Accuracy and clinical outcomes of mandibular reconstruction with a virtually planned deep circumflex iliac artery flap with stock temporomandibular joint prosthesis

The repair of hemimandibulectomy defects involving the temporomandibular joint (TMJ) is challenging. This study compared the functional outcomes and reconstruction accuracy using a deep circumflex iliac artery (DCIA) flap with and without a virtually planned stock TMJ prosthesis (TMJP) after hemiman...

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Bibliographic Details
Published in:International journal of oral and maxillofacial surgery 2024-11, Vol.53 (11), p.911-918
Main Authors: Modabber, A., Raith, S., Winnand, P., Möhlhenrich, S.C., Bock, A., Kniha, K., Hölzle, F., Peters, F.
Format: Article
Language:English
Subjects:
Adult
Aged
Computer-aided design
Female
Free flaps
Free tissue flaps
Humans
Iliac Artery - surgery
Iliac crest
Joint Prosthesis
Male
Mandibular Neoplasms - surgery
Mandibular Reconstruction - methods
Maxillofacial prosthesis
Middle Aged
Retrospective Studies
Surgical Flaps
Temporomandibular joint
Temporomandibular Joint - surgery
Treatment Outcome
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Summary:The repair of hemimandibulectomy defects involving the temporomandibular joint (TMJ) is challenging. This study compared the functional outcomes and reconstruction accuracy using a deep circumflex iliac artery (DCIA) flap with and without a virtually planned stock TMJ prosthesis (TMJP) after hemimandibulectomy. Ten patients were assessed: five with a TMJP (TMJP group) and five without (control group). A three-dimensional comparison revealed a mean deviation of 0.11 ± 0.04 mm between the planned and actual DCIA flap with TMJP. The planned and actual TMJP positions differed by 0.56 ± 0.57 mm in height, 0.33 ± 0.24 mm ventrally/dorsally, and 1.18 ± 0.42 mm medially/laterally. Mouth opening, laterotrusion, and midline deviation were significantly greater in the control group than in the TMJP group (P = 0.024, P = 0.008, P = 0.024). The deviation in ventral to dorsal translation for the DCIA flap was slightly higher than reported values in the literature, while height deviation was comparable. Lower deviations in the literature were due to the DCIA flap being used where both TMJs were intact. The in-house virtually planned DCIA flap with stock TMJP yielded results comparable to more expensive patient-specific prostheses.
ISSN:0901-5027
1399-0020
1399-0020
DOI:10.1016/j.ijom.2024.07.009