Clinical applications of multiple tissue flap combined with costochondral graft in the reconstruction of temporomandibular joint

doi:10.3877/cma.j.issn.1673-9450.2018.02.005

Abstract

Abstract:

Objective

To discuss the using of multiple tissue flap(buccal fat pad flap and temporalis myofascial flap) on the inter-positional graft to combine effect of costochondral graft for temporomandibular joint reconstruction.

Methods

Twenty patients with temporomandibular joint ankylosis, 27 sides, in the first Affiliated Hospital of Xinjiang Medical University were enrolled in this study. Patients were divided into two groups according to the different surgical methods. The experimental group, including 8 patients, 10 sides, and the control group, including 12 patients, 17 sides. In the experimental group, the temporalis myofascial flap and buccal fat pad flap were used as double spacer, which were transferred to the region of temporomandibular joint ankylosis combined with costochondral graft, while the control group was reconstructed by gap arthroplasty and temporalis myofascial flap transplantation. All patients were performed with pro-operative and postoperative panaroma, CT scanning image of 3D reconstruction to evaluate the ankylosis and measure resection, and interactive medical image control system was used to assist in surgical design before surgery. Recording the size of postoperative maximum mouth opening data, two independent samples t tests between groups were carried out.

Results

The mouth opening of experimental group after surgery was 34-41 mm, the average mouth opening was (36.78±0.61)mm. The mouth opening of control group after surgery was 30-35 mm, the average mouth opening was(31.56±0.58)mm. The difference between the two groups was statistically significant (P<0.05). Chewing function was satisfaction on the all patients, postoperative panaroma and CT scan showed clear joint clearance, no tissue adhesion, no obvious malocclusion. There was no obvious facial nerve injury or functional impairment or chewing dysfunction after surgery.

Conclusion

The reconstruction of temporomandibular joint with composite tissue flap combining with rib cartilage grafting was superior in the treatment of postoperative temporomandibular joint ankylosis recovery of normal mouth opening and prevention of recurrence.

Key words: Temporomandibular joint, Ankylosis, Bone transplantation, Buccal fat pad flap, Temporalis myofascial flap

Kelimu Keyimu·, Ayifu Tayier·, Tuerxun Julaiti·, Zhitao Yao, Saimaiti Adilijiang·, Yun Yao, Tuerdi Maimaitituxun·. Clinical applications of multiple tissue flap combined with costochondral graft in the reconstruction of temporomandibular joint[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2018, 13(02): 100-106.

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References 41

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