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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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Schlabe J, Davies RO, Aagaard E, Cousin G, Edwards AI, McAlister K, Cascarini L. Extended Total Temporomandibular Joint Replacement - A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint. Craniomaxillofac Trauma Reconstr 2023; 16:180-194. [PMID: 37975029 PMCID: PMC10638972 DOI: 10.1177/19433875221094971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Study design: Retrospective case series. Objective: Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Methods: Included were all patients undergoing extended TMJ-replacements (TMJe), all operatrions were carried out by the senior author. Surgical technique was either single stage or two stage protocol. Surgical details and pitfalls and outcome of more than 2 years follow-up with reference to thirteen including twelve patients were recorded. Results: The most common diagnosis was ameloblastoma of the mandibular ramus. Single stage or two stagge regime were carried out depending on resection requirements and involvement of teeth. Improved mouth opening of more than 30mm was achieved in 10 of 12 patients. One patient with previous TMJ replacement reported temporary weakness of the facial nerve, which resolved after 10 months. Conclusions: The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.
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Affiliation(s)
- Juergen Schlabe
- Head and Neck Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rhodri O.H.L. Davies
- Oral- and Maxillofacial Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Esben Aagaard
- Oral- and Maxillofacial Surgery, Odense Universitetshospital, Odense, Europe
| | - Gary Cousin
- Oral- and Maxillofacial Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | | | - Kenneth McAlister
- Oral- and Maxillofacial Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Luke Cascarini
- Oral- and Maxillofacial Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Khattak YR, Arif H, Gull H, Ahmad I. Extended total temporomandibular joint reconstruction prosthesis: A comprehensive analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101404. [PMID: 36720364 DOI: 10.1016/j.jormas.2023.101404] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Alloplastic total temporomandibular joint replacement (TMJR) is the treatment of choice for end-stage temporomandibular joint diseases. Extended TMJR (eTMJR) is a modification of the standard alloplastic fossa-condyle joint that includes components extending further to the skull base or the mandible. The aim of this study is to review the use of the eTMJR prosthesis for the treatment of large craniomaxillofacial defects. Data mining was performed according to the PRISMA statement using online search in databases such as PubMed (Medline), Google Scholar, Dimensions, Semantic Scholar and Web of Science. A total of 19 case reports, 08 case series and 03 retrospective studies were identified. A total of 49 patients were presented in the case reports and case series, who were implanted with 56 eTMJR prostheses (07 bilateral and 42 unilateral procedures). The mean age of the patients was 36.02±16.54 years, the male to female patient ratio was 1:1.72 and the mean follow-up time was 23.74 ± 19.83 months. The eTMJR prosthesis was most frequently used to treat ameloblastoma and hemifacial microsomia. Analysis of the retrospective studies was performed in three domains: the baseline characteristic of patients, treatment outcomes in terms of functional variables and complications after eTMJR prostheses implantation. This study concluded that the implantion of the eTMJR prosthesis was uncommon, that appropriate class of eTMJR prosthesis was not reported, and that the width of the mandibular component (like the length) of eTMJR prosthesis has substantial variations.
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Affiliation(s)
| | | | - Hanan Gull
- Farooq Hospital Lahore, Pakistan; Akhtar Saeed Trust Hospital Lahore, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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Gonzalez-Perez LM, Montes-Carmona JF, Torres-Carranza E, Infante-Cossio P. Total Joint Replacement for Immediate Reconstruction following Ablative Surgery for Primary Tumors of the Temporo-Mandibular Joint. J Pers Med 2023; 13:1021. [PMID: 37511634 PMCID: PMC10381122 DOI: 10.3390/jpm13071021] [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: 04/30/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Temporomandibular joint (TMJ) tumors are rare and difficult to diagnose. The purpose of this retrospective study was to evaluate the clinicopathologic characteristics of twenty-one patients with primary TMJ tumors between 2010 and 2019 and to analyze the surgical outcome and morbidity after ablative surgery and TMJ replacement. This case series confirmed the difficulty of diagnosis and reaffirmed the need for early recognition and management of TMJ tumors. There were no pathognomonic findings associated with TMJ tumors, although single or multiple radiopaque or radiolucent areas were observed on plain or panoramic radiographs. Occasionally, bone resorption or mottled densities caused by pathologic calcification and ossification were seen. Computed tomography and magnetic resonance imaging played an important role in the diagnosis. In our study, the distribution of histologic types of TMJ tumors was quite different from that of other joint tumors. The recommended treatment was surgical intervention by ablation of the joint and TMJ replacement. The results of this retrospective study support the surgical exeresis and replacement with TMJ stock and custom-made prostheses and show that the approach is efficacious and safe, reduces pain and improves mandibular movements, with few complications.
