A Retrospective Analysis of Positional and Dimensional Changes in Temporomandibular Joint Following Mandibular Reconstruction With Fibula Flap and Influencing Factors Behind.

[OBJECTIVES] Stable condyle positioning is crucial for temporomandibular joint (TMJ) function, but its long-term stability in patients undergoing segmental mandibulectomy with free fibular flap (FFF) reconstruction is unclear. This study aimed to assess the long-term stability of TMJ parameters and the factors influencing it.

[METHODS] This retrospective study included patients who underwent mandibular reconstruction using FFF with condyle preservation. CBCT was used to assess TMJ measurements at four time points: pre-surgery (T0), 1 ± 1 month (T1), 6 ± 1 months (T2), and at least 20 ± 4 months post-surgery (T3). Parameters such as condylar inclination, position, dimensions, and joint spaces were measured.

[RESULTS] A total of 89 patients participated (51 with conventional freehand, 38 with 3D procedure). Condylar position changed over time: the operated side showed a slight downward shift, and the contralateral side showed inward and medial movement. Factors affecting condylar stability included surgical accuracy, mandible angle involvement, defect location (especially if crossing midline), and postoperative radiation therapy (p < 0.05).

[CONCLUSION] TMJ parameters are highly sensitive to skeletal changes post-reconstruction with condylar preservation. Our findings suggest that condylar position lacks long-term stability after surgery. Further studies are needed to assess clinical outcomes and disc-condyle relationship after mandibular reconstruction.