Simultaneous Autologus Mandible and Temporomandibular Joint Reconstruction

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.

Osteo-cutaneous microvascular free-flaps are a viable option for reconstructing the temporomandibular joint

“…Among TMJ reconstruction options are alloplastic total joint replacements, reconstructions with a condylar head prosthesis, non-vascularized bony flaps, and microvascular free flaps [ 10 , 11 ] Reconstruction bars with condylar heads are usually used as an interim treatment due to the high complication risk involved like plate fracture and/or exposure, facial nerve damage, and erosion into the external auditory meatus or skull base [ 7 , 8 ]. Total joint replacement prostheses like TMJ Concepts work well in cases with completed bone growth, benign tumors, and defects that do not have a large soft tissue component [ [10] , [11] , [12] ]. The use of free bone grafts for defects involving the TMJ has been widely reported.…”

“…Alloplastic reconstruction of the condyles with a recon bar and condylar head has been historically associated with several complications like plate fracture and sensory disturbances [ [7] , [8] , [9] ]. Custom and stock TMJ prostheses work well but have limitations depending on the amount of bone and soft tissue that is being reconstructed simultaneously [ [10] , [11] , [12] ]. Additionally, they are not ideal in wounds with poor recipient beds due to multiple prior surgeries, infection, or irradiation [ [13] , [14] , [15] ].…”

Flow through fibula and fasciocutaneous free flaps in oromandibular reconstruction

“…We preferred to anastomose two flaps on operation table firstly. Our previous use of flow‐through double free flaps was the combination of fibula and metatarsal bones for simultaneous mandible and temporo‐mandibular joint reconstruction (Tiftikcioglu, Gur, & Bilkay, 2017). From the experience of our previous report, we found it useful to make the anastomosis between flaps before bone fixation for two reasons.…”

3D‐printed temporomandibular joint‐mandible combined prosthesis: A prospective study

“…The temporomandibular joint (TMJ) is formed by the articulation of the mandible and the temporal bone of the cranium (Singh, 2016). Undoubtedly, there is a close anatomical relationship between the TMJ and the mandible (Kumar et al, 2016; Tiftikcioglu et al, 2017; Vittayakittipong et al, 2016). In clinical circumstances, the combined lesions which invaded both TMJ and mandible occur frequently (Ferri et al, 1997; Ghassemi et al, 2016; Ishii et al, 2016).…”