Improved mandible function after hemimandibulectomy, condylar head preservation, and vascularized fibular reconstruction.

Abstract

Temporomandibular joint dysfunction after tumor extirpation of the hemimandible is a frequent sequela after condylar head reconstruction. Condylar head resection is often performed because of oncological and vascular considerations. Recent studies have demonstrated that malignancies of the mandibular ramus and body rarely involve the condylar head, and that the vascularity and supportive structures of the condylar head are sufficient to maintain viability and function. This study demonstrates that temporomandibular joint function is preserved after hemimandibulectomy without resection of the condylar head. Fixation of a vascularized fibular flap to the condylar head is performed in situ. Condylar viability and growth is maintained with painless incisal opening. The condylar head is a growth center for the mandible in the pediatric population. Its preservation in these patients will avoid the long-term problems associated with growth center loss such as malocclusion and concomitant maxillary deformity.