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Affiliation(s)
- Luis-Miguel Gonzalez-Perez
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain
- Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain
| | | | - Eusebio Torres-Carranza
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain
| | - Pedro Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain
- Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain
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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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Callahan N, Patel M, Dyalram D, Lubek JE. Is the prevention of condylar sag with maxillomandibular fixation the key to functional reconstruction of a mandibular disarticulation resection? Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:317-322. [PMID: 35428599 DOI: 10.1016/j.oooo.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the long-term outcomes of the use of the free fibula flap for reconstruction with mandibular disarticulation resections. STUDY DESIGN A retrospective chart cohort review was performed in patients reconstructed with a fibula free flap for a mandibular disarticulation resection at an academic tertiary care institution over a 5-year period. RESULTS Twenty-four patients were included in the study. Fourteen patients were treated for benign pathology, and 10 cases were malignant. Average follow-up was 20 months. Virtual surgical planning/3-dimensional models were used in all cases. Maxillomandibular fixation (MMF) with surgical wires was used in 65% (n = 13/20) of the dentate patients. Average maximum interincisal opening was 28.2 mm in patients receiving radiation and 38.7 mm in the nonradiated group (P = .01). No patient developed joint ankylosis. Neocondyle position was an average of 11.7 mm from condylar fossa, radiographically. Seventeen of the dentate patients (85%) had reproducible class I occlusion. Occlusion was superior in patients placed into MMF compared with those with elastics or no MMF (P = .06) and independent of the position of the neocondyle (P = .19). CONCLUSIONS The vascularized fibula flap can be used to provide functional reconstruction of the mandibular condyle defect. The use of at least 2 weeks of MMF maintains an adequate occlusion irrespective of the fibula-glenoid fossa position. The neocondyle does not need to directly abut the articular disc or fossa for adequate functional outcomes.
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Affiliation(s)
- Nicholas Callahan
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Manan Patel
- Resident, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA
| | - Donita Dyalram
- Assistant Professor and Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA
| | - Joshua E Lubek
- Associate Professor and Fellowship Director, Oral-Head & Neck Surgery/Microvascular Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
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Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection. J Craniofac Surg 2021; 33:284-288. [PMID: 34510060 DOI: 10.1097/scs.0000000000008124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Ameloblastomas are benign tumors that most commonly affecting the mandible. The current standard of treatment for ameloblastomas is resection followed by reconstruction that has historically been accomplished through the use of a microsurgical vascularized flaps taken from the iliac crest or fibula. Alloplastic reconstruction methods have gained popularity over recent years with success reported in the reconstruction of many pathologies, including ankylosis, condylar fracture, neoplasia involving extensive resection, severe inflammatory/degenerative temporomandibular joint (TMJ) disease, and congenital TMJ abnormalities. The authors present a patient who successfully underwent ameloblastoma resection and TMJ reconstruction with a custom TMJ Concepts alloplastic implant. The authors also present a review of the literature on alloplastic TMJ reconstruction following ameloblastoma resection. To our knowledge, this is the second report in the literature on the use of a TMJ Concepts implant after ameloblastoma resection.
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Mertens F, Dormaar JT, Vander Poorten V, Vranckx JJ. Objectifying growth of vascularized bone transfers after mandibular reconstruction in the pediatric population. J Plast Reconstr Aesthet Surg 2021; 74:1973-1983. [PMID: 34187765 DOI: 10.1016/j.bjps.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autologous vascularized bone transfer is the preferred strategy for the reconstruction of mandibular defects in a pediatric population. The principal argument is the theoretical postoperative growth potential of the neomandible, which uses vascularized donor tissues. OBJECTIVES The purpose of this study was to objectify the veritable growth potential of vascularized bone transfers in children. METHODS A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, revealing 57 patients younger than or equal to 18 years who had undergone a mandibular reconstruction with a vascularized free flap. Only studies using postoperative imaging were included. Outcomes regarding growth and postoperative corrections and complications were analyzed. RESULTS Neomandibular growth was observed in 63.2% of all included patients. The proportion of growth was higher in patients with condylar preservation (95.7%) than that of patients with condylar involvement (41.2%). Reconstruction of the condyle by a free flap, which includes an epiphyseal growth plate or cartilage increased postoperative growth potential (77.8%) but did not reduce the need for later orthognathic surgery. CONCLUSION After mandibular reconstruction with a vascularized bone transfer, the majority of pediatric patients shows neomandibular growth. Condylar preservation, the inclusion of epiphyseal growth plates or cartilage, and the patients age at the time of reconstruction are essential defining parameters.
