RECONSTRUCTION OF THE TEMPOROMANDIBULAR-JOINT USING A TEMPORALIS GRAFT WITH OR WITHOUT SIMULTANEOUS ORTHOGNATHIC SURGERY

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).