A retrospective analysis of temporomandibular joint reconstruction with free fibula microvascular flap

Objectives: The temporomandibular joint is occasionally encountered in exti rpative surgery of the head and neck, It presents a difficult management is sue. Little has been reported on functional outcomes after resection and re construction of the temporomandibular joint. Design: A retrospective analys is consisting of chart reviews and phone interviews was performed on 17 pat ients who underwent fibular free flap reconstruction of the temporomandibul ar joint from 1993 to 1998, Results: Mean follow-up in surviving patients ( 10) was 41.3 months, Mean age of the group was 62; male-to-female ratio was 11:6. Average hospital stay was 11.6 days. Four patients had no radiation therapy, 2 had preoperative and 11 had postoperative treatment. Five patien ts had one osteotomy, seven had two, one had three, and one had four. Ten p atients could chew, one could not, and none were recorded for the remaining . Diet consisted of regular food for two patients, soft food for seven, ful l liquids for four, and tube feeds for four. Cosmesis was judged as excelle nt by eight patients, acceptable by two, and unacceptable by two. Five pati ents did not describe cosmesis, Most patients stated that bony contour was excellent, but that the soft tissue defect was noticeable, Speech was judge d as intelligible by seven and moderately understandable by one. Nine patie nts did not describe speech. Two patients had postoperative displacement of the fibular head out of the fossa. Conclusion: Primary reconstruction of t he temporomandibular joint with microvascular fibular flaps is a viable and effective means of restoring function. The majority of patients are able t o resume oral feeds, obtain excellent or pleasing cosmetic results, and mai ntain intelligible speech.