Discectomy with Subsequent Free Fat Flap Insertion in Disc Perforation Therapy of Temporomandibular Joint. Assessment of Results 24 Months after Operation.

Discectomy with replacement of disc is one possibility for treating disc perforation where conservative, mini-invasive therapy and arthroscopy has had no effect. Allogenic or autologous materials are used to replace the disc. The authors assess the use of a free fat flap (FFF) in 19 patients who in 2015-2016 underwent a unilateral discectomy with disc replacement. In the retrospective 24-month follow-up study a total of 16 patients (84%) were free of difficulties. 24 months after the operation mouth opening was on average 39.3 mm, pain (VAS - visual analog scale (0-10) was assessed on average at 0.3). Crepitus was present after 24 months in 37.5% of patients (6 patients). An assessment of changes in joint structures on cone beam computed tomography (CBCT) for these patients 24 months after the operation showed the progression of flattening of the joint head, in one case unevenness of the joint head. In 3 cases (16%) there was a recurrence of the state within 24 months - in all cases with clinical manifestations of pain and limited mobility, for these patients on the CBCT significant unevennesses of the joint head, subchondral cysts were noted. The authors find discectomy with use of FFF to be an effective method of treatment with a minimum of complications. However, one should take into account the relatively short time of monitoring after the operation (2 years) and limited number of patients in the cohort (19 patients).