[Temporomandibular joint reconstruction with free rib and iliac crest bone transplants]

From 1981-1992 we reconstructed the temporomandibular joint in 42 patients. In 33 cases reconstruction followed tumour resection of the mandible, almost advanced squamous cell carcinomas of the retromolar region. Primary reconstruction was made by an alloplastic condylar prosthesis combined with a plate for mandibular reconstruction. 2 years after first treatment secondary reconstruction followed by transplantation of a free iliac bone graft. In some cases a new condylus was formed using autogenous rib graft or allogenous cartilage. Result was adequate and painless oral aperture. For reconstruction after ankylosis, arthrosis or arthritis we use a autogenous costochondral graft. 9 patients received such treatment. In 5 or 9 cases with severe ankylosis we prefer a two-time-approach: after resection of the ankylosis we first fix an alloplastic implant (Palacos) at the skull base for distraction of the scar. Two or three years later we do secondary reconstruction with a costochondral graft. The final result strongly depends on functional postoperative treatment and the compliance of the patient.