Vascularized bone graft reconstruction of the temporomandibular joint using the tunneled, anchored suture technique.

Abstract

To describe a novel technique that provides a simple, flexible and safe method to approximate and secure the neo-condyle into the glenoid fossa in reconstruction of hemi-mandibulectomy defects. Retrospective chart review of a case series was performed. Three patients underwent composite resection of the hemi-mandible with condylectomy. A minimally invasive tunneled suture, anchored with a miniplate to the zygomatic root, was used to approximate the neo-condyle into the glenoid fossa. Postoperative outcomes were assessed with clinical and radiographic measures. The median patient age was 64 years. Median follow-up was 19 months. All patients reported improved facial symmetry, jaw opening and acceptable dental occlusion. Post-operative CT imaging revealed sustained approximation within the TMJ without evidence of jaw drift. The described approach introduces a simple, safe, flexible and effective technique for neo-condylar suspension and appropriate realignment during mandibular reconstruction.