Considerations for Temporomandibular Joint Procurement in Vascularized Composite Allotransplantation

Nima Khavanin, Edward H. Davidson, Ryan M. Smith, Alexandra Macmillan, Patrick Byrne, Amir H. Dorafshar

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Methods for harvest of the temporomandibular joint (TMJ) for transplantation may involve several anatomic levels. The authors aim to assess the feasibility and identify challenges with 2 such methods, resuspending the donor condyles from the recipient glenoid fossae and en bloc harvest of the joint and surrounding temporal bone with plate-fixation to the recipient skull base. Two mock face transplantations were carried out using 4 fresh cadavers. Computed tomography imaging was obtained before and after the procedures to assess the technical success of each method. Both techniques were technically successful, allowing for full passive jaw range of motion following graft transfer and appropriate condyle positioning as assessed by computed tomography. En bloc TMJ harvest allowed for transfer of the entire joint without violating its capsule or altering its biomechanics. The authors found this technique better able to avoid issues with size mismatch between the donor mandible and recipient skull base width. When no such mismatch exists, graft harvest at the level of the mandibular condyle is technically easier and less time consuming. Although both methods of TMJ harvest are technically feasible with acceptable immediate postoperative jaw position and range of motion, the en bloc technique allows for more natural jaw function with less risk of postoperative joint immobility by preserving the joint capsule and its ligamentous support.

Original languageEnglish (US)
Pages (from-to)1742-1746
Number of pages5
JournalThe Journal of craniofacial surgery
Volume29
Issue number7
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

Fingerprint

Vascularized Composite Allotransplantation
Temporomandibular Joint
Jaw
Joints
Skull Base
Articular Range of Motion
Glenoid Cavity
Facial Transplantation
Tomography
Bone Plates
Mandibular Condyle
Transplants
Joint Capsule
Bone and Bones
Temporal Bone
Mandible
Cadaver
Biomechanical Phenomena
Capsules
Transplantation

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Considerations for Temporomandibular Joint Procurement in Vascularized Composite Allotransplantation. / Khavanin, Nima; Davidson, Edward H.; Smith, Ryan M.; Macmillan, Alexandra; Byrne, Patrick; Dorafshar, Amir H.

In: The Journal of craniofacial surgery, Vol. 29, No. 7, 01.10.2018, p. 1742-1746.

Research output: Contribution to journalArticle

Khavanin, Nima ; Davidson, Edward H. ; Smith, Ryan M. ; Macmillan, Alexandra ; Byrne, Patrick ; Dorafshar, Amir H. / Considerations for Temporomandibular Joint Procurement in Vascularized Composite Allotransplantation. In: The Journal of craniofacial surgery. 2018 ; Vol. 29, No. 7. pp. 1742-1746.
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