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Pyne JM, Davis CM, Kelm R, Bussolaro C, Dobrovolsky W, Seikaly H. Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning. J Otolaryngol Head Neck Surg 2023; 52:44. [PMID: 37400904 DOI: 10.1186/s40463-023-00639-4] [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: 08/15/2022] [Accepted: 04/04/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient's life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous reconstruction with a vascularized free fibular flap (FFF) using Surgical Design and Simulation (SDS) and alloplastic TMJ prosthesis. The objective of this study is to report the functional and quality of life (QOL) outcomes in a cohort of patients that had undergone our reconstructive protocol. METHODS This was a prospective case series of adult patients that underwent mandibular reconstruction with FFF and alloplastic TMJ prosthesis at the our center. Pre-operative and post-operative maximum inter-incisal opening (MIO) measurements were collected, and patients completed a QOL questionnaire (EORTC QLQ-H&N35) during those perioperative visits. RESULTS Six patients were included in the study. The median patient age was 53 years. Heat map analysis of the QOL questionnaire revealed that patients reported a positive clinically significant change in the domains of pain, teeth, mouth opening, dry mouth, sticky saliva, and senses (relative change of 2.0, 3.3, 3.3, 2.0, 2.0, and 1.0 respectively). There were no negative clinically significant changes. There was a median perioperative MIO increase of 15.0 mm, and this was statistically significant (p = 0.027). CONCLUSIONS This study highlights the complexities involved in mandibular reconstruction with involvement of the TMJ. Based on our findings, patients can obtain an acceptable QOL and good function following simultaneous reconstruction with FFF employing SDS and an alloplastic TMJ prosthesis.
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Affiliation(s)
- Justin M Pyne
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Clayton M Davis
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Ryan Kelm
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Claudine Bussolaro
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Walter Dobrovolsky
- Division of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
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Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps. Plast Reconstr Surg Glob Open 2023; 11:e4738. [PMID: 36655027 PMCID: PMC9839264 DOI: 10.1097/gox.0000000000004738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 01/20/2023]
Abstract
The free fibula flap is the gold standard in reconstruction of oncologic mandibular defects. When the mandibular condyle is resected, reconstruction of the temporomandibular joint (TMJ) continues to pose a unique challenge to the reconstructive surgeon. Several conventional methods have been described, including costochondral grafts, bone grafts, and alloplastic prostheses. These nonvascularized options are rarely employed in the oncologic patient receiving postoperative radiation therapy due to high rates of resorption, nonunion, and failure. The authors describe a novel technique for mandibular and TMJ reconstruction utilizing the fibula free flap as a flow through for a medial femoral trochlea flap for vascularized mandible and condylar reconstruction. This technique provides a vascularized cartilaginous surface to articulate with the glenoid fossa, making it an attractive option for the oncologic patient undergoing postoperative radiation therapy.
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Maurer M, Gottsauner JM, Meier JK, Reichert TE, Ettl T. CAD/CAM and conventional reconstruction of the mandibular condyle by fibula free flap: a clinical and radiological evaluation. Int J Oral Maxillofac Surg 2022; 52:531-538. [PMID: 36088184 DOI: 10.1016/j.ijom.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022]
Abstract
The aim of this study was to analyse the radiological and clinical outcomes of condylar reconstruction by fibula free flap (FFF), comparing conventional freehand and CAD/CAM techniques. Fifteen patients (nine CAD/CAM, six freehand) who underwent condylar reconstruction with a FFF were reviewed retrospectively regarding pre- and postoperative computed tomography/cone beam computed tomography scans and clinical function. After surgery, all patients were free of temporomandibular joint pain. Mean postoperative mouth opening was 30.80 mm, with no significant difference between the freehand and CAD/CAM groups. In all patients, laterotrusion was decreased to the contralateral side (P = 0.002), with no difference between freehand and CAD/CAM, while the axis of mouth opening deviated to the side of surgery (P < 0.001). All patients showed significant radiological deviation of the fibular neocondyle in the laterocaudal direction (lateral: P = 0.015; caudal: P = 0.001), independent of the technique. In conclusion, reconstruction of the mandibular condyle by FFF provided favourable functional results in terms of mouth opening, reduction of pain, and mandibular excursions. Radiological deviation of the neocondyle and deviation of laterotrusion and mouth opening did not impair clinical function. CAD/CAM planning facilitated surgery, decreased the surgery time, and improved the fit of the neocondyle in the fossa.
