Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis.

OBJECTIVE

The aim of this study was to investigate the feasibility of autogenous coronoid process pedicled on temporal muscle grafts (ACPTMG) for reconstruction of the mandible condyle, and to compare the differences in clinical effects with autogenous free coronoid process grafts (AFCPG) in patients with temporomandibular joint (TMJ) ankylosis.

STUDY DESIGN

From 2003 to 2005, 48 patients who were diagnosed with uni- or bilateral TMJ ankylosis were randomly divided into 2 groups: group A(24 cases, 28 joints) and group B(24 cases, 30 joints). All patients underwent operations for resection of condyle and surrounding bony masses and simultaneous recreation of the glenoid fossa, which was followed with, for group A, condylar reconstruction using ACPTMG and, for group B, AFCPG, as well as interposition of temporal muscle myofascial flaps or native articular disc. The pre- and postoperative interinsicial opening values and mouth-opening deviation were measured, and decrease in height of mandible ramus was analyzed by panoramic radiographs.

RESULTS

All patients showed apparent improved joint function except 1 patient of group B, who showed signs of reankylosis of the joint (<20 mm mouth opening). Radiographic examination and 3-dimensional computerized tomography both showed the grafts to be well attached to the ramus in their original positions and adaptive remodeling in both groups, but relatively more evident bony resorption was noted in group B. The mean measurement of mouth-opening deviation and postoperative decrease in height of mandible ramus in group B were significantly higher than in group A.

CONCLUSIONS

Satisfactory clinical outcomes show that both ACPTMG and AFCPG seem to be alternative and promising methods in the treatment of TMJ bony ankylosis. Compared with AFCPG, the advantages of ACPTMG include less bony resorption and better long-term clinical outcomes.