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. 2022 Sep-Oct;12(5):593-598.
doi: 10.1016/j.jobcr.2022.07.003. Epub 2022 Jul 15.

The temporo-mandibular joint: Reconstruction of the condyle post-ablation

Rhodri Davies  1 , Luke Cascarini  2
Affiliations

The temporo-mandibular joint: Reconstruction of the condyle post-ablation

Rhodri Davies et al. J Oral Biol Craniofac Res. 2022 Sep-Oct.

Erratum in

Abstract

Ablative surgery of the mandibular condyle poses a unique reconstructive challenge for many reasons. The condyle and it's relationship to the TMJ is a unique, complex, functional and aesthetically relevant piece of human anatomy. Resection may be required for both malignant and benign pathologies; each posing a differing set of surgical variables. Particularly in neoplastic processes, there must remain a certain degree of peri-operative flexibility with regards to the extent of the resection, and forethought to the requirement for post-operative radiotherapy; both of which further complicate choice of reconstructive option and surgical or prosthetic planning. The cases involved can often concern paediatric patients, and an additional aspect to be considered is that of growth potential. In this piece, we will discuss the indications for ablation and the techniques involved. We will elaborate on the reconstructive challenges specific to reconstructing the condyle in post-ablative cases. We will then describe and analyse the established reconstructive techniques; aiming to provide a balanced view on the advantages and disadvantages. Our focus will include autologous options such as vascularised and non-vascularised free tissue transfer, and the non-autologous options of custom and stock implants. We will also touch on distraction osteogenesis and ramus osteotomies. Lastly we will look to the future and consider possible innovative techniques which may become available to the surgeon.

Keywords: Ablative surgery; Condyle; Post-ablation; Reconstruction; Resection; TMJ; Temporo-mandibular joint.

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Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
An OPG showing an extensive ameloblastoma of the right hemi-mandible. When considering the post-resection defect, one can appreciate the associated reconstructive challenges.
Fig. 2
Fig. 2
A series of images of the virtual surgical planning of the case in Fig. 1. Note the planned defect involved the mandibular condyle and was planned to be reconstructed with a custom extended TMJ replacement.
Fig. 3
Fig. 3
An OPG showing the post-operative imaging of the case from Fig. 1, Fig. 2. Note the right hemi-mandibular defect reconstructed with a custom extended TMJ replacement.
See this image and copyright information in PMC

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