Auricular cartilage grafting in arthroplasty of the temporomandibular joint: a retrospective clinical follow-up.

OBJECTIVE: The aim of this study was to evaluate TMJ arthroplasty with auricular cartilage grafts in patients with osteoarthritis, refractory to previous surgical and nonsurgical treatment. STUDY DESIGN: Twenty-three TMJs in 18 patients where arthroplasty with auricular cartilage grafts had been performed were evaluated. Sixteen joints in 12 patients with grafts still in position were followed. TMJ pain at mandibular function, TMJ tenderness and mouth opening ability (MIO) were evaluated. RESULTS: The grafts had to be removed from 7 TMJs (30%), all of which had been subject to previous surgery. In the 16 joints with grafts still in position a significant (P < .001) reduction of pain at mandibular function was found and MIO had increased significantly (P = .015). CONCLUSIONS: TMJ arthroplasty with auricular cartilage grafts can reduce pain and improve mandibular function in patients with osteoarthritis. The method seems to be less favorable in patients where previous TMJ surgery has been performed.

Dental rehabilitation in 101 primarily reconstructed jaws after segmental resections--possibilities and problems. An 18-year study.

AIMS: To evaluate the possibility of providing every patient with dental rehabilitation after segmental resections and primary jaw reconstructions. MATERIALS AND METHODS: Ninety-five consecutive patients, followed for more than 1 year, were retrospectively evaluated without any exclusions, using the patients' records. RESULTS: 1) Forty percent received dental substitutes after a mean of 32 months for implant bridges and 20 months for removable dentures. Thirty-one percent were implant bridges and 9% removable dentures. 2) Of patients with mandibles, reconstructed with bone, 48% were dentally rehabilitated. 3) Seventeen percent decided against dental rehabilitation, either because they could manage with their remaining teeth or--in edentulous cases--because they could not cope with the additional treatment thought-to-be necessary for dental rehabilitation. 4) Jaws, reconstructed without bone, did not receive any dental rehabilitation. 5) The overall survival rate of the dental reconstructions was 92% with a mean observation time of 36 months (0-129). For implant-supported bridges, the survival ratio was 90% with a mean observation time of 39 months (0-129). 6) The overall survival rate of dental implants was 90% with a mean observation time of 53 months (12-149). CONCLUSIONS: When all patients were accounted for, less than 50% had their dentitions restored. This took more than 2 years to accomplish. Edentulous jaws, reconstructed without bone, never became rehabilitated. Several patients could not cope with the additional treatment necessary to restore their dentitions. The overall survival rate of dental reconstructions and implants was at least 90%.

Angle-to-angle mandibular reconstruction with two free fibular flaps in a patient with two consecutive gingival cancers.

Two consecutive mandibular reconstructions with free vascularised fibular grafts in a patient with gingival cancers are presented. After resection of a gingival cancer on the left side, reconstruction was performed with a free vascularised fibular graft from the left leg. Two-and-a-half years later, a second free vascularised osteoseptocutaneous fibular graft from the right leg was used to reconstruct the right mandible and floor of the mouth after resection of a new gingival cancer. The two flaps have reconstructed the mandible from angle-to-angle. During the second reconstruction, a deviation of the left neomandible to the right side was corrected. Both postoperative courses were uneventful. Donor site morbidity was negligible, and the osteosyntheses healed well. This result further emphasises the value of the free fibular flap and the importance of adequate contouring of the fibular graft with osteotomies.