No abstract

The aim of this study was to radiologically evaluate dermis-fat graft and temporalis muscle flap as replacements after TMJ discectomy. Patients and methods: fourteen female patients were categorized into two equal groups (seven patients on each group,) group (A) and group (B). Group A underwent TMJ discectomy followed by interpositional muscle flap. Group B underwent TMJ discectomy followed by interpositional dermis-fat graft. Pre-operative MRI (T1, T2 and proton density) were obtained in addition to 3 months and 12 months post-operative MRI for comparison and follow up of the graft. Results: Temporalis muscle flaps were diagnosed in all group (A) patients (12 joints). The dermis-fat graft was detected within the operated joints or surrounding the condyle in three patients of group B while mostly resorbed in the other four patients after one year follow up. Conclusion: Discectomy and dermis-fat graft appears to be a successful surgical option regarding to the clinical parameters. However, summed degenerative changes depending on surgical operation should be retained. Temporalis muscle flap still the gold standard after TMJ menesictomy.

Background: Gun shot wounds (GSW) to the temporomandibular joint (TMJ) generate comminute fractures that cause sever complications such as temporomandibular ankylosis. This in turn generates pathological changes to the anatomical and physiological integrity of the joint, causing severe limitations to the mandibular joint movement. The conventional focus on treating ankylosis consists of extraoral surgical procedures to expose and visualise anatomical structures. Due to the proximity to vital anatomical structures, there are inherit risks associated with this procedure, including injury to the facial nerves and salivary fistulas. Objectives: Describe a case of intraoral surgical release of TMJ ankylosis, followed by a second surgery to reconstruct de TMJ with a custom-made Hoffman articular prosthesis. Methods: We present a 37-year-old male with a five-year history of a GSW to the left TMJ that was not treated at the time of the initial trauma. The patient presented TMJ ankylosis as a result of multiple unsuccessful surgical interventions to release the joint. In 2015, the patient was treated at Centro Policlínico, where he received intraoral surgery to release the ankylosis on the left TMJ and subsequent joint reconstruction using custom-made joint prosthetics in a second procedure. An intraoral approach was selected in order to preserve tissue that would allow fitting a TMJ prosthesis. Conclusions: Intraoral ankylosis release is a valid surgical technique with successful results in highly selected cases when performed by experienced surgeons. This technique spares tissue that can be later used to reconstruct the TMJ with a prosthesis.