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Affiliation(s)
- M Maurer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J M Gottsauner
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J K Meier
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - T E Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - T Ettl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
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Rao S, Pandey S, Konuri VK, Khandelwal E. Vascularized Second Metatarsal Joint Transfer with Concomitant Orthognathic Surgery for Reconstruction of the Temporomandibular Joint: Our Pilot Experience. J Maxillofac Oral Surg 2022; 21:58-63. [PMID: 35400912 PMCID: PMC8934833 DOI: 10.1007/s12663-021-01615-z] [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: 12/19/2020] [Accepted: 07/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Temporomandibular joint ankylosis-associated deformity and dysfunction is a challenge to reconstruct. Alloplastic temporomandibular joints, both stock and custom-made, are used to replace the ankylotic mass with a functional joint. Still, the cost of these alloplastic joints is so expensive that it cannot be affordable to most of our population. Purpose A primary objective of achieving at least 35 mm of mouth opening was planned. Secondarily we planned to achieve a functional occlusion with acceptable facial balance and symmetry. Method Autologous TMJ reconstruction using vascularized second metatarsal joint transfer with concomitant orthognathic surgery. The surgery aims to achieve a significant functional rehabilitation with correction of maxillomandibular deformity in a single-stage surgery. Results As a result of this, we present our initial experience to rehabilitate the patient with temporomandibular joint ankylosis both functionally and aesthetically by performing simultaneously joint replacement using the patient's own vascularized second metatarsal joint and concomitantly performing the orthognathic surgery. By this, we could holistically treat the patient with minimal cost and make them socially acceptable. Conclusion We do not propose a 2nd metatarsal vascularized flap as a substitute for a custom-made total TMJ prosthesis. Still, we suggest a viable option in a selected set of patients where TMJ prosthesis cannot be afforded or has failed with a history of multiple surgeries in the same region.
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Affiliation(s)
- Santhosh Rao
- Department of Dentistry – Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Sameer Pandey
- Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Vijaya Kumar Konuri
- Department of Anatomy, All India Institute of Medical Sciences, Raipur, India
| | - Ekta Khandelwal
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
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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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Functional reconstruction of the glenoid fossa utilizing a pedicled temporal osteomuscular flap. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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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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Validation of an extended total joint replacement (eTJR) classification system for the temporomandibular joint (TMJ). Br J Oral Maxillofac Surg 2020; 59:788-791. [PMID: 34272106 DOI: 10.1016/j.bjoms.2020.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023]
Abstract
The aim of this paper was to validate a previously described classification system for extended total joint replacements (eTJRs) of the temporomandibular joint (TMJ). We engaged an expert panel to review 60 TMJ eTJR devices and classify them using the system, examining their responses for inter-rater agreement and concordance with the correct response as determined by the authors. Conger's kappa was 0.34 for the fossa (F) component sub-classification and 0.67 for the mandibular (M) component. A posthoc analysis showed improvements in inter-rater agreement for a modified three-tiered F sub-classification system which is suggested in a revised version of the TMJ eTJR classification system.
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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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Abstract
PURPOSE OF REVIEW Temporomandibular joint (TMJ) reconstruction represents one of the more challenging clinical problems that a head and neck surgeon encounters. Fortunately, the problem is fairly uncommon; however, at the same time, clear clinical guidelines have not been formulated. The goal of this review is to present the established solutions to this difficult reconstructive challenge and highlight key developments that have been recently published. RECENT FINDINGS Modern-day approaches to TMJ reconstruction include a handful of surgical modalities: costochondral grafting, revascularized tissue transfer, distraction osteogenesis, and alloplastic temporomandibular joint replacement (APTMJR). Over the past several years, publications have focused primarily on distraction osteogenesis and APTMJR. In particular, APTMJR is emerging as a highly successful and versatile surgical modality when faced with TMJ defects. SUMMARY With long-term follow-up after APTMJR approaching 20 years at several of the pioneering centers, alloplastic total joint replacement is emerging as the clinical standard when faced with TMJ defects in a variety of clinical situations. Unfortunately, the dogma of serious complications that occurred during early development may still be stalling widespread acceptance of APTMJR. Due to the complexity of the surgery, its relative infrequency and the lack of exposure in the majority of residency training programs, this surgery is currently best performed by tertiary referral centers.
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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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Fibular free flap reconstruction for the management of advanced bilateral mandibular osteoradionecrosis. J Craniofac Surg 2015; 26:e172-5. [PMID: 25675011 DOI: 10.1097/scs.0000000000001391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fibular osteoseptocutaneous flap has been widely used for unilateral mandibular reconstruction. However, reports about the effects of fibular osteoseptocutaneous flap for the reconstruction of bilateral mandibular defects are limited. In this study, we used free vascularized fibular flaps to successfully manage bilateral mandibular osteoradionecrosis(ORN) in 5 patients. Functional aspects were evaluated during the reconstruction process. All 5 patients had bilateral refractory ORN of the mandible and underwent radical resection between 2003 and 2011. The reconstruction surgery was performed in 2 stages using 2 free fibular flaps in 3 patients. In the other 2 patients, reconstruction was performed in a single stage using 2 separate flaps prepared from a single fibula. All patients had a healthy mandibular symphysis and meniscus of the temporomandibular joint, and these structures were preserved during the reconstruction.Of the 10 defects involving the mandible sides, 9 were successfully reconstructed. One microvascular composite flap failed because of radiation injury to the arterial endothelium at the recipient site. After the treatments, all patients had good esthetic and functional outcomes. Preoperative clinical features such as trismus and dysphagia were also markedly improved. Our surgical method may be an effective alternative for the clinical management of advanced bilateral mandibular ORN.
