Surg 2020; 78:479-487. [DOI: 10.1016/j.joms.2019.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/26/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022]
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Mandibular Condyle Reconstruction With Fibula Free-Tissue Transfer: The Role of the Masseter Muscle. J Craniofac Surg 2018; 28:1955-1959. [PMID: 28938332 DOI: 10.1097/scs.0000000000003998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Free fibula flap is an option for primary restoration after disarticulation mandibular resection, though literature on technique refinements is scarce. The authors hypothesized that inset of the masseter, the key mandibular elevator muscle, at the reconstructed mandible may optimize functional recovery. METHODS All patients undergoing reconstruction of mandibulectomy-condylectomy defect (January 2009 to January 2014) by means of a fibular flap were prospectively studied. The neocondyle was formed by the distal portion of the fibula and placed directly into the glenoid fossa with preservation of the temporomandibular disc. The deep portion of the masseter was inset at the angle of the reconstructed mandible.Condylar position was postoperatively evaluated by panoramic radiographs. Patients self-evaluated speech, chewing, swallowing, and facial appearance. RESULTS Two patients had immediate and 3 delayed reconstruction involving condyle ramus body, in the study period. During a mean follow-up of 32 months, 4 patients had satisfactory occlusion, 1 patient had an open-bite deformity, but was able to masticate solid food and maintain an oral diet. Although no significant condyle dislocation was recorded, 2 patients had slight ipsilateral deviation on mouth opening. Nevertheless, cosmesis was satisfactory and all patients maintained intelligible speech. Functional score was 13.6 ± 1.14 and facial appearance score was 4 ± 0.7. CONCLUSION The free fibula transfers with direct seating of the fibula into the condylar fossa followed by masseter muscle reinsertion provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.
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HUANG JEHNSHYUN, CHEN WENHUI, LIU PAOHSIN, HUANG TZETA, HSIAO JENNREN, HO CHEINLIANG. OUTCOME ANALYSIS OF CONDYLAR PROSTHESIS IN LARGE HEAD AND NECK NEOPLASM RECONSTRUCTION. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reconstruction of the condyle after an ablative procedure for mouth neoplasms remains a surgical challenge because these patients with advanced cancer involving the condyle are subjected to massive ablative surgery, and subsequent major reconstruction with free flap and/or reconstruction prosthesis, the prognosis being poor. Therefore, reports of condylar prosthesis in head and neck cancer reconstruction are rare and with mixed results. This report is for the review of the literature and case series study of the condylar prosthesis. As with virtual technique improvement nowadays, an innovation CAD CAM technique is applied for the treatment plan for these patients. We analyze a serial case of advanced oral neoplasms who receives tumor ablation, i.e., mandibulectomy and disarticular resection, and gains symmetrical mandibular architecture after reconstruction with plate and condylar prosthesis. There is still high complication rate (41.7%) noted, namely condylar prosthesis displacement (two cases), impinge on external ear canal (two cases), and erosion of cranial base (one case). The reasons are attributed to massive flap burden, scar contraction, poor dental articulation, and possible technique error during the operation. According to the outcome analysis, virtual technique including with reconstruction plate and condylar prosthesis in conjunction with flap reconstruction are feasible treatment modality for this serial case of advanced oral neoplasms.
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Affiliation(s)
- JEHN-SHYUN HUANG
- Institute of Oral Medicine National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
- Department of Stomatology National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - WEN-HUI CHEN
- Department of Dentistry, E-Da Hospital Kaohsiung, Taiwan
| | - PAO-HSIN LIU
- Department of Biomedical Engineering College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - TZE-TA HUANG
- Institute of Oral Medicine National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
- Department of Stomatology National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - JENN-REN HSIAO
- Department of Otolaryngology National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - CHEIN-LIANG HO
- Division of Plastic and Reconstructive Surgery Department of Surgery National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
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[Condylar remodelling after temporomandibular joint reconstruction with fibula free flap]. ACTA ACUST UNITED AC 2015; 116:72-6. [PMID: 25813146 DOI: 10.1016/j.revsto.2015.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/02/2014] [Accepted: 02/09/2015] [Indexed: 11/21/2022]
Abstract
AIM Mandibular reconstructions with fibula free flap are commonly used in maxillo-facial surgery; termino-lateral mandibulectomy with reconstruction of the ramus and condylar unit is seldom used. Consequences on the temporomandibular joint remain unclear, and the type of reconstruction is still subject to controversy. METHODS Six patients were followed after terminal mandibulectomy, reconstructed with fibular free flap. Evaluations of the results were made on functional and radiological criteria. RESULTS No patient presented functional disturbances due to reconstruction. Remodeling of the neocondyle extremity was weak in adults but important in children, with modification of morphology and architecture of the condyle in children. DISCUSSION Preservation of the disc is recommended. Many techniques are described to improve congruence, preservation and remodeling of the free extremity of the fibula flap. All give similar results. It seems that the real determinant factors on the quality of the result are age, presence of the disc or not, previous surgery performed, with or without radiotherapy.
