Subjective and objective assessment of the temporalis myofascial flap in previously operated temporomandibular joints

Abstract

Purpose: This study evaluated the subjective and objective findings in patients who had undergone temporomandibular joint (TMJ) reconstruction with a temporalis myofascial flap. All joints had previously been reconstructed with alloplastic, allogeneic, or autogenous material.

Patients and methods: Twenty-three consecutive patients who underwent 28 temporalis myofascial flap procedures were assessed subjectively and objectively preoperatively and at an average of 36 months postoperatively. Panoramic radiographs, magnetic resonance imaging (MRI), or coronal computed axial tomography scans (CT scans) were performed on all patients preoperatively to evaluate for joint disease. A visual analog scale (VAS) was used to assess pain preoperatively and postoperatively. Patients also reported their use of pain medication, ability to function, diet, complications, and overall satisfaction. Preoperative and postoperative objective assessment consisted of an evaluation of range of motion, deviation on opening, joint noise on function, and cosmesis.

Results: On preoperative radiographic examination, 24 of 28 joints showed signs of bony degeneration, including cortical erosion, condylar flattening, and joint space alterations. Four joints showed evidence of ankylosis. The average preoperative maximal interincisal opening (MIO) was 23.7 mm, and the postoperative average was 32.3 mm (P<.05). Preoperatively, all patients displayed one or more objective clinical signs of joint disease such as joint noise on function, deviation on opening, limited mouth opening (less than 20 mm), or limited excursions (less than 2 mm). Postoperatively, 65% displayed one or more of these signs, a significant reduction (P<.05). Preoperatively, the average pain score was 8.2 on the VAS, and postoperatively the average pain score was 3.4 (P<.0005). Fifteen patients used less pain medication postoperatively, 7 used the same amount, and 1 patient used more. Thirteen patients were very satisfied with the overall results of the surgery, 4 were satisfied, and 4 were not satisfied. Two patients were satisfied with their increased function but were not satisfied with their pain reduction. All were satisfied with their cosmetic appearance. Minor complications after the procedure included 3 patients who had preauricular paresthesia and 1 who had an intraoperative dura mater exposure without sequelae. Two patients had postoperative superficial suture infections, and 2 noted hearing changes that were found to be clinically insignificant by audiologic examination.

Conclusion: The temporalis myofascial flap is an autogenous graft that has the advantages of close proximity to the temporomandibular joint, minimal surgical morbidity, and successful clinical results. It was found to be a valuable option for TMJ reconstruction in joints in which alloplastic, allogeneic, or autogenous materials have previously been placed unsuccessfully.