- Email: [email protected]
Transparotid approach for tumor excision from the infratemporal space in temporomandibular joint reconstruction: a 3-year follow-up
Transparotid approach for tumor excision from the infratemporal space in temporomandibular joint reconstruction: a 3-year follow-up Christoph Leiggener, MD, DDS,a Claude Jaquiéry, MD, DDS,a Christoph Kunz, MD, DDS,a and Anders Westermark, DDS, PhD,b Basel, Switzerland and Stockholm, Sweden UNIVERSITY HOSPITAL BASEL AND KAROLINSKA UNIVERSITY HOSPITAL
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e1-e4)
Surgery for tumors extending into the infratemporal fossa requires adequate exposure to identify and protect vital structures. We present a patient who had, at some time in the past, been treated by condylar resection of the right temporomandibular joint (TMJ) because of a pigmented villonodular synovitis. The condyle had been replaced with a standard reconstruction plate that had eroded deep into the skull base. Prosthetic reconstruction of the TMJ was performed 1.5 years later after renewed bone tumor excision from the infratemporal space. The standard preauricular and submandibular approaches for implantation of a total TMJ prosthesis did not offer adequate access for tumor removal from the infratemporal fossa. The tumor was excised successfully through an additional transparotid approach. Bone tumors originating from the mandibular condylar process can extend into the infratemporal fossa, an area which is challenging to access surgically. Few primary tumors arise in this area and, in fact, metastases to the infratemporal space from tumors elsewhere are a rare occurrence.1,2 The infratemporal fossa is the irregular retromaxillary space under the floor of the middle cranial fossa, and it is circumscribed by the ascending ramus of the mandible laterally and by the lateral pterygoid plate of the sphenoid medially. The anterior boundary of the fossa is formed by the posterior wall of the maxilla. The standard approach for installation of a total alloplastic temporomandibular joint (TMJ) prosthesis is a combination of preauricular and submandibular incisions.3 These approaches provide adequate exposure for placement of the fossa and mandibular components, and are followed by a good cosmetic a
Division of Craniomaxillofacial Surgery, Clinic for Reconstructive Surgery, University Hospital Basel. b Department of Oral and Maxillofacial Surgery, Karolinska University Hospital. Received for publication Apr 22, 2009; returned for revision Aug 1, 2009; accepted for publication Aug 11, 2009. 1079-2104/$ - see front matter © 2010 Published by Mosby, Inc. doi:10.1016/j.tripleo.2009.08.018
outcome. However, the combined preauricular and submandibular exposure may not offer an adequate surgical approach to tumors extending into the infratemporal fossa. Owing to the oblique course of the facial nerve, access is limited, especially to the medial part of the infratemporal fossa. The case reported here illustrates the addition of a transparotid approach to the standard procedure for tumor exicision from the infratemporal fossa and insertion of a TMJ prosthesis. CASE REPORT A 22-year-old woman was admitted to the Department of Craniomaxillofacial Surgery, University Hospital Basel, in February 2005, because of pain in the right TMJ and limited mouth opening. Six months before, at another institution, she had undergone condylectomy for treatment of a pigmented villonodular synovitis (PVNS) of the right TMJ. The condyle had been replaced by a 2.4 reconstruction plate (Synthes, Oberdorf, Switzerland) as a spaceholder for later TMJ reconstruction. Apart from extensive fossa erosion from the impact of the reconstruction plate, a computerized tomography (CT) scan also showed 30 ⫻ 25 mm bony mass around the condylar neck extending into the infratemporal fossa (Fig. 1). A biopsy from the mass revealed bone with signs of bone regeneration. The patient was scheduled for tumor resection and total joint reconstruction with a TMJ Concepts prosthesis (TMJ Concepts, Ventura, CA; Fig. 2). At surgery, the preauricular and submandibular incisions were combined in a “lazy-S incision,” but it was obvious that the preauricular and submandibular dissections were not sufficient to gain access to the bony mass on the medial aspect of the mandibular ramus. Therefore, an additional transparotid approach (Fig. 3) was opened to create appropriate access to the medial part of the infratemporal fossa by using a nerve stimulator. After removal of the reconstruction plate, the bony tumor was removed in sections (Fig. 4) with the help of a piezosurgical device (Mectron, Carasco, Italy). Thereafter, the TMJ prosthesis was implanted uneventfully. The incision wounds were closed in layers. The subsequent histologic examination described a reactive new bone formation without residues of the previously treated pigmented villonodular synovitis. The postoperative course was uneventful. An initial weakness of the frontal and marginal mandibular branches of the facial nerve was observed,
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Fig. 2. The patient’s custom-made TMJ Concepts total joint prosthesis mounted on a 3-dimensional model after model surgery. The device is constructed on a 3-dimensional model, is designed to meet each patient’s specific anatomic needs, and has metal-on-polyethylene articulations.