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The use of temporalis muscle graft, fresh and cryopreserved amniotic membrane in preventing temporomandibular joint ankylosis after discectomy in rabbits. J Craniomaxillofac Surg 2014; 42:1868-76. [PMID: 25218148 DOI: 10.1016/j.jcms.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate the efficacy of temporalis muscle-fascia graft, fresh and cryopreserved human amniotic membrane as an interpositional material in preventing temporomandibular joint ankylosis in a rabbit model. MATERIALS AND METHODS In this experimental study, 21 New Zealand white rabbits were used. The condyle and the joint disc were removed to induce ankylosis in left TMJs. Reconstruction was immediately performed with temporalis muscle-fascia graft (tMFG) in group I (n = 7), fresh human amniotic membrane (fHAM) in group II (n = 7) and cryopreserved human amniotic membrane (cHAM) in group III (n = 7). All rabbits were sacrificed at 3 months after the operation. The comparison was made among three groups by means of vertical mouth opening and weight measurements, radiologic and histologic findings obtained before and after surgery. RESULTS In all rabbits, there was no statistically significant difference in the jaw movements and weight among groups at commencement and 3 months after surgery. The condylar surfaces were more irregular in HAM groups. There were mild osteophyte formations, sclerosis, fibrosis and calcification around the condyle in all groups however the joint gap was more preserved in group I. All interpositional materials were also seen to be partially present in the joint gap at 3 months. Ankylosis was not seen in the joint gap in any group. CONCLUSION With the results of this study it was concluded that interpositional arthroplasty with HAM and tMFG have an almost similar effect in preventing TMJ ankylosis after discectomy in the rabbit model.
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Tuncel U, Ozgenel GY. Use of human amniotic membrane as an interpositional material in treatment of temporomandibular joint ankylosis. J Oral Maxillofac Surg 2011; 69:e58-66. [PMID: 21444140 DOI: 10.1016/j.joms.2010.12.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 11/12/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study was to demonstrate whether the human amniotic membrane (HAM) as an interpositional material could prevent temporomandibular joint (TMJ) reankylosis in the randomized rabbit model. MATERIALS AND METHODS In our experimental study, 24 New Zealand white rabbits were used and all right joints were operated. The rabbits were divided into 2 groups. The first group was specified as the demonstration group (n = 8). In this group, fibrous ankylosis formation was shown experimentally. The rabbits in the second group, the treatment group (n = 16), were divided into 2 subgroups: gap arthroplasty, performed in group A (n = 8); and HAM, used as an interpositional arthroplasty material in group B (n = 8). RESULTS In all rabbits, the range of jaw movements and weight decreased after induction of ankylosis. After surgical treatment of fibrous ankylosis, the vertical, right, and left movements of the jaw and weights of rabbits increased immediately. The results were evaluated clinically, macroscopically, histologically, and radiologically. There was a statistically significant difference in the jaw movements between groups A and B (P < .05). All operated joints in group A showed fibrous adhesions across the gap, and the articular surface was irregular with osteophytes and bony islands on the joint surface. In group B, no fibrous adhesions were observed. CONCLUSION It was concluded that interpositional arthroplasty with HAM was superior to gap arthroplasty in the rabbit model in preventing ankylosis.
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Affiliation(s)
- Umut Tuncel
- Department of Plastic Reconstructive and Aesthetic Surgery, Gaziosmanpasa University, Faculty of Medicine, Tokat, Turkey.
