ABSTRACT
INTRODUCTION: Temporomandibular Joint (TMJ) reankylosis is one of TMJ arthroplasty complications that can interfere masticatory function and aesthetics. This case report aimed to describe a TMJ reankylosis in growing age patient that occurred 5 years after interpositional arthroplasty using gold foil. Interpositional arthroplasty using temporalis fascia and costochondral graft followed by unilateral coronoidectomy could be a treatment option. CASE PRESENTATION: A 17-year-old female came with inability to open her mouth 5 years after first interpositional arthroplasty using gold foil due to traumatic TMJ ankylosis. Patient was diagnosed type IV left TMJ reankylosis with left coronoid process hyperplasia. Patient was treated with interpositional arthroplasty using temporalis fascia as an interposition material for articular disc substitution, costochondral graft for ramus condyle unit (RCU) reconstruction and followed by unilateral coronoidectomy. Postoperative mouth opening was ±26 mm. One year evaluation showed stable mouth opening and no recurrency occured. DISCUSSION: Age at growing period, insufficient gap width, surgical technique and the effects of previous surgery may generate TMJ reankylosis. Temporalis fascia widely used for interposision material and act as a lubricant that makes movement frictionless. Costochondral graft can be used for RCU reconstruction to prevent decreasing mandibular ramus height and openbite. CONCLUSION: Growing age increases the risk of TMJ reankylosis. Interpositional arthroplasty, which used temporalis fascia and a costochondral graft, has resulted in a sufficient mouth opening and an improvement in masticatory function. Recurrence was not found in the 1-year postoperative evaluation.
ABSTRACT
INTRODUCTION: Mandibular abnormalities caused by ameloblastoma present significant surgical and reconstructive difficulties. This study investigates double barrel fibular bone graft to correct these abnormalities and improve mandibular function and appearance. CASE PRESENTATION: A 28-year-old male presented with a mandibular lump and facial asymmetry. The radiographic and histologic examination detected was subsequently diagnosed as ameloblastoma. After undergoing a hemi mandibulectomy procedure, a free vascularized fibular bone graft was harvested from the patient's left leg and transplanted to reconstruct the mandibular angle. The evaluation of the patient's functional outcomes was assessed utilising the University of Washington Quality of Life (UW-QOL) questionnaire. The patient UW - QOL Score has increased 62.5 pre-treatment to 93.75 post-treatment. DISCUSSION: The suggested strategy to treating aggressive ameloblastomas is radical surgery, involving the use of wide resection and following bone reconstruction. Vascularized grafts, including the double-barrel fibular bone graft, are usually preferred in relation to mandibular defect reconstruction for their ability to offer improved stability, height, and thickness, which enhances functional results. In contrast to conventional approaches, our case did not show any signs of facial deformities or bone resorption. The utilization of the vascularized fibular bone graft proved to be a valuable option for early rehabilitation in patients with mandibular continuity defects, offering promising outcomes in terms of patient well-being and quality of life. This final result provides proof supporting the potential of this technique for managing mandibular defects. CONCLUSION: Double-barrel fibular bone grafts and dental rehabilitation can restore mandibular continuity defect from ameloblastoma.