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Affiliation(s)
- Fien Mertens
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and OMFS-IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium; ORL Head & Neck Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Department of Plastic and Reconstructive Surgery, University Hospital of Leuven, 49 Herestraat, Herestraat 3000 Leuven, Belgium
| | - Jakob Titiaan Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and OMFS-IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium.
| | - Vincent Vander Poorten
- ORL Head & Neck Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Jan Jeroen Vranckx
- Department of Plastic and Reconstructive Surgery, University Hospital of Leuven, 49 Herestraat, Herestraat 3000 Leuven, Belgium.
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Primary aneurysmal bone cyst of the temporomandibular joint: Multidisciplinary management with a CAD/CAM total joint replacement in a unique patient population. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mommaerts MY, Nicolescu I, Dorobantu M, De Meurechy N. Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm. Ann Maxillofac Surg 2020; 10:73-79. [PMID: 32855919 PMCID: PMC7433953 DOI: 10.4103/ams.ams_245_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/23/2019] [Accepted: 01/28/2020] [Indexed: 11/05/2022] Open
Abstract
Context: Alloplastic temporomandibular joint (TMJ) replacement is a treatment strategy for segmental mandibular defects with occlusal abnormalities. Aims: To describe our experience with extended total TMJ replacement (eTMJR) by reporting operative obstacles, complications, and patient-reported outcomes, as well as to suggest a subclassification system and paradigm shift. Setting and Design: University hospital and private clinic; case series with retrospective follow-up. Methods and Materials: Five patients (6 eTMJRs) were followed for more than 1 year after surgery. Patient-reported outcomes were assessed using FACE-Q™ “Satisfaction with Outcome” questionnaires (sum and corresponding transformed Rasch scores). Statistical Analysis: Descriptive analyses were performed. Results: Problems were related to contralateral mandibular osteotomy healing (if performed), keying the prosthetic condyle into the fossa component, intra- and postoperative prosthetic lag, and intraoperative proper establishment of the occlusion when unilateral replacement was performed. Patients reported high satisfaction with the outcome, with a mean Rasch score of 89.2/100. Conclusions: Unilateral eTMJR obstacles related to three-dimensional rotational repositioning of the remaining mandible. We suggest a paradigm shift, considering primary alloplastic replacement instead of microvascular osseous transplantation for reconstruction when radiotherapy is not required. This can avoid donor site morbidity and long reconstructive surgery. An autologous osseous transplant is still available in case of implant failure. A subclassification system is proposed for eTMJR, which accounts for contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy.
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Nicot R, Raoul G, Ferri J, Schlund M. Temporomandibular disorders in head and neck cancers: Overview of specific mechanisms and management. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:563-568. [PMID: 32151696 DOI: 10.1016/j.jormas.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Diagnosis classification system of Temporomandibular disorders (TMD) is based on the biopsychosocial model of pain. The pathogenesis is poorly understood, leading to difficulties in treating these multifactorial conditions. The predisposing factors are pathophysiological, psychological or structural processes that alter the masticatory system and lead to an increase in the risk of development of TMD. The purpose of this integrative review was then to point out the specific mechanisms of TMD in the oral oncologic context to optimize the TMJ functional results in the management of patients with oral oncologic conditions. We explored in this paper the role of Axis II assessment of the biopsychosocial model of pain, the involvement of mechanical concepts such as dental occlusion, mandibular condyle positioning and related-structures reconstruction, and the stomatognathic changes induced by radiation.
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Affiliation(s)
- R Nicot
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France.