Fig. 1. Computerized tomography scan. A, Coronal view demonstrating a space-filling bony cystic lesion in the infratemporal fossa with extension medially to the pterygoid process. B, Sagittal scan showing that the temporarily inserted fracture plate eroded deeply toward the medial cranial fossa.
but it was completely resolved after 3 months. At the 3-year follow-up, the interincisal opening was 50 mm and there was good occlusal stability. The radiologic follow-up at 36 months showed no heterotopic bone formation and no recurrence of PVNS-associated lesions (Fig. 5).
DISCUSSION The standard approach for the implantation of total TMJ prostheses is a combination of a preauricular and submandibular incision, as previously described.3 These approaches normally provide adequate exposure for the placement of the fossa and condylar components with a minimum of morbidity and a good cosmetic outcome. But in the case presented here, these approaches offered insufficient access for removal of the tumor from the infratemporal fossa. The preauricular incision allows only limited entry to the infratemporal space. Access to the medial part of the infratemporal fossa is particulary limited owing to the oblique course of the facial nerve.
Fig. 3. Intraoperative view of the implanted total temporomandibular joint prosthesis. The buccal and marginal branches of the facial nerve are identified and cross the mandibular component.
The facial nerve leaves the base of the skull through the stylomastoid foramen, crosses posterior to the rim of the mandibular ramus, and then passes over the lateral aspect of the ramus, where it branches into several rami.4,5 However, as described above, the infratemporal fossa is also inaccessible from below, i.e., through the submandibular incision, because of the course of the marginal mandibular branch of the facial nerve.
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Leiggener et al. e3
Fig. 4. Lateral aspect of the reconstructed sections of the resected bony tumor.
Therefore, an additional approach was needed to complete tumor resection. Complex transfacial approaches to the infratemporal fossa as reported by MoreiraGonzalez et al.6 and Vilela and Rostomily7 were considered but not used, because the tumorous mass had clear borders and did not involve the lateral skull base. The transparotid approach used here offers several advantages regarding access to the medial part of the infratemporal fossa. The technique was first described by Hindis and Girotti in 1967 in relation to a vertical subcondylar osteotomy.8 It is commonly performed for open reduction and internal fixation of condylar fractures.5,9 The approach gives direct access to the mandibular collum and, if the condyle is resected, as in the case presented here, it also allows exposure of the medial part of the infratemporal fossa. One of the challenges of the transparotid approach is facial nerve disturbance. The incidence of a temporary weakness of the facial nerve varies between 17%-30% with predominance of the marginal mandibular branch. In all reported cases, nerve function returns to normal within 3-6 months.9,10 In the present patient, temporary weakness of the frontal and marginal mandibular branches occurred and recovered completely after 3 months; it was probably caused by tissue retraction during surgery. In the case reported here, prosthetic reconstruction of the TMJ was successfully performed with a TMJ Concepts prosthesis. This prosthesis system is individually manufactured on the basis of 3-dimensional models derived from patient CT scans. The fossa component is made of ultra-high-molecular-weight polyethylene (UHMWPE) attached to a pure titanium mesh which conforms to the anatomy of the fossa and is stabilized by the adjacent zygomatic arch. The mesh allows bone and soft tissue ingrowth to maximize long-term stability and secure the tight fit of the fossa component. The body of the mandibular component is made of titanium,
Fig. 5. Computerized tomography scan: coronal (A) and sagittal (B) views showing the integrated TMJ Concepts prosthesis in place 3 years after surgery with no recurrence of pigmented villonodular synovitis–associated lesions or heterotopic bone formation.
