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Martes, 17 Septiembre 2019 14:26

218 - ATM reconstruction with autologous graft

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A 21 years old female patient is referred to Maxillofacial Diagnostic Institute (IDM) for post-surgical tomographic control of ATM reconstruction.

The panoramic radiography (Figure 1) shows the presence of bone graft in the right condylar area associated with surgical fixation screws, as well as surgical plates and screws in the nasomaxillary area, body, symphysis, and mandibular para-symphysial region with the presence of fixed appliances. for bimaxillary orthodontics.

At the evaluation of the volumetric tomography (CBCT) axial cuts (Figure 2), coronal (Figure 3), sagittal (Figure 4), and ATM (Figures 5), absence of condyle and part of the right mandibular branch is observed by post-surgical sequel; instead, the presence of bone graft located in the right mandibular branch that extends from the mandibular angle zone to the condylar region with the presence of five fixation screws to the area of ​​remaining mandibular bone is appreciated. The elongation of the coronoid process of the right side and presence of severe facetting with subchondral sclerosis of the left mandibular condyle can also be seen.

In 3D reconstructions, the presence of the bone graft in the condylar region and of the right branch is observed in detail with the surgical fixation screws (Figure 6).



Tomographic signs compatible with autologous bone graft of right mandibular condyle.



Surgical interventions on the temporomandibular joint have two main objectives: to restore the normal anatomy of the joint and to decompress the articular structures. Both requirements must lead to a clinical situation of absence of pain and recovery of joint function. These final objectives must be very present when considering a reconstructive option of the ATM.

In the medical literature we find numerous publications that determine the advantages of reconstructing bone defects through autologous grafts. In the reconstruction of the TMJ, several types of autogenous grafts have been used: costochondral, sternoclavicular, peroneal, tibial, iliac crest, cranial shell, or metatarsal. Without a doubt, the most traditionally used by oral and maxillofacial surgeons has been the costochondral graft. 

At present there is no doubt about the excellent results obtained with autologous grafts in ATM reconstruction. However, it has been described that the incidence of pain and especially recurrence of ankylosis and complications is higher in those patients who have undergone multiple joint surgeries previously. According to some authors, the total replacement of ATM structures by certain alloplastic prostheses seems to produce better results in these multi-operative cases that present with avascular necrosis of the condylar segment. However, other authors propose a staggered approach using autologous tissues as a definitive reconstructive technique.


Research Team IDM

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