title: One-stage microvascular mandible reconstruction and alloplastic TMJ prosthesis.
abstract: Severely deformed or absent temporomandibular joints (TMJ) benefit from total alloplastic joint replacement and large mandibular defects from revascularized free tissue transfer for reconstruction. However no cases of their combined one-stage placement with outcomes can be found in the literature. We present two cases with different indications and reconstruction. The first patient required mandibular body and ascending ramus reconstruction after previous sarcoma resection. This was with a condyle-bearing reconstruction plate which resulted in significant dysfunction, leaving the patient unable to open her mouth. A one-stage vascularized iliac crest free flap and alloplastic TMJ prosthesis was used to reconstruct the mandible. Subsequently, metal removal, soft tissue augmentation by lipotransfer and dental implant placement were performed. At 63 months follow-up patient was pain-free, with mouth opening, protrusion and lateral excursion back to normal. The second patient required mandibular body, ascending ramus and joint reconstruction, performed by transoral vascularized fibula free flap with temporal vessel anastomosis. The traumatic deep bite and posterior facial height were corrected, additional submandibular scars avoided by transoral placement of the fibula transplant and a miniaturized TMJ prosthesis along with the vascularised free flap with 28 months follow-up. A miniaturized TMJ prosthesis may become placed transorally for reconstruction of the TMJ, together with a vascularized free flap for mandibular reconstruction and promises good long-term stability with normal function above all for protrusion and lateral excursion.
authors: Cranio-Maxillofacial and Plastic Facial Surgery, (Head: Sader, Robert MD, DMD, PhD, FEBOMFS), J. W. Goethe-University of Frankfurt Medical Center, Frankfurt, Germany. Electronic address: constantinlandes@googlemail.com.
authors: Constantin
authors: C
authors: Landes
authors: Cranio-Maxillofacial and Plastic Facial Surgery, (Head: Sader, Robert MD, DMD, PhD, FEBOMFS), J. W. Goethe-University of Frankfurt Medical Center, Frankfurt, Germany.
authors: Tadas
authors: T
authors: Korzinskas
authors: Cranio-Maxillofacial and Plastic Facial Surgery, (Head: Sader, Robert MD, DMD, PhD, FEBOMFS), J. W. Goethe-University of Frankfurt Medical Center, Frankfurt, Germany.
authors: Jan-Friedrich
authors: JF
authors: Dehner
authors: Cranio-Maxillofacial and Plastic Facial Surgery, (Head: Sader, Robert MD, DMD, PhD, FEBOMFS), J. W. Goethe-University of Frankfurt Medical Center, Frankfurt, Germany.
authors: Gregor
authors: G
authors: Santo
authors: Cranio-Maxillofacial and Plastic Facial Surgery, (Head: Sader, Robert MD, DMD, PhD, FEBOMFS), J. W. Goethe-University of Frankfurt Medical Center, Frankfurt, Germany.
authors: Shahram
authors: S
authors: Ghanaati
authors: Cranio-Maxillofacial and Plastic Facial Surgery, (Head: Sader, Robert MD, DMD, PhD, FEBOMFS), J. W. Goethe-University of Frankfurt Medical Center, Frankfurt, Germany.
authors: Robert
authors: R
authors: Sader
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D019643:Arthroplasty, Replacement / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods; D015921:Dental Implants; D005146:Facial Asymmetry / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D007595:Joint Prosthesis; D008312:Malocclusion, Angle Class II / Q000601:surgery; D008339:Mandibular Neoplasms / Q000601:surgery; D063175:Mandibular Reconstruction / Q000379:methods*; D008866:Microsurgery / Q000379:methods; D012516:Osteosarcoma / Q000601:surgery; D057887:Overbite / Q000601:surgery; D059745:Piezosurgery / Q000379:methods; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D013704:Temporomandibular Joint / Q000601:surgery*
chemical_list: D015921:Dental Implants
keywords: Mandibular reconstruction; TMJ alloplastic reconstruction; TMJ prosthesis; TMJ reconstruction; Vascularized mandibular reconstruction