and the condylar head is a cobalt-chromium-molybdenum alloy, which is attached to the titanium shaft under high pressure. The functional surfaces of the chromium-cobalt-molybdenum alloy and UHMWPE represent the gold standards for orthopedic joint replacement regarding wear debris and structural stability and have proven to be viable for TMJ reconstruction as well.11,12 Condylar replacement with condyle-bearing reconstruction plates can be used temporarily but will, in the long run, result in fossa erosions and heterotopic bone formation,13,14 although Marx et al.15 recently reported good results with that treatment modality. Condylar reconstruction of the type initially applied to the patient presented here, however, should not be used even for short-term replacement. The painful deep fossa erosion demonstrates the obvious unphysiologic character of such a procedure.
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Leiggener et al.
Within 6 months of condylectomy, a massive heterotopic ossification developed in the infratemporal fossa, arising from the cut edge of the condylar neck. Histologically, a reactive bone formation was identified with exclusion of recurrent PVNS. These findings drew attention to the high potential of heterotopic bone formation as a complication frequently seen after implantation of alloplastic materials at the TMJ.13,16,17 The presence of a dead space after condylectomy, kept open by the temporarily applied osteosynthesis reconstruction plate, may promote a hematoma with subsequent osseous organization. However, such excessive bone formation must be induced and supported by migrating osteogenic cells from the surrounding periosteum and from the bone marrow of the cut edge of the condylar neck. These progenitor cells differentiate toward osteoblasts as a reaction to surgical trauma and produce growth factors important for bone regeneration.18 The considerable osteogenic potential of grafted periosteum has been demonstrated during regeneration of the mandibular head in rabbits19 and has been observed along the vascular pedicle after fibula free-flap maxillary and mandibular reconstruction.20 As a consequence, to prevent or limit heterotopic bone formation, periosteal stripping should be kept to a minimum and hemostasis should be performed thoroughly to decrease the risk of hematoma formation. Any dead space should also be eliminated by insertion of an autologous fat pad.17,21 In conclusion, the transparotid approach was found to be safe in this case and has the potential to be a versatile approach offering several advantages for accessing the medial part of the infratemporal fossa without risking lesions of the facial nerve. The case reported here also shows the efficacy of this total alloplastic TMJ reconstruction after 3 years.
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REFERENCES 1. Conley JJ. Tumors of the infratemporal fossa. Arch Otolaryngol 1964;79:498-504. 2. Tiwari R, Quak J, Egeler S, Smeele L, van der Waal I, van der Valk P, et al. Tumors of the infratemporal fossa. Skull Base Surg 2000;10:1-9. 3. Wolfort LM, Cottrell DA, Henry CH. Temporomandibular joint reconstruction of the complex patient with the Techmedica custom-made total joint prosthesis. J Oral Maxillofac Surg 1994; 52:2-10. 4. Bernstein L, Nelson RH. Surgical anatomy of the extraparotid distribution of the facial nerve. Arch Otolaryngol 1984;110: 177-83. 5. Ellis E, Dean J. Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1993;76: 6-15. 6. Moreira-Gonzalez A, Pieper DR, Cambra JB, Simman R, Jackson IT. Skull base tumors: a comprehensive review of transfacial
20.
