Temporomandibular joint reconstruction with medial femoral condyle osseocartilaginous flap: a case series

Xia, Lin; Jie, B.B.; Zhang, Y.; An, J.; Zheng, Lei; He, Yang

doi:10.1016/j.ijom.2020.09.017

Cited by 10 publications

(18 citation statements)

References 26 publications

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“…8,9 The use of the MFT for TMJ reconstruction was first reported in the oral maxillofacial literature by Lee et al in 2014. 10 Recently, Xia et al 4 reported TMJ reconstruction in four patients with satisfactory outcomes and negligible morbidity using the MFT flap. These cases utilized the MFT in isolation for benign TMJ pain.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The application of the medial femoral trochlea (MFT) flap is well described in upper extremity surgery and recently by oral maxillofacial surgeons for isolated TMJ pain. 3,4 The MFT flap is based off the transverse branch of the descending geniculate artery (DGA) and offers a cartilage-bearing segment from the MFT, whereas the longitudinal branch supplies the corticocancellous portion of the more common medial femoral condyle flap. 5 We present the novel application of the MFT flap for mandibular condyle reconstruction using a free fibula flap as a flow through in an oncologic hemi-mandibular resection.…”

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confidence: 99%

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Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps

Shuck

Andejani

Garvey

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: The free fibula flap is the gold standard in reconstruction of oncologic mandibular defects. When the mandibular condyle is resected, reconstruction of the temporomandibular joint (TMJ) continues to pose a unique challenge to the reconstructive surgeon. Several conventional methods have been described, including costochondral grafts, bone grafts, and alloplastic prostheses. These nonvascularized options are rarely employed in the oncologic patient receiving postoperative radiation therapy due to high rates of resorption, nonunion, and failure. The authors describe a novel technique for mandibular and TMJ reconstruction utilizing the fibula free flap as a flow through for a medial femoral trochlea flap for vascularized mandible and condylar reconstruction. This technique provides a vascularized cartilaginous surface to articulate with the glenoid fossa, making it an attractive option for the oncologic patient undergoing postoperative radiation therapy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps

Shuck

Andejani

Garvey

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…1,12 This poses a limitation, as the SGA's shorter pedicle leads to higher risk of flap complications and failure, much like the iliac crest. 1,12,13,25,26 Laryngotracheal region 19,[32][33][34] Mandible 6,13,22,24,35,36 Maxillary alveolus 13,[19][20][21]37 Orbit 16,20 Palate 13,20 Other facial bony structures 19,[38][39][40] Problematic nonunions 6,20,36 Failed nonvascularized bone grafts 13,19,20,37 Recalcitrant defects 19,20,37 Osteoradionecrosis 13,16,20,22,24 Fig. 2.…”

Section: Discussionmentioning

confidence: 99%

Expanding Indications of the Medial Femoral Condyle Free Flap: Systematic Review in Head and Neck Reconstruction

Patel

Tipps

Bartlett

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background:The medial femoral condyle free flap serves as an attractive reconstructive option for small-to intermediate-sized bony defects. It is commonly applied in the extremities with limited reports in the head and neck. Methods: A systematic review of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Seventeen articles met inclusion criteria, yielding 166 cases for analysis, with a majority of the cohort from a single study (n = 107; 64.4%). However, all included studies represented novel reconstructive sites and surgical indications. Flap components were described in 157 cases; periosteum was used only in four cases (2.5%), whereas all others are composed of cortical bone combined with periosteum, cancellous bone, and/or cartilage (97.5%). Additionally, a skin island was used in 43 cases (25.9%). Flap measurements were reported in 51 cases, averaging 4.5 ± 2.7 cm in length. Seven cases listed skin island dimensions, averaging 20.2 ± 12.8 cm 2 . The descending genicular artery was the primary pedicle employed (n = 162; 97.6%), while the superior medial genicular was used in the descending genicular artery's absence (n = 4; 2.4%). Descending genicular artery pedicle length from 15 reporting cases averaged 6.4 ± 1.2 cm. Successful reconstructions totaled 160 cases (96.4%). Recipient complications were seen in 16 cases (9.6%) with six constituting flap failures (3.6%). Donor site complications were minimal (n = 6; 3.6%); however, this included one major complication of femoral shaft fracture. Conclusion:The medial femoral condyle free flap is an effective reconstructive option for the head and neck due to its versatile nature, low complication profile at both recipient and donor site, ease of harvest, and two-team approach.

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“…Therefore, the operated side will lose the ability to actively protrude or laterotrude toward the contralateral side. (Chauvel-Picard et al, 2021;Tarsitano et al, 2017;Wolford et al, 2003) A more conservative approach is possible with an osteochondral graft or a microvascular osteochondral flap that can replace the condyle preserving healthy tissues and muscular attachments (Enzinger et al, 2018;Wong et al, 2015;Xia et al, 2021). A graft can be easily shaped into the correct form-congruent to the glenoid fossa and condylar neck.…”

Section: Introductionmentioning

confidence: 99%

“…Enzinger et al, in 2018, were the first to describe the application of lateral condyle flap (LFC) for mandibular condyle reconstruction (Enzinger et al, 2018). Instead, Xia et al in 2021 used the medial femoral condyle (MFC) flap for the same indication (Xia et al, 2021). This preliminary study aims to describe the use of the LFC flap in mandibular condylar head reconstruction in case of severe osteoarthritis of the TMJ using a new surgical technique called condylar capping.…”

Section: Introductionmentioning

confidence: 99%

The condylar capping for microvascular temporomandibular joint reconstruction: A preliminary study

et al. 2022

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Background Defects of the temporomandibular joint (TMJ) are often difficult to be reconstructed in the correct dimensions and function. This preliminary study aims to describe a novel technique of condylar reconstruction with a microvascular flap in case of deforming arthrosis of the TMJ: condylar capping. Patients and Methods Four patients between 22 and 62 years old—three females and one male—with severe unilateral arthrosis of the TMJ underwent condylar capping. All patients had already had a failed conservative treatment, followed by arthroscopy with lysis and lavage and later open surgery with total or subtotal diskectomy combined with a condylar arthroplasty. Nevertheless, their pain was still at level six or more on a visual analogue scale. Moreover, they could eat only soft food. At this stage, they underwent condylar capping using an osteochondral lateral femoral condyle (LFC) flap. The surgical technique and the postoperative management are described in detail. Crucially the attachment of the lateral pterygoid muscle to the condylar neck was preserved in all cases. The patients were followed up clinically and by CT scan preoperatively, 6, and 12 months postoperatively. Results The mean height of the reconstructed neo‐condyle was 6.0 mm, the mean width 16.2 mm, and the mean sagittal length 9.8 mm. The follow‐up period ranged from 14 to 64 months. The procedures were uneventful for all patients, and the donor site morbidity was negligible. Twelve months later, the patients were all pain‐free and able to have a regular diet. The TMJ and the knee had a normal range of movement and power. Postoperative imaging demonstrated bone healing and stable and anatomically correct condyle reconstruction. Conclusions Based on the author's experience, the condylar capping with the LFC appears promising for reconstructing the condylar head in cases of severe osteoarthritis. Preserving the attachment of the lateral pterygoid muscle allows a complete restoration of the physiologic range of movement, including protrusion and laterotrusion of the mandible.

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Temporomandibular joint reconstruction with medial femoral condyle osseocartilaginous flap: a case series

Cited by 10 publications

References 26 publications

Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps

Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps

Expanding Indications of the Medial Femoral Condyle Free Flap: Systematic Review in Head and Neck Reconstruction

The condylar capping for microvascular temporomandibular joint reconstruction: A preliminary study

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