Abstract
Objectives: Vascularized free bone grafts have been used extensively for reconstruction of the mandible. When surgical resection includes the temporal mandibular joint, definitive management remains controversial. We describe a novel technique that involves the use of a fibula free flap with alloderm to reconstruct the lateral hemimandible and temporal mandibular joint capsule.
Methods: Retrospective case series at an academic center. Patients undergoing composite resection of the lateral hemimandible including the condyle, or with disruption of the temporal mandibular joint were evaluated in this study.
Results: There were 6 patients (5 male, 1 female) with a mean age of 53.7 years. Indications for surgery were carcinoma (n = 4) and osteoradionecrosis (n = 2). Mean follow-up was 12 months. All patients reported improved facial symmetry, decreased trismus, adequate jaw opening, and improved occlusion. The majority of patients demonstrated good postoperative speech and swallowing. All but one patient was able to chew and tolerate a normal diet. There were no flap failures, infections, or complications.
Conclusion: The lateral hemimandible and temporal mandibular joint can be resected and successfully reconstructed using a fibula free flap with alloderm. Improved cosmesis, decreased trismus, adequate jaw opening, minimal jaw drift, and the ability to chew were achieved in the majority of patients treated in this manner.
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