21.
swing osteotomy approaches. Plast Reconstr Surg 2005;115: 711-20. Vilela MD, Rostomily RC. Temporomandibular joint–preserving preauricular subtemporal-infratemporal fossa approach: surgical technique and clinical application. Neurosurgery 2004;55: 143-53. Hindis EC, Girotti WJ. Vertical subcondylar osteotomy: a reappraisal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1967;24:164-70. Manisali M, Amin M, Aghabeigi B, Newman L. Retromandibular approach to the mandibular condyle: a clinical and cadaveric study. Int J Oral Maxillofac Surg 2000;32:253-6. Ellis E, McFadden D, Simon P, Throckmorton G. Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 2000;58:950-5. Wolford LM, Pitta MC, Reiche-Fischel O, Franco PF. TMJ Concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year follow up study. Int J Oral Maxillofac Surg 2003;32: 268-74. Mercuri LG, Edibam NR, Giobbie-Hurder A. Fourteen-year follow-up of a patient-fitted total temporomandibular joint reconstruction system. J Oral Maxillofac Surg 2007;65:1140-8. Lindqvist C, Söderholm AL, Hallikainen D, Sjövall L. Erosion and heterotopic bone formation after alloplastic temporomandibular joint reconstruction. J Oral Maxillofac Surg 1992;50:942-9. Westermark A, Koppel D, Leiggener C. Condylar replacement alone is not sufficient for prosthetic reconstruction of the temporomandibular joint. Int J Oral Maxillofac Surg 2006;35: 488-92. Marx RE, Cillo JE, Broumand V, Ulloa JJ. Outcome analysis of mandibular condylar replacements in tumor and trauma reconstruction: A prospective analysis of 131 cases with long-term follow-up. J Oral Maxillofac Surg 2008;66:2515-23. Reid R, Cooke H. Postoperative ionizing radiation in the management of heterotopic bone formation in the temporomandibular joint. J Oral Maxillofac Surg 1999;57:900-05. Wolford LM, Morales-Ryan CA, Morales PG, Cassano DS. Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation. Proc (Bayl Univ Med Cent) 2008;21:248-54. Brownlow HC, Reed A, Simpson AH. Growth factor expression during the development of atrophic non union. Injury 2001;32: 519-24. Takaaki U, Toshimasa K, Jyoji F, Nobuyoshi M, Miwa K, Takashi F, et al. Regeneration of the mandibular head from grafted periosteum. Ann Plast Surg 2003;51:77-83. Smith RB, Funk GF. Severe trismus secondary to periosteal osteogenesis after fibula free flap maxillary reconstruction. Head Neck 2003;25:406-11. Mercuri LG, Ali FA, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint. J Oral Maxillofac Surg 2008,66:1794-03.
Reprint requests: Christoph S. Leiggener Division of Craniomaxillofacial Surgery University Hospital Basel Spitalstr. 21 4031 Basel Switzerland [email protected]
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e1-e4)
Surgery for tumors extending into the infratemporal fossa requires adequate exposure to identify and protect vital structures. We present a patient who had, at some time in the past, been treated by condylar resection of the right temporomandibular joint (TMJ) because of a pigmented villonodular synovitis. The condyle had been replaced with a standard reconstruction plate that had eroded deep into the skull base. Prosthetic reconstruction of the TMJ was performed 1.5 years later after renewed bone tumor excision from the infratemporal space. The standard preauricular and submandibular approaches for implantation of a total TMJ prosthesis did not offer adequate access for tumor removal from the infratemporal fossa. The tumor was excised successfully through an additional transparotid approach. Bone tumors originating from the mandibular condylar process can extend into the infratemporal fossa, an area which is challenging to access surgically. Few primary tumors arise in this area and, in fact, metastases to the infratemporal space from tumors elsewhere are a rare occurrence.1,2 The infratemporal fossa is the irregular retromaxillary space under the floor of the middle cranial fossa, and it is circumscribed by the ascending ramus of the mandible laterally and by the lateral pterygoid plate of the sphenoid medially. The anterior boundary of the fossa is formed by the posterior wall of the maxilla. The standard approach for installation of a total alloplastic temporomandibular joint (TMJ) prosthesis is a combination of preauricular and submandibular incisions.3 These approaches provide adequate exposure for placement of the fossa and mandibular components, and are followed by a good cosmetic a
Division of Craniomaxillofacial Surgery, Clinic for Reconstructive Surgery, University Hospital Basel. b Department of Oral and Maxillofacial Surgery, Karolinska University Hospital. Received for publication Apr 22, 2009; returned for revision Aug 1, 2009; accepted for publication Aug 11, 2009. 1079-2104/$ - see front matter © 2010 Published by Mosby, Inc. doi:10.1016/j.tripleo.2009.08.018
