Condyle transplantation in free flap mandible reconstruction

Fourteen patients requiring hemimandible resection were reconstructed with bone free flaps onto which the resected condyle was mounted as a nonvascularized graft. Postoperative mandible function, facial aesthetics, and patient symptoms were reviewed. The follow-up period ranged from 13 to 56 months (average 30.4 months). Interincisal opening ranged from 25 to 52 mm (average 37.10 mm). Opening ability inversely correlated with a need for intraoral soft tissue replacement and with the administration of postoperative radiation therapy. Eight patients were available for late study of the transplanted condyle with lateral tomograms and computed tomographic scans. Condyle volume diminished considerably in some, but this did not correlate with a decrease in function. Dual joint function and preoperative occlusion were maintained long term with this technique. Aesthetic results were enhanced by the contribution of the transplanted condyle to improved accuracy of free flap bone graft fabrication and insetting. There were neither postoperative morbidity nor abnormal symptoms due to the use of the condyle as a nonvascularized graft. This study demonstrates the effectiveness and safety of condyle transplantation in free flap mandible reconstruction.