| | - G Raoul
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
| | - J Ferri
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
| | - M Schlund
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
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12
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Nunes Ota TM, Rodrigues Couto APG, de Menezes SAF, Viana Pinheiro JDJ, Ribeiro Ribeiro AL. An Alternative Approach for Treating Severe Injured Temporomandibular Joints by Gunshot Wounds. Ann Maxillofac Surg 2020; 9:393-396. [PMID: 31909021 PMCID: PMC6933982 DOI: 10.4103/ams.ams_35_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Temporomandibular joint (TMJ) reconstruction is a challenging clinical problem that has been revolutionized due to the development of total alloplastic TMJ replacement (TMJ-TJR); however, the costs are still very high. We used an alternative approach to treat comminuted mandibular condyle fracture with an unviable condyle head caused by gunshot wounds. Our surgical technique consisted of an extended preauricular incision; removal of the fractured condyle, bone fragments, and foreign bodies; reshape/flattening of the fracture edge; fixation of the articular disc (if viable); lining of the TMJ with temporalis muscle/fascia; application of Erich arch bars; and early elastic therapy. We successfully used this approach in five sequential cases that resulted in a good mouth opening (>35 mm) and satisfactory occlusion with teeth in maximum intercuspation. We believe that this technique is an excellent option for treating severe injured TMJs in places where TMJ-TJR is not available.
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Affiliation(s)
- Tâmara Melo Nunes Ota
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University Centre of Para - CESUPA, Belem, PA, Brazil
| | - Ana Paula Guerreiro Rodrigues Couto
- Department of Periodontology, School of Dentistry, University Centre of Para - CESUPA, Belem, PA, Brazil.,Cell Culture Laboratory, Faculty of Dentistry, Federal University of Pará, Belem, PA, Brazil
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Voss PJ, Steybe D, Fuessinger MA, Semper-Hogg W, Metzger M, Schmelzeisen R, Poxleitner P. Vascularized scapula and latissimus dorsi flap for CAD/CAM assisted reconstruction of mandibular defects including the mandibular condyle: technical report and clinical results. BMC Surg 2019; 19:67. [PMID: 31242878 PMCID: PMC6595593 DOI: 10.1186/s12893-019-0535-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022] Open
Abstract
Background Reconstruction of mandibular continuity and function after tumor resection is challenging, particularly in cases including the mandibular condyle. Various approaches for reconstruction after disarticulation resection have been reported. However, the scapula flap has received little attention as a treatment option in these cases. Patients and methods Three cases of computer aided design and computer aided manufacturing (CAD/CAM) assisted reconstruction after disarticulation resection using a vascularized scapula and latissimus dorsi flap are reported. All cases required reconstruction of the mandibular ramus and condyle in combination with the reconstruction of large and complex soft tissue defects. Results The surgical procedure was deemed successful in all cases. The scapula flap could be placed as preoperatively planned and patients regained their preoperative occlusion pattern and satisfying mouth opening-ranges. The large soft tissue defects could reliably be reconstructed using a latissimus dorsi flap. Conclusions The scapula and latissimus dorsi flap can be considered a suitable option for the reconstruction of mandibular disarticulation resection defects in combination with large soft tissue defects.
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Affiliation(s)
- Pit Jacob Voss
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - David Steybe
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Anton Fuessinger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Wiebke Semper-Hogg
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Metzger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany. .,Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Extended total temporomandibular joint replacements: a classification system. Br J Oral Maxillofac Surg 2018; 56:578-581. [DOI: 10.1016/j.bjoms.2018.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
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Franz L, Isola M, Bagatto D, Tuniz F, Robiony M. A novel approach to skull-base and orbital osteotomies through virtual planning and navigation. Laryngoscope 2018; 129:823-831. [PMID: 30151894 DOI: 10.1002/lary.27479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Computer-assisted planning of osteotomy lines, coupled with navigation-guided performance of planned osteotomies, is a highly innovative approach to skull-base and orbital surgery. The aim of this pilot study is to provide an assessment of the accuracy of this novel approach in guiding the correct positioning of osteotomy lines in frontal, temporal, and orbital regions, defining the agreement between the spatial position of the planned and performed osteotomies. METHODS Fifteen patients with orbital, frontal sinus, and lateral skull-base diseases underwent virtual surgical planning. Osteotomies to access the orbit, frontal sinus, and lateral skull base were planned on computer tomography-based three-dimensional models. The planned osteotomies were reproduced on the operating field using a navigation system. The positions of the performed and planned osteotomies were compared. The results were described as the mean positional difference between planned and performed osteotomies and as Lin's concordance coefficient, and Bland-Altman limits of agreement were also defined. RESULTS The overall mean difference was 0.719 mm (95% confidence interval [CI]: 0.472 to 0.965 mm). Overall, Lin's concordance coefficient was 0.997 (95% CI: 0.996 to 0.998), and overall Bland-Altman limits of agreement ranged from -1.407 to 2.844 mm. The smallest mean difference (0.587 mm, 95% CI: 0.244 to 0.931 mm) was calculated in the orbit group, whereas the highest mean difference (0.904 mm, 95% CI: 0.428 to 1.379 mm) was described in the lateral skull-base group. CONCLUSION This study's results support the use of this novel planning and navigation protocol for guiding osteotomy in anterior and lateral skull-base surgery, providing a clinical validation of this technique. LEVEL OF EVIDENCE 4 Laryngoscope, 00:1-9, 2018 Laryngoscope, 129:823-831, 2019.