outcome. However, the combined preauricular and submandibular exposure may not offer an adequate surgical approach to tumors extending into the infratemporal fossa. Owing to the oblique course of the facial nerve, access is limited, especially to the medial part of the infratemporal fossa. The case reported here illustrates the addition of a transparotid approach to the standard procedure for tumor exicision from the infratemporal fossa and insertion of a TMJ prosthesis. CASE REPORT A 22-year-old woman was admitted to the Department of Craniomaxillofacial Surgery, University Hospital Basel, in February 2005, because of pain in the right TMJ and limited mouth opening. Six months before, at another institution, she had undergone condylectomy for treatment of a pigmented villonodular synovitis (PVNS) of the right TMJ. The condyle had been replaced by a 2.4 reconstruction plate (Synthes, Oberdorf, Switzerland) as a spaceholder for later TMJ reconstruction. Apart from extensive fossa erosion from the impact of the reconstruction plate, a computerized tomography (CT) scan also showed 30 ⫻ 25 mm bony mass around the condylar neck extending into the infratemporal fossa (Fig. 1). A biopsy from the mass revealed bone with signs of bone regeneration. The patient was scheduled for tumor resection and total joint reconstruction with a TMJ Concepts prosthesis (TMJ Concepts, Ventura, CA; Fig. 2). At surgery, the preauricular and submandibular incisions were combined in a “lazy-S incision,” but it was obvious that the preauricular and submandibular dissections were not sufficient to gain access to the bony mass on the medial aspect of the mandibular ramus. Therefore, an additional transparotid approach (Fig. 3) was opened to create appropriate access to the medial part of the infratemporal fossa by using a nerve stimulator. After removal of the reconstruction plate, the bony tumor was removed in sections (Fig. 4) with the help of a piezosurgical device (Mectron, Carasco, Italy). Thereafter, the TMJ prosthesis was implanted uneventfully. The incision wounds were closed in layers. The subsequent histologic examination described a reactive new bone formation without residues of the previously treated pigmented villonodular synovitis. The postoperative course was uneventful. An initial weakness of the frontal and marginal mandibular branches of the facial nerve was observed,
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Fig. 2. The patient’s custom-made TMJ Concepts total joint prosthesis mounted on a 3-dimensional model after model surgery. The device is constructed on a 3-dimensional model, is designed to meet each patient’s specific anatomic needs, and has metal-on-polyethylene articulations.
Fig. 1. Computerized tomography scan. A, Coronal view demonstrating a space-filling bony cystic lesion in the infratemporal fossa with extension medially to the pterygoid process. B, Sagittal scan showing that the temporarily inserted fracture plate eroded deeply toward the medial cranial fossa.
but it was completely resolved after 3 months. At the 3-year follow-up, the interincisal opening was 50 mm and there was good occlusal stability. The radiologic follow-up at 36 months showed no heterotopic bone formation and no recurrence of PVNS-associated lesions (Fig. 5).
DISCUSSION The standard approach for the implantation of total TMJ prostheses is a combination of a preauricular and submandibular incision, as previously described.3 These approaches normally provide adequate exposure for the placement of the fossa and condylar components with a minimum of morbidity and a good cosmetic outcome. But in the case presented here, these approaches offered insufficient access for removal of the tumor from the infratemporal fossa. The preauricular incision allows only limited entry to the infratemporal space. Access to the medial part of the infratemporal fossa is particulary limited owing to the oblique course of the facial nerve.
Fig. 3. Intraoperative view of the implanted total temporomandibular joint prosthesis. The buccal and marginal branches of the facial nerve are identified and cross the mandibular component.
The facial nerve leaves the base of the skull through the stylomastoid foramen, crosses posterior to the rim of the mandibular ramus, and then passes over the lateral aspect of the ramus, where it branches into several rami.4,5 However, as described above, the infratemporal fossa is also inaccessible from below, i.e., through the submandibular incision, because of the course of the marginal mandibular branch of the facial nerve.
