Evaluation of Temporomandibular Joint Movement After Mandibular Reconstruction

Mandibular head dislocation and problems with mouth opening may develop after mandibular reconstruction. The authors investigated dislocation of the mandibular head and amount of protrusive sliding (excursion) and their effect on mouth opening. The authors divided 55 mandibular reconstruction patients into 3 groups on the basis of the extent of masticatory muscle and mandibular resection and investigated mandibular head dislocation. On the other hand, the authors focused on mandibular head protrusive excursion as a function of a reconstructed mandible. Protrusive excursion was measured by plain radiography in 29 patients. The extent of mouth opening was measured between the central incisors. Fluoroscopy was performed in 9 patients and the motions of the mandible were analyzed with video-analysis software. Mandibular head dislocation was observed in 15 patients (27.2%) who underwent resection of the mandibular ramus and coronoid process. The extent of mouth opening did not vary significantly among the 3 groups but was lower than that in healthy persons. Mandibular excursion was restricted in patients with conserved temporalis and lateral pterygoid muscles. Protrusive excursion was correlated with the extent of mouth opening. Structural problems involving dislocation of the mandibular head are caused by severing the coronoid process and protrusive excursion disorders are important factors causing mouth opening problems. Physiological sliding and other motions were observed in reconstructed models. The authors believe that when the ramus is resected, there is a greater chance of articular head dislocation. These findings suggest that dislocation of the mandibular head and protrusive excursion disorders arise from imbalances of the remaining masticatory muscles.