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Bak M, Jacobson AS, Buchbinder D, Urken ML. Contemporary reconstruction of the mandible. Oral Oncol 2010; 46:71-6. [DOI: 10.1016/j.oraloncology.2009.11.006] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 11/14/2009] [Accepted: 11/16/2009] [Indexed: 11/30/2022]
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Surgical and Prosthetic Rehabilitation of Patients With Hemimandibular Defect. J Craniofac Surg 2009; 20:2163-7. [DOI: 10.1097/scs.0b013e3181bf014a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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González-García R, Naval-Gías L, Rodríguez-Campo FJ, Martínez-Chacón JL, Gil-Díez Usandizaga JL. Vascularized Fibular Flap for Reconstruction of the Condyle After Mandibular Ablation. J Oral Maxillofac Surg 2008; 66:1133-7. [PMID: 18486777 DOI: 10.1016/j.joms.2007.06.680] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 05/19/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
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Engroff SL. Fibula flap reconstruction of the condyle in disarticulation resections of the mandible: a case report and review of the technique. ACTA ACUST UNITED AC 2006; 100:661-5. [PMID: 16301145 DOI: 10.1016/j.tripleo.2005.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Revised: 03/01/2005] [Accepted: 03/16/2005] [Indexed: 10/23/2022]
Abstract
Segmental resection of the mandible with disarticulation of the temporomandibular joint is occasionally required in the management of extensive tumors. The reconstruction of these deformities is complex, frequently involves staged procedures, and may result in significant deformity and loss of function for patients. The fibula free flap has become a standard treatment option for primary restoration of segmental mandibular deformities. However, little is published about its role in reconstructing the mandibular condyle. This paper describes a simplified technique for primary reconstruction of mandibular defects, including the mandibular condyle, in disarticulation resections of the mandible utilizing the fibula free flap.
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Affiliation(s)
- Stephen L Engroff
- Oral and Maxillofacial Surgery, Tri-County Oral-Facial Surgeons, State College, Pa 16801, USA.
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Guyot L, Richard O, Layoun W, Cheynet F, Bellot-Samson V, Chossegros C, Blanc JL, Gola R. Long-term radiological findings following reconstruction of the condyle with fibular free flaps. J Craniomaxillofac Surg 2004; 32:98-102. [PMID: 14980591 DOI: 10.1016/j.jcms.2003.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2003] [Accepted: 11/07/2003] [Indexed: 10/26/2022] Open
Abstract
AIM Fibular bone grafts are considered as one of the best choices for reconstruction of the condyle. However, little data are available on bone remodelling after such reconstruction. The purpose of this study was to evaluate the long-term radiological outcome. PATIENTS AND METHODS Eleven patients underwent condylar reconstruction with a free fibular transplant. In all cases the end of the fibular graft was placed into the glenoid fossa under the intact temporomandibular joint (TMJ) disc. Evaluation consisted of digital width and length measurement of the end of the fibula on panorex studies. RESULTS Remodelling of the end of the neocondyle was found and consisted of rounding off and narrowing of the end of the transplant. CONCLUSION The most likely explanation for these changes is the fact that the TMJ disc was preserved.
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Affiliation(s)
- Laurent Guyot
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Northside University Hospital, Marseille, France.
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Landa LE, Gordon C, Dahar N, Sotereanos GC. Evaluation of long-term stability in second metatarsal reconstruction of the temporomandibular joint. J Oral Maxillofac Surg 2003; 61:65-71. [PMID: 12524611 DOI: 10.1053/joms.2003.50048] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Our goal was to evaluate long-term stability and function of 5 condyles reconstructed with vascularized second metatarsal joint grafts. MATERIALS AND METHODS Four patients were reconstructed with 5 vascularized metatarsal grafts. These reconstructed joints were then followed for an average of 12.5 years. These patients represent the entire series and were all successfully contacted and reevaluated for this article. Measures of opening, deviation, excursion, symmetry, and clinical symptoms relating to the reconstructed joints are evaluated. RESULTS Mean preoperative interincisal aperture was 12 mm, and postoperative aperture 48.5 mm. Three unilaterally treated patients had lateral excursion with opening. The mean deflection was 4.3 mm toward the operated side. Lateral and protrusive movements were limited in reconstructed joints, but up to 3 mm of protrusion was shown at 12.5 years. Subjectively, all patients rated their function as acceptable and were able to occlude and masticate without difficulty. Symmetry at rest was improved by surgery. CONCLUSIONS Vascularized metatarsal joints represent a potentially suitable long-term substitute for condylar reconstruction. This limited series shows the technical viability of the procedure. A larger series may be warranted to compare this promising technique with conventional methods of temporomandibular joint reconstruction.
