Evaluation of long-term stability in second metatarsal reconstruction of the temporomandibular joint.
OBJECTIVE
Our goal was to evaluate long-term stability and function of 5 condyles reconstructed with vascularized second metatarsal joint grafts.


METHODS
Four patients were reconstructed with 5 vascularized metatarsal grafts. These reconstructed joints were then followed for an average of 12.5 years. These patients represent the entire series and were all successfully contacted and reevaluated for this article. Measures of opening, deviation, excursion, symmetry, and clinical symptoms relating to the reconstructed joints are evaluated.


RESULTS
Mean preoperative interincisal aperture was 12 mm, and postoperative aperture 48.5 mm. Three unilaterally treated patients had lateral excursion with opening. The mean deflection was 4.3 mm toward the operated side. Lateral and protrusive movements were limited in reconstructed joints, but up to 3 mm of protrusion was shown at 12.5 years. Subjectively, all patients rated their function as acceptable and were able to occlude and masticate without difficulty. Symmetry at rest was improved by surgery.


CONCLUSIONS
Vascularized metatarsal joints represent a potentially suitable long-term substitute for condylar reconstruction. This limited series shows the technical viability of the procedure. A larger series may be warranted to compare this promising technique with conventional methods of temporomandibular joint reconstruction.
Landa
Leopoldo E
LE
Division of Plastic, Recontructive and Maxillofacial Surgery, University of Pittsburgh, Pittsburgh, PA, USA. leopoldplanda@hotmail.com
Gordon
Christopher
C
Dahar
Nicolas
N
Sotereanos
George C
GC
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001178:Arthroplasty / Q000379:methods*; D002508:Cephalometry; D003766:Dental Occlusion; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008297:Male; D008334:Mandible / Q000503:physiopathology; D008335:Mandibular Condyle / Q000503:physiopathology / Q000601:surgery*; D008409:Mastication / Q000502:physiology; D008682:Metatarsal Bones / Q000637:transplantation*; D008866:Microsurgery; D008875:Middle Aged; D009068:Movement; D016059:Range of Motion, Articular / Q000502:physiology; D013524:Surgical Flaps; D013704:Temporomandibular Joint / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome