Temporomandibular Joint Reconstruction Using a Vascularized Bone Graft with Alloderm™

ABSTRACT

Vascularized free bone grafts have been used extensively for reconstruction of the mandible. When surgical resection includes the temporomandibular joint, definitive management remains controversial. We describe a novel technique that involves the use of a fibula free flap with Alloderm™ to reconstruct the lateral hemi-mandible and temporomandibular joint capsule. The study was performed by retrospective review of a case series at an academic center. Patients undergoing composite resection of the lateral hemi-mandible including the condyle with disruption of the temporomandibular joint were evaluated. These patients were all reconstructed with a vascularized fibula free flap with an Alloderm neocondyle reconstruction. There were nine patients with a mean age of 49.9 years. Mean follow-up was 13.1 months. There were no flap failures, infections, or complications. All patients reported improved facial symmetry, excellent jaw opening, and acceptable occlusion. All patients were able to tolerate a soft oral diet following surgery. No patients required gastrostomy tubes postoperatively.

The lateral hemi-mandible and temporomandibular joint can be resected and successfully reconstructed using a fibula free flap with Alloderm to create the neocondyle. Improved postoperative cosmesis, decreased trismus, adequate jaw opening, minimal jaw drift, and the ability to chew were achieved in the majority of patients treated in this manner.

KEYWORDS

Acellular human dermus - TMJ reconstruction - vascularized bone graft - Alloderm™

REFERENCES

• 1 Raustia A, Pernu H, Pyhtinen J et al.. Clinical and computed tomographic finding in costochondral grafts replacing the mandibular condyle.  J Oral Maxillofac Surg. 1996;  54 1393-1400
• 2 Daniel E, Browne J D. Minimizing complications in the use of titanium condylar head reconstruction prostheses.  Otolaryngol Head Neck Surg. 2004;  130 344-350
• 3 Lee J J, Worthington P. Reconstruction of the temporomandibular joint using calvarial bone after a failed Teflon-proplast implant.  J Oral Maxillofac Surg. 1999;  57 457-461
• 4 Wax M K, Winslow C P, Hansen J et al.. A retrospective analysis of temporomandibular joint reconstruction with free fibular microvascular flap.  Laryngoscope. 2000;  110 977-981
• 5 Cothren C C, Gallego K, Anderson E D, Schmidt D. Chest wall reconstruction with acellular dermal matrix (AlloDerm) and a latissimus muscle flap.  Plast Reconstr Surg. 2004;  114 1015-1017
• 6 Minsk L. The use of acellular dermal connective-tissue graft for root coverage in periodontal plastic surgery.  Compend Contin Educ Dent. 2004;  25 170 172-174
• 7 Agag R L, Granick M S, Omidi M, Catrambone J, Benevenia J. Neurosurgical reconstruction with acellular cadaveric dermal matrix.  Ann Plast Surg. 2004;  52 571-577
• 8 Poswillo D. Experimental reconstruction of the mandibular joint.  Int J Oral Surg. 1974;  3 400-411
• 9 Seymour R L, Bray T E, Irby W B. Replacement of condylar process.  J Oral Surg. 1977;  35 405-408
• 10 Mercuri L G, Wolford L M, Sanders B. Long-term follow-up of the CAD/CAM patient fitted total Temporomandibular Joint Reconstruction system.  J Oral Maxillofac Surg. 2002;  60 1440-1448