Background : The temporomandibular joint is not often affected in ablative head and neck surgery and thus controversial with no standardized approach. Purpose of the study was to analyse the application and outcome of different reconstructive approaches.

Materials and methods : Analysis of all patient’s records receiving ablative surgery involving the temporomandibular joint in the Department of Craniomaxillo-facial and Oral Surgery, University Hospital of Zürich, identifying 20 patients and 15 reconstructive procedures. A literature search was done identifying all relevant literature on current approaches.

Results : Indications were most commonly tumour ( n = 15) related. Free vascularized bone grafts ( n = 14) were involved in 14 of the patients, either alone or in combination with a metal condylar head. The only major complication ( n = 1) was associated with revision surgery. Literature review indicated only seven relevant studies, not uniform reporting with nonhomogeneous patient groups. Risk factors appear to be radiation, costochondral graft, disk loss and plate use alone. An evidence risk based flow chart was developed assisting surgical decisions.

Conclusion : Risk factors are important when planning surgery. Fibula free vascularized grafts appear to have the least complications that have to be weighed against the donor site morbidity.

Key words : ablation; temporomandibular joint; reconstruction; risk