Subjective and objective assessment of the temporalis myofascial flap in previously operated temporomandibular joints

Purpose: This study evaluated the subjective and objective findings in pati ents who had undergone temporomandibular joint (TMJ) reconstruction with a temporalis myofascial nap. All joints had previously been reconstructed wit h alloplastic, allogeneic, or autogenous material; Patients and Methods: Twenty-three consecutive patients who underwent 28 te mporalis myofascial flap procedures were assessed subjectively and objectiv ely preoperatively and at an average of 36 months postoperatively. Panorami c radiographs, magnetic resonance imaging (MRI), or coronal computed axial tomography scans (CT scans) were performed on, all patients preoperatively to evaluate for joint disease. A visual analog scale (VAS) was used to asse ss pain preoperatively and postoperatively., Patients also reported their u se of pain medication, ability to function, diet, complications, and overal l satisfaction. Preoperative and postoperative objective assessment consist ed of an evaluation of range of motion, deviation on opening, joint noise o n function, and cosmesis. Results: On preoperative radiographic examination, 24 of 28 joints showed s igns of bony degeneration, including cortical erosion, condylar flattening, and joint space alterations. Four joints showed evidence of ankylosis. The average preoperative maximal interincisal opening (MIO) was 23.7 mm, and t he postoperative average was 32.3 mm CP (.05). Preoperatively, all patients displayed one or more objective clinical signs of joint disease such as jo int noise on function, deviation on opening, limited mouth opening (less th an 20 mm), or limited excursions (less than 2 mm). Postoperatively, 65% dis played one or more of these signs, a significant reduction (P < .05). Preop eratively, the average pain score was 8.2 on the VAS, and postoperatively t he average pain score was 3.4 (P < .0005). Fifteen patients used less pain medication postoperatively, 7 used the same amount, and 1 patient used more . Thirteen patients were very satisfied with the overall results of the sur gery, 4 were satisfied, and 4 were not satisfied. Two patients were satisfi ed with their increased function but were not satisfied with their pain red uction. All were satisfied with their cosmetic appearance. Minor complicati ons after the procedure included 3 patients who had preauricular paresthesi a and 1 who had an intraoperative dura mater exposure without sequelae. Two patients had postoperative superficial suture infections, and 2 noted hear ing changes that were found to be clinically insignificant by audiologic ex amination. Conclusion: The temporalis myofascial flap is an autogenous graft that has the advantages of close proximity to the temporomandibular joint, minimal s urgical morbidity, and successful clinical results. It was found to be a va luable option for TMS reconstruction in joints in which alloplastic, alloge neic, or autogenous materials have previously been placed unsuccessfully.