J Korean Assoc Oral Maxillofac Surg.  2025 Jan;51(1):46-53. 10.5125/jkaoms.2025.51.1.46.

Temporomandibular joint capsule suspension for neocondyle stability in free fibular flap reconstruction of the mandibular condyle

• Bai S
• Yu Y
• Zhang WB
• Mao YQ
• Wang Y
• Mao C
• Wang DC
• Peng X

• KMID: 2565638
• DOI: http://doi.org/10.5125/jkaoms.2025.51.1.46

Abstract

Objectives
This study evaluates the efficacy of a new temporomandibular joint (TMJ) capsule suspension technique for stabilizing the TMJ after free fibular flap reconstruction of the mandibular condyle.
Patients and Methods
Patients undergoing the TMJ capsule suspension technique during free fibular flap reconstruction after mandibulectomy with condylectomy (study group; n=9) were compared with a control group (n=9). Mandibular movement trajectory and surface electromyographic signals of bilateral masseters were recorded. The neocondyle–disc relationship was examined with magnetic resonance imaging (MRI) at 6 months after surgery.
Results
Maximal mouth opening and bilateral marginal movement distances were comparable between the two groups (P>0.05). The asymmetry index of the condyle path length was significantly higher in controls (P=0.02). Bilateral mouth opening trajectories were symmetric in 7 patients and deviated to the affected side in 2 patients in the study group; they deviated to the affected side in all controls. The mean electromyographic values of the masseter on the affected side in resting, maximum bite, and chewing states were comparable between the two groups (P=0.13, P=0.65, and P=0.82, respectively). On MRI at 6 months, the thicknesses of the anterior, medial, and posterior bands and TMJ disc length were similar on the affected and normal sides in the study group (P=0.57, P=0.13, P=0.48, and P=0.87, respectively).
Conclusion
The proposed TMJ capsule suspension technique could improve postoperative TMJ structure and function after fibular free flap reconstruction following mandibulectomy with condylectomy.

Keyword

Mandibular reconstruction; Temporomandibular joint; Masticatory muscles

Figure

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  Fig. 1 Temporomandibular joint (TMJ) capsule suspension technique. A. Suture between the anteromedial wall of TMJ capsule and the anteromedial hole on the fibula. B. Suture between the anterolateral hole on the fibula and the anterolateral wall of TMJ capsule. C. Suture between the posteromedial wall of TMJ capsule and the posteromedial hole on the fibula. D. Suture between the posterolateral hole on the fibula and the posterolateral wall of TMJ capsule. E. Suspension suture performed in a horizontal mattress suture style. F. Neocondyle seated in the glenoid fossa after the sutures are tied.

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  Fig. 2 Measurement of temporomandibular joint (TMJ) disc thickness at the level of anterior, intermediate, and posterior bands (left). Measurement of TMJ disc length (right).

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  Fig. 3 Comparison of mean electromyographic value of masseter on the affected side in the TMJ capsule suspension group and the control group. (TMJ: temporomandibular joint)

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  Fig. 4 Comparison of anterior, intermediate, and posterior band thickness, and length of temporomandibular joint (TMJ) disc, between the affected side and normal side in the TMJ capsule suspension group.

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  Fig. 5 A representative case. Temporomandibular joint magnetic resonance images obtained at 12 months after surgery. A. Mouth closing. B. Mouth opening.

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  Fig. 6 Intraoperative photograph of temporomandibular joint capsule suspension technique.

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  Fig. 7 A representative case. Mandibular movement assessments at 12 months after the surgery showed symmetric bilateral condyle movement trajectory.

Reference

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