PURPOSE: Our goal was to evaluate long-term stability and function of 5 condyles reconstructed with vascularized second metatarsal joint grafts. MATERIALS AND METHODS: Four patients were reconstructed with 5 vascularized metatarsal grafts. These reconstructed joints were then followed for an average of 12.5 years. These patients represent the entire series and were all successfully contacted and reevaluated for this article. Measures of opening, deviation, excursion, symmetry, and clinical symptoms relating to the reconstructed joints are evaluated. RESULTS: Mean preoperative interincisal aperture was 12 mm, and postoperative aperture 48.5 mm. Three unilaterally treated patients had lateral excursion with opening. The mean deflection was 4.3 mm toward the operated side. Lateral and protrusive movements were limited in reconstructed joints, but up to 3 mm of protrusion was shown at 12.5 years. Subjectively, all patients rated their function as acceptable and were able to occlude and masticate without difficulty. Symmetry at rest was improved by surgery. CONCLUSIONS: Vascularized metatarsal joints represent a potentially suitable long-term substitute for condylar reconstruction. This limited series shows the technical viability of the procedure. A larger series may be warranted to compare this promising technique with conventional methods of temporomandibular joint reconstruction. Copyright 2003 American Association of Oral and Maxillofacial Surgeons
PURPOSE: Our goal was to evaluate long-term stability and function of 5 condyles reconstructed with vascularized second metatarsal joint grafts. MATERIALS AND METHODS: Four patients were reconstructed with 5 vascularized metatarsal grafts. These reconstructed joints were then followed for an average of 12.5 years. These patients represent the entire series and were all successfully contacted and reevaluated for this article. Measures of opening, deviation, excursion, symmetry, and clinical symptoms relating to the reconstructed joints are evaluated. RESULTS: Mean preoperative interincisal aperture was 12 mm, and postoperative aperture 48.5 mm. Three unilaterally treated patients had lateral excursion with opening. The mean deflection was 4.3 mm toward the operated side. Lateral and protrusive movements were limited in reconstructed joints, but up to 3 mm of protrusion was shown at 12.5 years. Subjectively, all patients rated their function as acceptable and were able to occlude and masticate without difficulty. Symmetry at rest was improved by surgery. CONCLUSIONS: Vascularized metatarsal joints represent a potentially suitable long-term substitute for condylar reconstruction. This limited series shows the technical viability of the procedure. A larger series may be warranted to compare this promising technique with conventional methods of temporomandibular joint reconstruction. Copyright 2003 American Association of Oral and Maxillofacial Surgeons