Assessment of functional improvement with temporalis myofascial flap after condylectomy in elderly patients with anterior disc displacement without reduction and an erosive condylar surface

Abstract

Background: The purpose of this study was to investigate the functional effects of temporalis myofascial flap aftercondylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) withoutreduction and an erosive condylar surface of the temporomandibular joint (TMJ). Methods: A total of 15 joints from 11 elderly patients (71–78 years old) were included. The patients had pain,mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface ofthe TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or withoutdisc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomywas also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateralmovements, were evaluated. Results: No patient experienced serious complications. Most measurements improved significantly after surgerycompared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported seriouspain during the follow-up period. Conclusion: Although nonsurgical therapy is often the first treatment choice for ADD without reduction of theTMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be areasonable first option for elderly patients with an erosive condylar surface of the TMJ.