Buccal Fat Pad for Interpositional Arthroplasty in Temporomandibular Joint Ankylosis

The buccal fat pad (BPF) is a readily accessible mass of adipose tissue in the oro-maxillofacial region. It is a specialized type of fat tissue that enhances intermuscular motion. It has been used extensively for reconstruction of oral cavity defects with satisfactory outcomes. However, its use as an interpositional material in the management of temporomandibular joint ankylosis is not widespread. This report aims to present our experience with its use as an interpositional tissue in the management of temporomandibular joint ankylosis.

A total of four patients who presented with either unilateral or bilateral temporomandibular joint ankylosis were included in this study. Three patients presented with bilateral temporomandibular joint ankylosis while one patient had right unilateral bony ankylosis of the temporomandibular joint. All the patients were treated under general anaesthesia during which airway was maintained intraoperatively using tracheostomy tubes. In all cases, interpositional arthroplasty using BPF as the interpositional material was done.

There were two males and two females with age range between 4 and 24 years and a median age of 12.5 years. Trauma was the aetiological factor in all cases. There were a total of seven ankylosed joints. Autogenous pedicled BPF was used in five joints, while BPF graft was utilized in two joints. Maximal interincisal opening of 35 mm or more was achieved intraoperatively before placement of the BPF in all cases. Immediate postoperative jaw exercise was commenced. Mouth opening remained satisfactory at all postoperative reviews.

Buccal fat pad is a reliable option for interpositional arthroplasty in the management of TMJ ankylosis, and it can be used either as a free graft or as a pedicled flap.