Reconstruction of the temporomandibular joint using a temporalis graft with or without simultaneous orthognathic surgery.
OBJECTIVE
This article reports the outcome of free temporalis fascia and muscle graft (TFG) reconstruction of the temporomandibular joint (TMJ) with and without simultaneous orthognathic surgery (SOS).


METHODS
Twenty-nine patients (45 joints) were evaluated retrospectively. Group 1 consisted of 17 patients (16 women 1 man) and 30 joints. Fifteen (88%) patients had sagittal split ramus osteotomies (SSRO); 8 (53%) of these patients also had Le Fort I osteotomies, and 2 patients (12%) had only Le Fort I osteotomies with TFG. Group 2 consisted of 12 patients (15 joints) who received only TFG and no SOS.


RESULTS
Group 1 had 9 patients (53%) with an incisal opening greater than 35 mm, 11 joints (37%) with greater than 6 mm lateral excursive movement, and 11 patients (65%) were asymptomatic postoperatively. Average follow-up was 57.4 months (range, 23 to 69 months). Group 2 had eight patients (67%) with an incisal opening greater than 35 mm, six joints (40%) with greater than 6 mm lateral excursive movement, and seven patients (58%) were asymptomatic postoperatively. Average follow-up was 55.1 months (range, 48 to 64 months).


CONCLUSIONS
TFG with and without SOS produced similar treatment outcomes in comparing groups 1 and 2. No significant differences were observed for the number of patients with an incisal opening > 35 mm (P = .703), lateral excursion > 6 mm (P = 1.00), and successful elimination of pain (P = 1.00), even though group 2 had a significantly greater number of patients (P < 0.01) that were operated on unilaterally. Combining treatment outcomes for both groups, the number of previous joint surgeries significantly affected success (P < .01). The presence of osteoarthritic changes did-not significantly affect treatment outcome (P = .187).
Henry
C H
CH
Baylor University Medical Center, Dallas, TX, USA.
Wolford
L M
LM
D000293:Adolescent; D000328:Adult; D002358:Cartilage, Articular / Q000601:surgery; D016009:Chi-Square Distribution; D005205:Fascia / Q000637:transplantation; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D016013:Likelihood Functions; D008297:Male; D008310:Malocclusion / Q000601:surgery; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures; D010003:Osteoarthritis / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D013703:Temporal Muscle / Q000637:transplantation*; D013704:Temporomandibular Joint / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D016896:Treatment Outcome