Long-term results of condylar-ramal reconstruction using vascularized costo-chondral serratus anterior composite flap

Serratus anterior muscle flap with vascularized rib incorporating a chondral segment (VCG) has peculiar advantages to reconstruct the defect of mandibular condyle-ramus with soft tissue augmentation. The purpose of study was to evaluate the long-term functional results of temporomandibular joint (TMJ) reconstruction with VCG. From January 1999 to December 2009, 15 patients (mean age 27.3 ranging from 4 to 48 years old, 6 men and 9 women) received mandibular condylar-ramal reconstruction using VCG. The viability and the morphological change of the VCG were evaluated. The mouth opening was measured clinically and kinesiographically. The factors which can influence the condylar function including presence or absence of temporomandibular disc, the number of rib taken, patient’s age and original pathology were investigated. All the grafts healed uneventfully. Among 15 patients, 3 underwent bilateral condylar-ramal reconstruction. Only 2 joints had intact remaining meniscus. Mouth opening was increased from 23.54 ± 11.16 at pre-operation to 31.29 ± 7.56 at final follow-up. Four of the 15 patients developed mouth opening limitation less than 15 mm from post op 10-month to 94-month. All of them, the meniscus were absent before reconstruction. After receiving additional gap arthroplasty, mouth opening was increased to 21.88 ± 12.29. There were no observable resorptions or overgrowth of the reconstructed condyle both in young and old ages. The serratus/rib composite myo-osseous flap reliably provided bone and cartilage for the reconstruction of mandibular condyle and ramus with additional soft tissue for the lateral face bulk. TMJ function after reconstruction was within normal limit in most cases, however, it showed the tendency towards ankylosis of joint where the flap was placed in case of meniscal absence with heavy compressive situation between the graft and mandibular fossa.

Acknowledgement: This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A121035).

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Long-term results of condylar-ramal reconstruction using vascularized costo-chondral serratus anterior composite flap
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