title: Oral rehabilitation outcomes after free fibula reconstruction of the mandible without condylar restoration.
abstract: OBJECTIVE
  Resection of the posterior mandible for tumor or osteonecrosis may include the mandibular condyle, an integral part of the temporomandibular joint (TMJ). Condylar reconstruction, including use of prostheses, the native condylar head, or part of the fibula, all have associated drawbacks including skull base erosion and the potential for ankylosis and TMJ dysfunction as well as the increased difficulty associated with trying to recapitulate the TMJ with high fidelity. We report our experience leaving a single side of the reconstructed mandible unsecured to the glenoid fossa, allowing the mandible to "hang." We hypothesized that a good functional recovery may be achieved with this simple approach while avoiding the potential for ankylosis and TMJ dysfunction.
  
  
  METHODS
  A retrospective chart review of all patients undergoing free fibula reconstruction of the mandible with condylar removal was performed. Outcomes were determined by maximum interincisal opening, occlusion, and diet after full recovery.
  
  
  RESULTS
  Six patients were studied. Two had condylar reconstruction with a contoured fibular head secured to the glenoid fossa. One of them had progressive postoperative trismus and ankylosis. One patient was reconstructed with the native condyle rigidly fixed to the fibula flap, complicated by avascular necrosis requiring condylar resection, with good function afterward. Three patients were left to "hang." All 3 had either normal or improved function after surgery. Two had slight ipsilateral deviation on mouth opening.
  
  
  CONCLUSIONS
  Function can reliably be reestablished after segmental mandibulectomy and condylectomy with a vascularized fibula flap whose distal end is not precisely contoured or actively seated in the glenoid fossa, as a valid alternative to condylar reconstruction.
authors.affiliation: From the *Division of Plastic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York; †Division of Plastic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York; and ‡Department of Otolaryngology/Head and Neck Surgery, and §Department of Oral and Maxillofacial Surgery, New York Presbyterian Hospital, New York, New York.
authors.forename: Jerry W
authors.initials: JW
authors.lastname: Chao
authors.forename: Christine H
authors.initials: CH
authors.lastname: Rohde
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Chang
authors.forename: David I
authors.initials: DI
authors.lastname: Kutler
authors.forename: Joel
authors.initials: J
authors.lastname: Friedman
authors.forename: Jason A
authors.initials: JA
authors.lastname: Spector
mesh_terms: D000328:Adult; D000844:Ankylosis / Q000209:etiology; D016025:Bone Transplantation / Q000379:methods*; D003768:Dental Occlusion, Centric; D004032:Diet; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008335:Mandibular Condyle / Q000601:surgery; D008336:Mandibular Diseases / Q000209:etiology; D008339:Mandibular Neoplasms / Q000601:surgery; D008875:Middle Aged; D010020:Osteonecrosis / Q000209:etiology; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013701:Temporal Bone / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000209:etiology; D016896:Treatment Outcome; D014313:Trismus / Q000209:etiology