Condylar Reconstruction

The condyle is sometimes resected in combination with the ramus and angle of the mandible for tumors which originate in the lateral pharynx, external skin, or parotid gland. In cases where the condyle is not involved with tumor it is preferable to transplant the proximal 2.0 to 2.5 cm of condyle back onto the reconstructed mandible using titanium plates and screws.35 An intraoperative frozen section of the

Figure 19-5. A, A 49-year-old woman with a recurrent parotid tumor after receiving radiation therapy. She underwent resection of the cheek skin, parotid gland, facial nerve, masticatory muscles and the ascending ramus of the mandible. B, The defect was reconstructed using an osteocutaneous scapular free flap. Note that this flap provides an extensive amount of skin and subcutaneous tissue, in conjunction with the lateral border of the scapula, which is used for reconstruction of the ascending ramus of the mandible. C, Inset of the vascularized bone graft with the condyle mounted and rigidly fixed to the native mandible.

Figure 19-5. A, A 49-year-old woman with a recurrent parotid tumor after receiving radiation therapy. She underwent resection of the cheek skin, parotid gland, facial nerve, masticatory muscles and the ascending ramus of the mandible. B, The defect was reconstructed using an osteocutaneous scapular free flap. Note that this flap provides an extensive amount of skin and subcutaneous tissue, in conjunction with the lateral border of the scapula, which is used for reconstruction of the ascending ramus of the mandible. C, Inset of the vascularized bone graft with the condyle mounted and rigidly fixed to the native mandible.

marrow from the condylar margin of resected mandible is obtained to avoid the possibility of transferring tumor back into the patient (Figures 19-2B, 19-3C, 19-4B and 19-5C). Autotransplantation usually is the most effective method of condy-lar reconstruction and reliably produces the best functional results with minimal complications. If it is necessary to resect more than 1 to 2 cm above the angle of the mandible, then it is easier to disarticulate the condyle with the specimen and to transplant it back onto the reconstructed mandible. Exposure of this area of the mandible and condyle risks injury to the facial nerve and makes application of plates and screws practically impossible. Condylar disarticulation and reimplantation provides the simplest and safest solution.

Relocating Dislocated Jaw
Figure 19-5. D and E Postoperative result at 2 years. Although an excellent mandibular contour is observed, the esthetic result was considered fair, due to facial palsy and poor external skin color match. F, Panoramic roentgenograph showing adequate position of the bone graft.

When condyle transplantation is oncologically unsafe, the proximal end of the reconstructed mandible can be shaped and rounded to mimic a condyle (with fascia used as a spacer), or a 1 cm gap can simply be left in the temporomandibular joint. The potential for ankylosis or some dislocation of the jaw to the side of the defect is higher with this type of reconstruction, but most patients function remarkably well with only one intact tem-poromandibular joint. This is essentially the equivalent of a condylar resection for a shattered condyle after trauma. Although prosthetic condylar implants have been used, potential extrusion or erosion of these implants into the temporal fossa is a serious complication that should be avoided if at all possible. Thus we do not advocate the use of these prostheses.

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