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The condylar capping for microvascular temporomandibular joint reconstruction: A preliminary study
Alexander Gaggl1, Simon Enzinger1, Heinz Bürger1
1Department of Oral and Maxillofacial Surgery, Center of Reconstructive Surgery, University Hospital, Paracelsius Medical University, Salzburg, Austria.
Microsurgery
|November 23, 2022
Summary
This study introduces condylar capping, a novel technique using a lateral femoral condyle (LFC) flap for temporomandibular joint (TMJ) reconstruction. The procedure successfully restored function and eliminated pain in patients with severe TMJ arthrosis.
Area of Science:
- Orthopedic Surgery
- Oral and Maxillofacial Surgery
- Regenerative Medicine
Background:
- Reconstructing temporomandibular joint (TMJ) defects with correct dimensions and function remains challenging.
- Severe TMJ arthrosis often leads to persistent pain and functional limitations despite conventional treatments.
- This study presents a novel microvascular flap technique for condylar reconstruction: condylar capping.
Observation:
- Four patients with severe unilateral TMJ arthrosis underwent condylar capping using an osteochondral lateral femoral condyle (LFC) flap.
- All patients had previously failed conservative treatments and surgical interventions, experiencing significant pain (VAS ≥ 6) and dietary restrictions.
- The lateral pterygoid muscle attachment was preserved during the surgical procedure.
Findings:
- Postoperative CT scans confirmed stable, anatomically correct condyle reconstruction with mean dimensions: height 6.0 mm, width 16.2 mm, sagittal length 9.8 mm.
- Follow-up (14-64 months) showed all patients were pain-free, could resume a regular diet, and exhibited normal TMJ and knee function.
- The procedure was uneventful with negligible donor site morbidity.
Implications:
- Condylar capping with the LFC flap shows promise for reconstructing the condylar head in severe TMJ osteoarthritis.
- Preserving the lateral pterygoid muscle attachment is crucial for restoring the full physiological range of mandibular movement.
- This technique offers a viable solution for complex TMJ reconstruction, improving patient quality of life.
