Abstract
Context:Surgery for the release of temporomandibular joint (TMJ) ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw.Aims:We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint.Settings and Design:There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA), which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint.Materials and Methods:Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid.Results:The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained.Conclusions:The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.
Highlights
Temporomandibular joint (TMJ) ankylosis needs aggressive management consisting of several parts: Release of the restraining forcesIndian J Plast Surg July-December 2008 Vol 41 Issue 2 Management of the defect created Postoperative physiotherapyWhile several methods of interposition arthroplasty have been described, there are very few attempts to recreate the ‘milieu interior’ of the joint
KEY WORDS Temporomandibular joint ankylosis, vascularised cartilage ßap Temporomandibular joint (TMJ) ankylosis needs aggressive management consisting of several parts:
We have attempted to Vascularised cartilage interposition in temporomandibular joint ankylosis address this issue by means of a pedicled, vascularised cartilage flap
Summary
While several methods of interposition arthroplasty have been described, there are very few attempts to recreate the ‘milieu interior’ of the joint. We have attempted to Vascularised cartilage interposition in temporomandibular joint ankylosis address this issue by means of a pedicled, vascularised cartilage flap. The temporoparietal fascia (TPF) can be harvested as an extension based on the STA for additional use. This flap is used to line the raw surface of the glenoid fossa in an attempt to provide a cartilaginous surface, against which the condyle can move. By this manoeuvre, we hope that a more physiological joint can be recreated
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