The use of a pedicled temporalis muscle-pericranial flap for replacement of the TMJ disc: preliminary report

Abstract

Disc replacement in temporomandibular joint surgery has been troublesome. Problems such as migration, fragmentation, foreign body reactions, and unpredictable biodegradation have occurred. Autogenous tissue is presently the material of choice, but requires a second surgical site. In addition, it is a free graft, and thus its fate is unknown. A technique has been developed that uses a pedicled autogenous flap composed of a portion of the temporalis muscle and pericranium to act as an interpositional material in temporomandibular joint surgery. The flap, based on the deep temporal arteries, and pedicled off of the coronoid process, is rotated anterior to the articular eminence and then posteriorly into the temporomandibular joint where it is sutured to the retrodiscal tissue. This procedure allows maintenance of tissue viability and functional movement of the flap during mandibular excursions. The technique offers numerous advantages over the existing autogenous, allogeneic, and alloplastic materials presently used in temporomandibular joint surgery.