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Fig. 4. Lateral aspect of the reconstructed sections of the resected bony tumor.
Therefore, an additional approach was needed to complete tumor resection. Complex transfacial approaches to the infratemporal fossa as reported by MoreiraGonzalez et al.6 and Vilela and Rostomily7 were considered but not used, because the tumorous mass had clear borders and did not involve the lateral skull base. The transparotid approach used here offers several advantages regarding access to the medial part of the infratemporal fossa. The technique was first described by Hindis and Girotti in 1967 in relation to a vertical subcondylar osteotomy.8 It is commonly performed for open reduction and internal fixation of condylar fractures.5,9 The approach gives direct access to the mandibular collum and, if the condyle is resected, as in the case presented here, it also allows exposure of the medial part of the infratemporal fossa. One of the challenges of the transparotid approach is facial nerve disturbance. The incidence of a temporary weakness of the facial nerve varies between 17%-30% with predominance of the marginal mandibular branch. In all reported cases, nerve function returns to normal within 3-6 months.9,10 In the present patient, temporary weakness of the frontal and marginal mandibular branches occurred and recovered completely after 3 months; it was probably caused by tissue retraction during surgery. In the case reported here, prosthetic reconstruction of the TMJ was successfully performed with a TMJ Concepts prosthesis. This prosthesis system is individually manufactured on the basis of 3-dimensional models derived from patient CT scans. The fossa component is made of ultra-high-molecular-weight polyethylene (UHMWPE) attached to a pure titanium mesh which conforms to the anatomy of the fossa and is stabilized by the adjacent zygomatic arch. The mesh allows bone and soft tissue ingrowth to maximize long-term stability and secure the tight fit of the fossa component. The body of the mandibular component is made of titanium,
Fig. 5. Computerized tomography scan: coronal (A) and sagittal (B) views showing the integrated TMJ Concepts prosthesis in place 3 years after surgery with no recurrence of pigmented villonodular synovitis–associated lesions or heterotopic bone formation.
and the condylar head is a cobalt-chromium-molybdenum alloy, which is attached to the titanium shaft under high pressure. The functional surfaces of the chromium-cobalt-molybdenum alloy and UHMWPE represent the gold standards for orthopedic joint replacement regarding wear debris and structural stability and have proven to be viable for TMJ reconstruction as well.11,12 Condylar replacement with condyle-bearing reconstruction plates can be used temporarily but will, in the long run, result in fossa erosions and heterotopic bone formation,13,14 although Marx et al.15 recently reported good results with that treatment modality. Condylar reconstruction of the type initially applied to the patient presented here, however, should not be used even for short-term replacement. The painful deep fossa erosion demonstrates the obvious unphysiologic character of such a procedure.
e4
OOOOE January 2010
Leiggener et al.
Within 6 months of condylectomy, a massive heterotopic ossification developed in the infratemporal fossa, arising from the cut edge of the condylar neck. Histologically, a reactive bone formation was identified with exclusion of recurrent PVNS. These findings drew attention to the high potential of heterotopic bone formation as a complication frequently seen after implantation of alloplastic materials at the TMJ.13,16,17 The presence of a dead space after condylectomy, kept open by the temporarily applied osteosynthesis reconstruction plate, may promote a hematoma with subsequent osseous organization. However, such excessive bone formation must be induced and supported by migrating osteogenic cells from the surrounding periosteum and from the bone marrow of the cut edge of the condylar neck. These progenitor cells differentiate toward osteoblasts as a reaction to surgical trauma and produce growth factors important for bone regeneration.18 The considerable osteogenic potential of grafted periosteum has been demonstrated during regeneration of the mandibular head in rabbits19 and has been observed along the vascular pedicle after fibula free-flap maxillary and mandibular reconstruction.20 As a consequence, to prevent or limit heterotopic bone formation, periosteal stripping should be kept to a minimum and hemostasis should be performed thoroughly to decrease the risk of hematoma formation. Any dead space should also be eliminated by insertion of an autologous fat pad.17,21 In conclusion, the transparotid approach was found to be safe in this case and has the potential to be a versatile approach offering several advantages for accessing the medial part of the infratemporal fossa without risking lesions of the facial nerve. The case reported here also shows the efficacy of this total alloplastic TMJ reconstruction after 3 years.
