Functional outcomes of temporomandibular joint reconstruction with vascularized tissue

Hjelm, Nikolaus; Ortlip, Timothy; Topf, Michael C.; Luginbuhl, Adam; Curry, Joseph; Krein, Howard; Heffelfinger, Ryan

doi:10.1016/j.amjoto.2019.06.004

Cited by 6 publications

(12 citation statements)

References 17 publications

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“…Regarding the size of skull base defects, high-pressure and largediameter leaks require multilayered repair using inlay-free fascia grafts and pedicled NSF/PCF, 3 although it is not always necessary to use an NSF when managing a small fistula. 7 In the current case, the radioisotope distribution was confined to the right nasal cavity in cisternography, and the suspicious bony defect depicted in CT indicated that occult spontaneous leak sites may be present in the lateral wall of the right ethmoidal fovea. The probable CSF fistulas of the right cribriform plate and ethmoidal fovea were therefore repaired using pedicled/vascularized MTF, which was sufficient to cover the unilateral cribriform plate.…”

Section: Discussionmentioning

confidence: 51%

“…Over the years, various techniques of total or subtotal nasal reconstructions have been reported by many authors, including prelaminated and prefabricated free flaps, radial forearm free flap (RFFF), infolded RFFF, osteocutaneous RFFF, multiple skin paddles RFFF, auricular free flap (AFF) (sometimes described as ''helical rim flap'') or microvascular free flaps with titanium mesh for structural support. [1][2][3][4][5][6][7] According to Zhang et al 8 AFF provides both inner and outer lining of the nose with cartilaginous framework in between. In AFFs ascending helical rim is usually used to reconstruct ala, and the crus of the helix -the nostril sill.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Endonasal Reconstruction Using a Pedicled Middle Turbinate Flap for Spontaneous Cerebrospinal Fluid Rhinorrhea

Takahara

Ueda

Toda

2021

Journal of Craniofacial Surgery

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However, the postoperative reconstruction for such large defect including TMJ component is a very difficult challenge.For TMJ reconstruction, 2 main options are available: alloplastic condylar prosthesis and autologous tissue transfer. Alloplastic TMJ prosthesis is considered the clinical standard. 5 However, this alloplastic joint replacement is widely used, although only by few surgeons who perform TMJ reconstruction. 6 To prevent prosthesis penetrate the cranial fossa, a combined use of stock prosthesis is necessary. However, this TMJ-stock prosthesis needs elaborate adaptation, which is difficult to achieve after cancer radical surgery. For large, challenging defects, the commercial TMJ prosthesis cannot restore mandible continuity. In comparison with our method, the commercial TMJ prosthesis is very expensive.The autologous bone graft is another option for TMJ reconstruction, such as ribs and the free fibular flap. Costochondral rib graft is the gold standard in children due to growth potential from the cartilage, although it is unpredictable. Moreover, joint ankylosis and a decrease in joint function are complications. Besides, costochondral graft is not resistant to postoperative radiotherapy after advanced oral cancer operation. Vascularized bone graft, such as fibular flap, is another option with acceptable long-term outcomes. 7 However, there are concern such as donor site morbidity and insufficient soft tissue volume to restore large defect like hemimandibulectomy. Furthermore, hypomobility, difficulty in achieving appropriate condylar position, and postoperative ankylosis also reported. 8 For our case, using fibular flap will need another ALT free flap to restore such a large soft tissue defect. It is a timeconsuming operation. Moreover, the possibility of postoperative ankylosis, joint hypomobility, osteonecrosis due to following radiotherapy is another concern. Therefore, we did not perform free fibular flap simultaneously.When alloplastic TMJ condyle is unavailable, a reconstruction plate is a candidate for temporal TMJ reconstruction. Shukla et al 9 first mentioned the use of a reconstruction plate to reconstruct the defect after hemimandibulectomy in cT2N1M0, stage III retromolar trigone squamous cell carcinoma. However, Shukla did not show a clinical picture of his case. Hocaoglu et al 10 presented a case of ameloblastoma treated with segmental mandibulectomy and reconstruction by using a reconstruction plate-bended artificial condyle. His method is similar to ours, but he connected the condylar head and reconstruction plate with wire and screws. However, the author did not mention how he fixed the condylar head to the fossa. Back to our case, we present a well document case with details using this method for the defect of hemimandibulectomy. Such large defect is unable to restore by alloplastic TMJ prosthesis. Free fibular flap is most widely used for such cases. However, postoperative CCRT usually leads to poor healing of the bone, even osteoradionecrosis of the fibular. In such circumstance, ...