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Affiliation(s)
- Leonardo Franz
- Department of Maxillofacial Surgery, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Miriam Isola
- Department of Maxillofacial Surgery, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.,Institute of Statistics, Department of Medicine, University of Udine
| | | | - Francesco Tuniz
- Department of Neurosurgery , Academic Hospital of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Maxillofacial Surgery, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
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Yoshimura H, Matsuda S, Ohba S, Minegishi Y, Nakai K, Fujieda S, Sano K. Stereolithographic model-assisted reconstruction of the mandibular condyle with a vascularized fibular flap following hemimandibulectomy: Evaluation of morphological and functional outcomes. Oncol Lett 2017; 14:5471-5483. [PMID: 29113176 PMCID: PMC5656033 DOI: 10.3892/ol.2017.6909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/25/2017] [Indexed: 12/04/2022] Open
Abstract
The vascularized fibular flap is one of the standard treatment choices for the reconstruction of the mandible; however, the consequences of condylar restoration have not previously been reported. The use of three-dimensional models allows for a more predictable reconstruction. The purpose of the present study was to assess the outcome of stereolithographic model-assisted reconstruction of the mandibular condyle with a vascularized fibular flap. A total of 5 patients underwent mandibular resection including the condyle and immediate reconstruction with a vascularized fibular flap. A stereolithographic model was used to determine the length and angle of the bony reconstruction. In all patients, the temporomandibular joint (TMJ) disc was preserved, and the contoured fibular end was placed directly into the glenoid fossa under the TMJ disc. To investigate the morphological and functional outcomes, radiographic and clinical examinations were performed, and a food scale questionnaire was administered. The mean period of follow-up was 23 months, and all the flaps were viable. Cosmetic results were generally satisfactory. Radiographic assessment revealed that the end of the fibular graft became round-shaped. None of the patients had abnormal bone resorption, dislocation or ankylosis. The mean value of maximum mouth opening was 31 mm. No patients exhibited difficulties with occlusion. All patients recovered their ability to ingest nearly the same foods that were ingested prior to surgery. The stereolithographic model-assisted reconstruction of mandibular condyle with a vascularized fibular flap is therefore useful for morphological and functional reconstructions of the hemimandible, including condylar defects.
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Affiliation(s)
- Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoshiki Minegishi
- Department of Plastic and Reconstructive Surgery, University of Fukui Hospital, Fukui, Japan
| | - Kunihiro Nakai
- Department of Plastic and Reconstructive Surgery, University of Fukui Hospital, Fukui, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology Head and Neck Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazuo Sano
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Abstract
Ablative surgery of mandible often necessitates combined reconstruction of the mandible and the temporomandibular joint. Fibula-free flaps with gap arthroplasty or osseochondral grafts are common procedures in the authors' practice. In search for a better reconstructive option free fibula flap is used together with a metatarsal bone flap for the vascular reconstruction of the mandibular body and the condyle at the same time. The 2 osseous-free flaps have been fused and used as a combined flow through double-free flap. The literature has been reviewed for other reconstructive options, but no alternatives providing autologous reconstruction of both the mandible and the condyle with vascular tissue have been found. This is a preliminary report of this new technique which the authors humbly think is very promising.
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Abstract
PURPOSE OF REVIEW Multiple disease processes, including neoplasia, trauma, and medication side-effects, necessitate segmental resection and subsequent reconstruction of the mandible. As surgical techniques have advanced, several technologies have been developed with the potential to significantly transform a surgeon's approach to the restoration of mandibular continuity. The purpose of this review is to highlight many of these relatively newer tools and discuss their evolving role in mandibular reconstruction. RECENT FINDINGS Several contemporary studies have documented the application of different approaches and modifications to mandibular reconstruction - including computer-aided design or computer-aided modeling, contemporary plating systems, osseointegrated implants, and various modifications to existing osseocutaneous free tissue transfer options - and have reported relatively high success rates. SUMMARY In discussing these reports, we present a survey of current and developing technologies in the field of mandibular reconstruction and aim to provide sufficient context for the gradual integration of these techniques into practice.
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