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Affiliation(s)
- Leopoldo E Landa
- Division of Plastic, Recontructive and Maxillofacial Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Nahabedian MY, Tufaro A, Manson PN. Improved Mandible Function After Hemimandibulectomy, Condylar Head Preservation, and Vascularized Fibular Reconstruction. Ann Plast Surg 2001; 46:506-10. [PMID: 11352424 DOI: 10.1097/00000637-200105000-00009] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Temporomandibular joint dysfunction after tumor extirpation of the hemimandible is a frequent sequela after condylar head reconstruction. Condylar head resection is often performed because of oncological and vascular considerations. Recent studies have demonstrated that malignancies of the mandibular ramus and body rarely involve the condylar head, and that the vascularity and supportive structures of the condylar head are sufficient to maintain viability and function. This study demonstrates that temporomandibular joint function is preserved after hemimandibulectomy without resection of the condylar head. Fixation of a vascularized fibular flap to the condylar head is performed in situ. Condylar viability and growth is maintained with painless incisal opening. The condylar head is a growth center for the mandible in the pediatric population. Its preservation in these patients will avoid the long-term problems associated with growth center loss such as malocclusion and concomitant maxillary deformity.
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Affiliation(s)
- M Y Nahabedian
- Division of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Ozcan M, Akin S, Ozbek S, Kahveci R, Safak E, Karacalar A. Temporomandibular joint reconstruction with free microvascular transfer of the metatarsophalangeal joint: a case report. Microsurgery 2000; 18:152-5. [PMID: 9727924 DOI: 10.1002/(sici)1098-2752(1998)18:3<152::aid-micr3>3.0.co;2-n] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Free microvascular transfer of the second metatarsophalangeal joint was performed for the treatment of temporomandibular joint ankylosis in a 15-year-old male patient. The result is excellent in one-year follow-up. The technique seems to be a good alternative to the problem in selected patients.
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Affiliation(s)
- M Ozcan
- Department of Plastic and Reconstructive Surgery, Uludag University Medical School, Bursa, Turkey
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Wax MK, Winslow CP, Hansen J, MacKenzie D, Cohen J, Andersen P, Albert T. A retrospective analysis of temporomandibular joint reconstruction with free fibula microvascular flap. Laryngoscope 2000; 110:977-81. [PMID: 10852517 DOI: 10.1097/00005537-200006000-00018] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The temporomandibular joint is occasionally encountered in extirpative surgery of the head and neck. It presents a difficult management issue. Little has been reported on functional outcomes after resection and reconstruction of the temporomandibular joint. DESIGN A retrospective analysis consisting of chart reviews and phone interviews was performed on 17 patients who underwent fibular free flap reconstruction of the temporomandibular joint from 1993 to 1998. RESULTS Mean follow-up in surviving patients (10) was 41.3 months. Mean age of the group was 62; male-to-female ratio was 11:6. Average hospital stay was 11.6 days. Four patients had no radiation therapy, 2 had preoperative and 11 had postoperative treatment. Five patients had one osteotomy, seven had two, one had three, and one had four. Ten patients could chew, one could not, and none were recorded for the remaining. Diet consisted of regular food for two patients, soft food for seven, full liquids for four, and tube feeds for four. Cosmesis was judged as excellent by eight patients, acceptable by two, and unacceptable by two. Five patients did not describe cosmesis. Most patients stated that bony contour was excellent, but that the soft tissue defect was noticeable. Speech was judged as intelligible by seven and moderately understandable by one. Nine patients did not describe speech. Two patients had postoperative displacement of the fibular head out of the fossa. CONCLUSION Primary reconstruction of the temporomandibular joint with microvascular fibular flaps is a viable and effective means of restoring function. The majority of patients are able to resume oral feeds, obtain excellent or pleasing cosmetic results, and maintain intelligible speech.
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Affiliation(s)
- M K Wax
- Department of Otolaryngology--Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA.
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