The Use of Reconstruction Plates and Add-on Condyles with an Alloplastic Unmatched Fossa, Following Partial Mandibulectomy with Disarticulation

Abstract

The reconstruction of a mandible after ablative surgery poses many challenges. This is particularly true if the temporomandibular joint (TMJ) has been sacrificed, and the intention is to replace the mandibular defect and the joint with an alloplastic reconstruction plate and add-on condyle. A metal only condyle poses serious complication risk, and thus function against a prosthetic fossa is desirable. Currently, no stock matched prosthesis exists to fulfil this role. Aim: a series of cases are presented, whereby unmatched add-on condyles and alloplastic fossas were used safely and effectively. Materials and method: nine patients that received hemi-mandibulectomies and subsequent reconstruction with reconstruction plates, add-on condyles and alloplastic TMJ fossas, were retrospectively reviewed. The radiographs were reviewed for structural integrity of the prostheses, or the formation of heterotypic bone; and the patients were clinically evaluated for localised signs of sepsis or dehiscence. Results: all nine patients showed no sign of clinical or radiographic failure of the hybrid prostheses. Conclusion: it appears as though the use of unmatched TMJ fossas and reconstruction plates with add-on condyles, are an acceptable method of treating an ablated TMJ after hemi-mandibulectomy with disarticulation.

Current indications of mandibular condyle plate osteosynthesis: two cases reports

“…However, the authors did not cover the plate with a flap and had interposed the prosthetic condylar in direct contact with the temporal bone. Other studies have found a higher success rate [1,2,6,10,11]. In one retrospective study in 2003 that examined six cases, of which four involved chemotherapy and an average follow-up of more than 2 years, there were no failed cases when the metallic condylar prostheses was used [6].…”

“…Furthermore, Desai and Smit propose the use of a temporal plate made of high-density polyethylene (Zimmer Biomet CMF TM , Jacksonville, Florida, USA) as a means of supporting the metallic condylar prostheses. They applied this protocol 12 weeks after surgery among nine patients who presented with no clinical and radiological pathological signs [10].…”