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Reconstruction Using a Pedicled Middle Turbinate Flap for Spontaneous Cerebrospinal Fluid Rhinorrhea

Takahara

Ueda

Toda

2021

Journal of Craniofacial Surgery

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“…Restoration of oral function and contour symmetry of the lower face is the primary goal of mandibular reconstruction 1–4 . The mandibular condyle is occasionally resected in ablative surgery, but condylar resection without reconstruction of the temporomandibular joint (TMJ) can result in severe functional and cosmetic impairment 5,6 . Although several methods for TMJ reconstruction have been proposed, 3–18 TMJ management remains challenging and no standardized method has been established.…”

Section: Introductionmentioning

confidence: 99%

An Artificial Intelligence‐Based Cosmesis Evaluation for Temporomandibular Joint Reconstruction

2022

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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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confidence: 99%

“…6 Another alternative biomaterial in endodontics is mineral trioxide aggregate, which showed highly excellent biocompatibility and stability over time. 7 The treating dentist should be aware of the advantages and the disadvantages of the current biomaterials in market, and make the appropriate of choice of treatment based on each individual patients.Unfortunately, dental practitioner negligence, which jeopardizes the required standards of healthcare, fails to prevent this potentially life-changing injury, as seen in the current case. In dental practice, an injury resulting from lack of care can be considered negligence.…”

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confidence: 99%

Clinical T4b Squamous Cell Carcinoma Resection With Hemimandibulectomy and Temporomandibular Joint Reconstruction With Bridging Plate and Modified Dautrey Procedure

Shih

Lee²,

Lin

2021

Journal of Craniofacial Surgery

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beam CT-based radiographic measurements were the most accurate method for determining the working length, followed by electronic apex locators, which had very close results to cone-beam CT. 5 One of the disadvantages of Ca(OH) 2 is that when it comes in contact with pulp proteins, the bactericidal activity quickly weakens due to the oxidation reaction. Recently, copper-calcium hydroxide has been widely available for its potent antimicrobial properties and superior regenerative attributes. According to a recent study, the copper-calcium hydroxide and electrophoresis technique is more effective in treating destructive periodontitis up to 8 months compared to that of traditional method. 6 Another alternative biomaterial in endodontics is mineral trioxide aggregate, which showed highly excellent biocompatibility and stability over time. 7 The treating dentist should be aware of the advantages and the disadvantages of the current biomaterials in market, and make the appropriate of choice of treatment based on each individual patients.Unfortunately, dental practitioner negligence, which jeopardizes the required standards of healthcare, fails to prevent this potentially life-changing injury, as seen in the current case. In dental practice, an injury resulting from lack of care can be considered negligence. In the current literature, there are no official representative article concerning the potential hazards of root canal filling material extrusion into the IAN, and its legal justice for urgent management.In this current case report, the ethnical responsibilities of the clinician were not upheld due to failure to assess the osteomyelitic lesion before treatment, lack of appropriate clinician-patient communication and trust, lack of clinician experience, and failure to identify the dental negligence that ultimately caused the IAN injury. In the event of malpractice, the professional liability of the dentist must be established. As a lifeguard of human health, dentists have the legal and ethical obligations to perform the optimal treatment procedure in accordance with the ethical mission. Though law is universal and applicable to all fields of medicine, including dentistry, ethics and morals can differ by individual. Because of this, a minimum threshold of ethics must be established by law. CONCLUSIONSIn the current corporate environment of dentistry within a highly developing market system governed by profit and loss concerns, one should never forget the main goal of medicine, which is to not harm.

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Functional outcomes of temporomandibular joint reconstruction with vascularized tissue

Cited by 6 publications

References 17 publications

Endoscopic Endonasal Reconstruction Using a Pedicled Middle Turbinate Flap for Spontaneous Cerebrospinal Fluid Rhinorrhea

Endoscopic Endonasal Reconstruction Using a Pedicled Middle Turbinate Flap for Spontaneous Cerebrospinal Fluid Rhinorrhea

An Artificial Intelligence‐Based Cosmesis Evaluation for Temporomandibular Joint Reconstruction

Clinical T4b Squamous Cell Carcinoma Resection With Hemimandibulectomy and Temporomandibular Joint Reconstruction With Bridging Plate and Modified Dautrey Procedure

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