Ch. Henry et Lm. Wolford, RECONSTRUCTION OF THE TEMPOROMANDIBULAR-JOINT USING A TEMPORALIS GRAFT WITH OR WITHOUT SIMULTANEOUS ORTHOGNATHIC SURGERY, Journal of oral and maxillofacial surgery, 53(11), 1995, pp. 1250-1256
Purpose: This article reports the outcome of free temporalis fascia an
d muscle graft (TFG) reconstruction of the temporomandibular joint (TM
J) with and without simultaneous orthognathic surgery (SOS). Materials
and Methods: Twenty-nine patients (45 joints) were evaluated retrospe
ctively. Group 1 consisted of 17 patients (16 women 1 man) and 30 join
ts. Fifteen (88%) patients had sagittal split ramus osteotomies (SSRO)
; 8 (53%) of these patients also had Le Fort I osteotomies, and 2 pati
ents (12%) had only Le Fort I osteotomies with TFG. Group 2 consisted
of 12 patients (15 joints) who received only TFG and no SOS. Results:
Group 1 had 9 patients (53%) with an incisal opening greater than 35 m
m, 11 joints (37%) with greater than 6 mm lateral excursive movement,
and 11 patients (65%) were asymptomatic postoperatively. Average follo
w-up was 57.4 months (range, 23 to 69 months). Group 2 had eight patie
nts (67%) with an incisal opening greater than 35 mm, six joints (40%)
with greater than 6 mm lateral excursive movement, and seven patients
(58%) were asymptomatic postoperatively. Average follow-up was 55.1 m
onths(range, 48 to 64 months). Conclusion: TFG with and without SOS pr
oduced similar treatment outcomes in comparing groups 1 and 2. No sign
ificant differences were observed for the number of patients with an i
ncisal opening > 35 mm (P = .703), lateral excursion > 6 mm (P = 1.00)
, and successful elimination of pain (P = 1.00), even though group 2 h
ad a significantly greater number of patients (P < 0.01) that were ope
rated on unilaterally. Combining treatment outcomes for both groups, t
he number of previous joint surgeries significantly affected success (
P < .01). The presence of osteoarthritic changes did not significantly
affect treatment outcome (P = .187).