J Korean Assoc Oral Maxillofac Surg.  2023 Dec;49(6):354-359. 10.5125/jkaoms.2023.49.6.354.

Bone remodeling of the fibula segment as a form of neocondyle after free vascularized bone transfer: a report of two cases

• Park HI
• Chang HJ
• Lee JH

• KMID: 2550299
• DOI: http://doi.org/10.5125/jkaoms.2023.49.6.354

Abstract

The temporomandibular joint is a unique structure composed of the joint capsule, articular disc, mandibular condyles, glenoid fossa of the temporal bone, surrounding ligaments, and associated muscles. The condyle is one of the major components of a functional temporomandibular joint. Reconstruction of large mandibular defects involving the condyle is a surgical challenge for oral and maxillofacial surgeons. To restore large mandibular defects, there are different options for free flap method such as fibula, scapula, and iliac crest. Currently, the vascularized fibula free flap is the gold standard for reconstruction of complex mandibular defects involving the condyle. In the present report, neocondyle regeneration after mandible reconstruction including the condyle head with fibula free flap was evaluated. In this report, two patients were evaluated periodically, and remodeling of the distal end of the free fibula was observed in both cases after condylectomy or mandibulectomy. With preservation of the articular disc, trapezoidal shaping of the neocondyle, and elastic guidance of occlusion, neocondyle bone regeneration occured without ankylosis. Preservation of the articular disc and maintenance of proper occlusion are critical factors in regeneration of the neocondyle after mandible reconstruction.

Keyword

Fibula free flap; Neocondyle regeneration; Mandibular reconstruction; Case reports

Figure

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  Fig. 1 On the day 6 postoperative panoramic radiograph, the vascularized fibula free flap was fixated with two L-shaped semi-rigid mini plates and three four-hole mini plates.

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  Fig. 2 The fibula bone was prepared in an L-shape according to the three-dimensional simulation surgical template.

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  Fig. 3 At the 40-month follow-up, the patient showed 35-mm maximum mouth opening.

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  Fig. 4 Rounding off at the distal end of the fibula was observed at the three-month postoperative follow-up.

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  Fig. 5 The distal end of the fibula was prepared in a right trapezoidal shape using a surgical template.

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  Fig. 6 On the day 4 postoperative panoramic radiograph, the vascularized fibula free flap was fixed with two L-shaped semi-rigid mini plates on the native mandible.

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  Fig. 7 Neocondyle bone growth in the direction of the lateral pterygoid traction started two months after surgery.

Reference

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