Optimizing functional outcomes in mandibular condyle reconstruction with the free fibula flap using CAD/CAM technology

Publication date: Available online 15 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Z-Hye Lee, Tomer Avraham, Casian Monaco, Ashish A. Patel, David L. Hirsch, Jamie P. Levine
IntroductionMandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint (TMJ) as it requires precise bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study is to analyze clinical and functional outcomes following reconstruction of mandibular condyle defects using only a free fibula graft with the help of virtual surgery techniques.MethodsA retrospective review was performed to identify all patients who underwent mandibular reconstruction with only free fibula flap without any TMJ adjuncts after a total condylectomy. Three-dimensional modeling software was used to plan and execute reconstruction for all patients.ResultsBetween 2009 and 2014, total of 14 patients underwent reconstruction of mandibular defects involving the condyle with the aid of virtual surgery technology. The average age was 38.7 (range 11-77) years. The average follow-up period was 2.6 (range 0.8 to 4.2) years. Flap survival was 100% (n=14). All patients reported improved facial symmetry, adequate jaw opening, and normal dental occlusion. In addition, they achieved good functional outcomes including normal, intelligible speech and ability to tolerate a regular diet with solid foods. Maximal intercisal opening range for all patients were 25-38mm with no lateral deviation or subjective joint pain. No patient had progressive joint hypomobility or condylar migration. One patient had ankylosis, which required release.ConclusionTMJ reconstruction poses significant challenges in bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise planning and intra-operative manipulation with optimal functional outcomes.



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