Outcome analysis of mandibular condylar replacements in tumor and trauma reconstruction: a prospective analysis of 131 cases with long-term follow-up.
OBJECTIVE
Replacement of the mandibular condyle with alloplastic materials is sometimes required when the mandibular condyle is involved in pathology or trauma. Previous investigations into alloplastic mandibular condylar replacement have met with mixed results because they reported only a limited number of patients with short-term follow-up. This investigation sought to determine the long-term outcome of alloplastic replacement of the mandibular condyle in a large population of patients after disarticulation due to pathology or trauma.


METHODS
This was a prospective, long-term investigation of 131 consecutive patients who had undergone alloplastic replacement of 132 mandibular condyle(s) for reconstruction after disarticulation for pathology or trauma. Metallic mandibular condylar replacement was carried out using standard principles of rigid fixation after disarticulation with placement of the metallic condylar head against the native condylar disc or a soft tissue interface of either autogenous or allogeneic grafts. Only patients with a minimum of 3-year follow-up were included in this study. Assessment analysis was conducted at 6-month intervals by direct questioning, direct clinical observation, measurements, and radiographic examination.


RESULTS
A total of 131 consecutive patients underwent 132 mandibular condylar replacements with a metallic condylar head attached to a 2.3- or 2.4-mm reconstruction plate after disarticulation. Follow-up time ranged from 3.4 to 18.6 years with an average of 7.8 years. A total of 13 (9.8%) patients developed minor complications including pain (2/132, 1.5%), loose plate (2/132, 1.5%), limited jaw opening (4/132, 3.0%), and plate exposures all of which were in irradiated patients (6/132, 4.5%). One patient (0.8%) who also was irradiated developed an erosion into the external auditory meatus with pain. None developed an erosion into the middle cranial fossa.


CONCLUSIONS
Alloplastic replacement of the mandibular condyle with a metallic condyle on a rigid reconstruction plate functioning against a natural disc or a soft tissue graft in the temporal fossa after disarticulation for pathology or trauma provides long-term stability with minimal complications (a total complication incidence of 10.6%).
Marx
Robert E
RE
Division of Oral and Maxillofacial Surgery, University of Miami Miller School of Medicine, Miami, FL 33157, USA. rmarx@med.miami.edu
Cillo
Joseph E
JE
Broumand
Vishtasb
V
Ulloa
Juan J
JJ
D019643:Arthroplasty, Replacement; D002356:Cartilage / Q000637:transplantation; D004388:Dura Mater / Q000637:transplantation; D005205:Fascia / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D008335:Mandibular Condyle / Q000601:surgery*; D008338:Mandibular Injuries / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D008341:Mandibular Prosthesis; D019647:Oral Surgical Procedures; D010019:Osteomyelitis / Q000601:surgery; D010025:Osteoradionecrosis / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013704:Temporomandibular Joint / Q000601:surgery; D019224:Temporomandibular Joint Disc / Q000601:surgery; D013710:Tendons / Q000637:transplantation; D014025:Titanium; D016896:Treatment Outcome
D014025:Titanium