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REFERENCES 1. Conley JJ. Tumors of the infratemporal fossa. Arch Otolaryngol 1964;79:498-504. 2. Tiwari R, Quak J, Egeler S, Smeele L, van der Waal I, van der Valk P, et al. Tumors of the infratemporal fossa. Skull Base Surg 2000;10:1-9. 3. Wolfort LM, Cottrell DA, Henry CH. Temporomandibular joint reconstruction of the complex patient with the Techmedica custom-made total joint prosthesis. J Oral Maxillofac Surg 1994; 52:2-10. 4. Bernstein L, Nelson RH. Surgical anatomy of the extraparotid distribution of the facial nerve. Arch Otolaryngol 1984;110: 177-83. 5. Ellis E, Dean J. Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1993;76: 6-15. 6. Moreira-Gonzalez A, Pieper DR, Cambra JB, Simman R, Jackson IT. Skull base tumors: a comprehensive review of transfacial
20.
21.
swing osteotomy approaches. Plast Reconstr Surg 2005;115: 711-20. Vilela MD, Rostomily RC. Temporomandibular joint–preserving preauricular subtemporal-infratemporal fossa approach: surgical technique and clinical application. Neurosurgery 2004;55: 143-53. Hindis EC, Girotti WJ. Vertical subcondylar osteotomy: a reappraisal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1967;24:164-70. Manisali M, Amin M, Aghabeigi B, Newman L. Retromandibular approach to the mandibular condyle: a clinical and cadaveric study. Int J Oral Maxillofac Surg 2000;32:253-6. Ellis E, McFadden D, Simon P, Throckmorton G. Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 2000;58:950-5. Wolford LM, Pitta MC, Reiche-Fischel O, Franco PF. TMJ Concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year follow up study. Int J Oral Maxillofac Surg 2003;32: 268-74. Mercuri LG, Edibam NR, Giobbie-Hurder A. Fourteen-year follow-up of a patient-fitted total temporomandibular joint reconstruction system. J Oral Maxillofac Surg 2007;65:1140-8. Lindqvist C, Söderholm AL, Hallikainen D, Sjövall L. Erosion and heterotopic bone formation after alloplastic temporomandibular joint reconstruction. J Oral Maxillofac Surg 1992;50:942-9. Westermark A, Koppel D, Leiggener C. Condylar replacement alone is not sufficient for prosthetic reconstruction of the temporomandibular joint. Int J Oral Maxillofac Surg 2006;35: 488-92. Marx RE, Cillo JE, Broumand V, Ulloa JJ. Outcome analysis of mandibular condylar replacements in tumor and trauma reconstruction: A prospective analysis of 131 cases with long-term follow-up. J Oral Maxillofac Surg 2008;66:2515-23. Reid R, Cooke H. Postoperative ionizing radiation in the management of heterotopic bone formation in the temporomandibular joint. J Oral Maxillofac Surg 1999;57:900-05. Wolford LM, Morales-Ryan CA, Morales PG, Cassano DS. Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation. Proc (Bayl Univ Med Cent) 2008;21:248-54. Brownlow HC, Reed A, Simpson AH. Growth factor expression during the development of atrophic non union. Injury 2001;32: 519-24. Takaaki U, Toshimasa K, Jyoji F, Nobuyoshi M, Miwa K, Takashi F, et al. Regeneration of the mandibular head from grafted periosteum. Ann Plast Surg 2003;51:77-83. Smith RB, Funk GF. Severe trismus secondary to periosteal osteogenesis after fibula free flap maxillary reconstruction. Head Neck 2003;25:406-11. Mercuri LG, Ali FA, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint. J Oral Maxillofac Surg 2008,66:1794-03.
Reprint requests: Christoph S. Leiggener Division of Craniomaxillofacial Surgery University Hospital Basel Spitalstr. 21 4031 Basel Switzerland [email protected]