Functional Reconstruction of the Midface and the Temporomandibular Joint

Introduction/Aim: Different choices for reconstructing existing defects in the midface and the temporomandibular joint are controversial. In addition to time-honored treatment strategies, today nonvascularized and vascularized autogenous tissue transfer is used more frequently. The aim of this study was to evaluate the suitability of microvascular transplants to reconstruct the midface and the temporomandibular joint and to compare the outcome to results of nonvascularized tissue transfer.

Material and Methods: Between June 2005 and June 2006, 14 patients (male n = 10, female n = 4) were treated with microvascular transplants (scapula flap n = 10, forearm flap n = 5, combined n = 1). Ten of these patients underwent reconstruction of the midface, whereas the temporomandibular joint was restored in 4 cases. All transplants were anastomosed to the external carotid artery and the jugular vein, respectively. During the same period, 16 patients (male n = 9, female n = 7) were treated with local revision of the temporomandibular joint and, if necessary, replacement of the intra-articular disc by an autogenous nonvascularized cartilage transplant. In order to evaluate clinical outcome and success, mouth opening, lateral deviation, occlusion and articulation measures, radiological findings, duration of hospitalization, and donor site morbidity were recorded.

Results: The average hospital stay was 14.5 days. An initial functional limitation at the donor site of the microvascular flaps was tolerated without problems by all patients. Ten days after surgery, the maximum mouth opening averaged 30 mm following both treatment strategies. Both microvascular tissue transfer and the locally modifying surgical approach resulted in a sufficient long-term masticatory function. Following reconstruction of the temporomandibular joint, the onset of bony ankylosis was prevented by early functional loading.

Conclusion: Both evaluated concepts led to sufficient functional result in the postsurgical course. Within the limits of this study, the use of microvascular transplants was not linked to a higher morbidity. Thus, microvascular tissue transfer represents a valuable treatment option for functional reconstruction of the midface and the temporomandibular joint.