Functional outcomes of temporomandibular joint reconstruction with vascularized tissue.

Abstract

OBJECTIVE\nTo determine how current temporomandibular joint (TMJ) reconstruction methods affect functional outcomes.\n\n\nMETHODS\nRetrospective review from January 2006 to July 2017 at a single tertiary care center. All patients who underwent mandibulectomy with subsequent reconstruction with vascularized free tissue were included in the study. Condylar segments were reconstructed with vascularized free tissue flap in conjunction with autologous tissue or allograft in the joint space. Preoperative, 3\u202fmonth, 1\u202fyear, and 2\u202fyear postoperative records were assessed for trismus, need for tube feeds, and Functional Oral Intake Scale (FOIS).\n\n\nRESULTS\nJoint space was reconstructed with autologous tissue (n\u202f=\u202f10), allograft (n\u202f=\u202f15) or both (n\u202f=\u202f9). At three months, FOIS scores significantly decreased from 5.4 preoperatively to 4.8 post operatively (P\u202f=\u202f.024) and need for tube feeds significantly increased from 15.8% preoperatively to 35.1% (P\u202f≤0.027). Trismus significantly decreased from 63.2% to 27% (P\u202f=\u202f.006). At one-year, there were no significant changes in functional status compared to pre-operative state. Patients who had previous RT had significantly worse FOIS scores preoperatively (p\u202f=\u202f.002), at three months (p\u202f<\u202f.001), one year (p\u202f<\u202f.001), and two years (p\u202f=\u202f.008). There was no significant difference in postoperative functional status of patients based on the method of TMJ reconstruction.\n\n\nCONCLUSION\nReconstruction of the TMJ with vascularized free tissue is a viable option and yields acceptable long-term outcomes. While functional status may improve or worsen in the immediate postoperative period, long term results mirror preoperative function. Preoperative trismus will likely improve.\n\n\nLEVEL OF EVIDENCE\nLevel 3; Retrospective Comparative Study.