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Abstract
Temporomandibular joint (TMJ) ankylosis is a pathologic condition where the mandible is fused to the fossa by bony or fibrotic tissues. This interferes with mastication, speech, oral hygiene, and normal life activities, and can be potentially life threatening when struggling to acquire an airway in an emergency. Trauma is the most common cause of TMJ ankylosis, followed by infection. Diagnosis of TMJ ankylosis is usually made by clinical examination and imaging studies. The management goal in TMJ ankylosis is to increase the patient's mandibular function, correct associated facial deformity, decrease pain, and prevent reankylosis.
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Affiliation(s)
- Reza Movahed
- Private practice, Orthodontics, Saint Louis University, St Louis, Missouri, USA.
| | - Louis G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, West Harrison Street, Chicago, IL 60612, USA
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Komune N, Komune S, Morishita T, Rhoton AL. Microsurgical anatomy of subtotal temporal bone resection en bloc with the parotid gland and temporomandibular joint. Neurosurgery 2015; 10 Suppl 2:334-56; discussion 356. [PMID: 24561868 DOI: 10.1227/neu.0000000000000324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subtotal temporal bone resection (STBR) has been used for half a century to remove temporal bone malignancies. However, there are few reports on the detailed anatomy involved in the resection. OBJECTIVE To describe the microsurgical anatomy of STBR combined en bloc with the resection of the parotid gland and temporomandibular joint (TMJ). METHODS Cadaveric specimens were dissected in a stepwise manner using 3× to 40× magnification. RESULTS STBR can be combined with the total parotidectomy and the resection of the TMJ if the tumor extends into the parotid gland, TMJ, or facial nerve. In this study, we describe the step-by-step microsurgical anatomy of STBR en bloc with the parotid gland and TMJ. The surgical technique described combines 3 approaches: the high cervical, subtemporal-infratemporal fossa, and retromastoid-paracondylar approaches. Combining these 3 approaches aided in efficiently completing this modified approach. CONCLUSION STBR is a complicated and technically challenging procedure. This study highlights the importance of understanding the surgical anatomy of STBR and will serve as a catalyst for improvement of the surgical technique for temporal bone resection.
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Affiliation(s)
- Noritaka Komune
- *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Otorhinolaryngology Head and Neck Surgery, Kyushu University, Fukuoka, Japan
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Vascularized Treatment Options for Reconstruction of the Ascending Mandible With Introduction of the Femoral Medial Epicondyle Free Flap. J Craniofac Surg 2014; 25:1690-7. [DOI: 10.1097/scs.0000000000001192] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nonsyndromic facial asymmetry with unilateral condylar aplasia. Case Rep Dent 2013; 2013:631284. [PMID: 24024045 PMCID: PMC3759262 DOI: 10.1155/2013/631284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/15/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. The temporomandibular joint (TMJ) is the most complex elegantly designed joint in the human body. Abnormal development and growth of TMJ may lead to condyle aplasia present in several syndromes expressions, but it is extremely rare when not connected to any underlying pathological disorder or in conjunction with any syndrome. Objective. A rare case of aplasia of the mandibular condyle is presented, along with 3D computed tomography (3D CT) findings. Conclusion. Based on clinical and radiological findings we suggest the abnormal development of the TMJ as the origin. The 3D CT has provided high-quality images, which made diagnosis and a prompt treatment plan possible.
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Vega LG, González-García R, Louis PJ. Reconstruction of Acquired Temporomandibular Joint Defects. Oral Maxillofac Surg Clin North Am 2013; 25:251-69. [DOI: 10.1016/j.coms.2013.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Combined second metatarsophalangeal joint and extended dorsalis pedis flap for reconstruction of temporomandibular joint and oral mucosa. Br J Oral Maxillofac Surg 2012; 51:e54-6. [PMID: 22495404 DOI: 10.1016/j.bjoms.2012.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/14/2012] [Indexed: 11/23/2022]
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Khadka A, Hu J. Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future. Int J Oral Maxillofac Surg 2011; 41:94-102. [PMID: 22088390 DOI: 10.1016/j.ijom.2011.10.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 07/26/2011] [Accepted: 10/20/2011] [Indexed: 11/25/2022]
Abstract
Temporomandibular joint (TMJ) ankylosis is characterized by difficulty or inability to open the mouth due to fusion of the temporal and the mandible, resulting in facial symmetry/deformity, malocclusion and dental problems. The only treatment option for TMJ ankylosis is surgical with or without condylar reconstruction. Various autogenous grafts are available for condylar reconstruction after freeing the ankylotic mass such as costochondral, sternoclavicular, fibular, coronoid, and metatarsophalangeal. Costochondral graft is preferred by surgeons, but distraction osteogenesis is slowly gaining popularity and may ultimately become the standard procedure, providing a cost-effective approach with low morbidity and excellent functional outcomes. Tissue engineering is another budding field which has shown promising results in animal studies but has not been applied to humans. To date, there is no ideal autogenous graft for condylar reconstruction that satisfies the complex anatomy and the myriad of functions of a missing condyle.
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Affiliation(s)
- A Khadka
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, Sichuan University, West China College of Stomatology, Chengdu 610041, China
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