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Temporalis Myofascial Flap and Conchal Bowl Cartilage Interposition Composite Grafting for Temporomandibular Joint Arthritis
Anthony DeLeonibus MD, Demetrius Coombs MD, Samantha Maasarani MD MPH, Bahar Bassiri Gharb MD PhD, Antonio Rampazzo MD PhD, Francis Papay MD
Cleveland Clinic Foundation
2022-01-15
Presenter: Anthony DeLeonibus
Affidavit:
Attestation that the above statement is correct
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
Temporomandibular arthritic pain represents a substantial clinical problem and in spite of multiple modalities for non-surgical and surgical treatment, outcomes remain inconsistent. Herein we describe an innovative technique to alleviate symptomatic TMJ arthritic pain: enveloping autologous conchal bowl cartilage in a vascularized temporalis myofascial flap and transposing the construct into the TMJ.
Methods:
A 62-year-old female with a history of a previous right subcondylar fracture after a mechanical fall presented to our clinic with significant pain and PET scan indicative of nonunion. During dissection, there was no mandibular nonunion and in order to relieve her pain, a novel composite graft was interposed between the remnant articular disk and the head of the condyle. The temporalis muscle was dissected with approximately 1 cm of muscle width harvested with the deep temporal fascia. In addition, the right conchal cartilage was then harvested using a standard anterior bowl incision and approximately 1x2 cm strip of cartilage was wrapped in the temporalis muscle
Results:
At 8 months follow-up, she reported no pain and significant improvement in her maximum intercisal opening (>30mm) and intercuspation. She endorsed resolution of pain, improved range of motion within the TMJ, and improved rightward displacement of the mandible on mouth opening.
Conclusion:
Multiple materials have been employed but composite grafting with a conchal cartilage and temporalis myofascial construct represent a novel option. The use of a composite graft provides robust soft tissue and stable cartilaginous foundation to potentially help with short term, intermediate and long-term reconstitution of TMJ biomechanics.
