AUTOLOGOUS FAT TRANSPLANTATION AROUND TEMPOROMANDIBULAR-JOINT TOTAL JOINT PROSTHESES - PRELIMINARY TREATMENT OUTCOMES

Purpose: This study evaluated the efficacy of autologous fat grafting to the temporomandibular joint (TMJ) as an adjunct to prosthetic joint reconstruction in preventing fibrosis and heterotopic bone formation and determined its effects on postoperative joint mobility. Patients a nd Methods: Fifteen patients (2 male, 13 female) underwent TMJ reconst ruction with Techmedica (Techmedica, Inc, Camarillo, CA) custom made t otal joint prostheses, Seven patients had bilateral and eight had unil ateral surgery, for a total of 22 joints, All patients had autologous fat from the abdomen grafted around the articulating portion of the jo int prostheses after the fossa and mandibular components had been stab ilized. Twenty patients (2 male, 18 female) without fat grafts sewed a s controls, There were 17 bilateral and 3 unilateral cases, for a tota l of 37 joints. These were the last 20 patients with adequate data ava ilable for inclusion treated before patients receiving primary fat gra fting as part of the joint reconstruction. Results: In the control gro up, the average preoperative maximum interincisal opening (MIO) was 26 .8 mm, and at long-term follow-up it was 33.1 mm. Contralateral excurs ive movements averaged 3.2 mm preoperatively and 1.7 mm at long-term f ollow-up. In the fat graft group, average preoperative MIO was 26.9 mm , and at long-term follow-up it was 38.7 mm. Contralateral excursive m ovements averaged 2.3 mm preoperatively and 2.2 mm at long-term follow -up, The differences in measured function between the two groups were found to be statistically significant (P less than or equal to.01), Al though both groups experienced a significant decrease in pain, there w as no significant difference noted in the patients' perception of thei r level of pain at long-term follow-up as expressed on visual analog s cale evaluations. There was no radiographic or clinical evidence of he terotopic calcifications or limitation of mobility secondary to fibros is in any of the experimental groups, whereas seven control patients ( 35%) exhibited this phenomenon and required reoperation. Conclusions: Autologous fat transplantation appears to be a useful adjunct to prost hetic TMJ reconstruction. Its use appears to minimize the occurrence o f excessive joint fibrosis and heterotopic calcification, consequently providing improved range of motion.