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

Jameel Desai

doi:10.11648/j.js.20190702.11

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.

Highlights

The reconstruction of a hemi-mandibulectomy or partial mandibulectomy with disarticulation presents a significant reconstructive challenge and remains a contentious topic
Some surgeons tend to favour the reconstruction with an autogenous costochondral graft [1,2,3], whilst others favour an alloplastic mode of repair [4,5]
The glenoid fossa prosthesis used in all cases was the ultra-high molecular weight polyethylene (UHMWPE) component, provided by Biomet (Zimmer Biomet CMF, Jacksonville, FL, USA) [11]

Summary

Introduction

The reconstruction of a hemi-mandibulectomy or partial mandibulectomy with disarticulation presents a significant reconstructive challenge and remains a contentious topic. Some surgeons have circumvented this by using a metal condyle with interpositional fat, cartilage, articular disc or muscle grafts These methods result in complications such as dehiscence, dystrophic bone formation and perforation of the external auditory canal [6,7]. In South Africa, as it probably would be in most developing countries, patients present at a late stage with both benign and malignant jaw tumours [Figure 1]. This leads to a large number of Jameel Desai and Coelette Smit: The Use of Reconstruction Plates and Add-on Condyles with an Alloplastic

Objectives

Methods

Results

Conclusion