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Autogenous Fat as an Ideal Interpositional Material in Temporomandibular Joint Surgery

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Abstract

Interpositional gap arthroplasty has established itself as the the standard surgical treatment of Temporomandibular joint (TMJ) ankylosis. The autogenous tissue has replaced the alloplastic and other xenografts materials owing to its bioavailability, easy uptake, and no additional cost. Commonly used autogenous tissue has been temporalis muscle and fascia, fascia lata, skin graft, auricular and costal cartilage, the masseter and/or medial pterygoid muscle. With the turn of the century, TMJ surgeons started using autogenous fat from the lower abdomen and today it has taken over as the most favored autogenous filler material in TMJ ankylosis surgery or total joint replacement (TMJ-TJR). The use of buccal fat pad (BFP) has increased in the last decade due to its local availability and pedicled nature. This paper will discuss various autogenous tissues used in interposition and bring forth the journey of the autogenous fat as the preferred interpositional material now and rest the case in its favor.

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References

  1. Topazian RG (1966) Comparison of gap and interpositional arthroplasty. J Oral Surg 24:405

    CAS  PubMed  Google Scholar 

  2. Moorthy AP, Finch LD (1983) Interpositional arthroplasty for ankylosis of the temporomandibular joint. Oral Surg 55:545

    Article  CAS  PubMed  Google Scholar 

  3. Rowe NL (1982) Ankylosis of the temporomandibular joint. J R Coll Surg Edinb 27:67

    CAS  PubMed  Google Scholar 

  4. Tideman H, Doddridge M (1987) Temporomandibular joint ankylosis. Aust Dent J 32:171

    Article  CAS  PubMed  Google Scholar 

  5. Moore JR (ed) (1985) Surgery of the face and mouth. Blackwell, Oxford, UK

    Google Scholar 

  6. Pogrel MA, Kaban LB (1990) The role of the temporalis fascia and muscle flap in temporomandibular surgery. J Oral Maxillofac Surg 48:14

    Article  CAS  PubMed  Google Scholar 

  7. Al-Moraissi EA, El-Sharkawy TM, Mounair RM, El-Ghareeb TI (2015) A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 44(4):470–482

    Article  CAS  PubMed  Google Scholar 

  8. Albert TW, Merrill RG (1989) Temporalis muscle flap for reconstruction of the temporomandibular joint. Oral Maxillofac Clin N Am 1:341

    Google Scholar 

  9. Brusati R, Raffaini M, Sesenna E (1990) The temporalis muscle flap in temporomandibular joint surgery. J Craniomaxillofac Surg 18:352

    Article  CAS  PubMed  Google Scholar 

  10. Feinberg SE, Larsen PE (1989) The use of a pedicled temporalis muscle-pericranial flap for the replacement of the TMJ disc. J Oral Maxillofac Surg 47:142

    Article  CAS  PubMed  Google Scholar 

  11. Van Bogaert W, De Meurechy N, Mommaerts MY (2018) Autologous fat grafting in total temporomandibular joint replacement surgery. Ann Maxillofac Surg 8:299–302

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dimitroulis G (2011) A critical review of interpositional grafts following temporomandibular joint discectomy with an overview of the dermis-fat graft. Int J Oral Maxillofac Surg 40(6):561–568

    Article  CAS  PubMed  Google Scholar 

  13. Blair VP (1913) Operative treatment of ankylosis of the mandible. Trans South Surg Assoc 28:435

    Google Scholar 

  14. Murphy JB (1914) Arthroplasty for intra-articular bony and fibrous ankylosis of temporomandibular articulation. JAMA 62:1783–1794

    Article  Google Scholar 

  15. Mehrotra D, Pradhan R, Mohammad S, Jaiswara C (2008) Random control trial of dermis-fat graft and interposition of temporalis fascia in the management of temporomandibular ankylosis in children. Br J Oral Maxillofac Surg 46:521–526

    Article  CAS  PubMed  Google Scholar 

  16. Perko M. Indikationen und Kontraindikationen für chirurgische Eingriffe am Kiefergelenk: Schweiz. Mschr. Zahnheilkunde 1973:83

  17. Ioannides C, Maltha JC (1988) Replacement of the intraarticular disc of the craniomandibular joint with fresh autogenous sternal or auricular cartilage. J Cranio Maxillofac Surg 16:343

    Article  CAS  Google Scholar 

  18. Takatsuka S, Narinobou M, Nakagawa K et al (1996) Histologic evaluation of articular cartilage grafts after discectomy in the rabbit craniomandibular joint. J Oral Maxillofac Surg 54:1216

    Article  CAS  PubMed  Google Scholar 

  19. Sandler NA, MacMillan C, Buckley MJ, Barnes L (1997) Histological and histochemical changes in failed auricular cartilage grafts used for a temporomandibular joint disc replacement. J Oral Maxillofac Surg 55:1014–1019

    Article  CAS  PubMed  Google Scholar 

  20. Georgiade NG (1962) The surgical correction of temporomandibular joint dysfunction by means of autogenous der- mal grafts. Plast Reconstr Surg Transplant Bull 30:68–73

    Article  CAS  PubMed  Google Scholar 

  21. Dimitroulis G (2004) The interpositional dermis-fat graft in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 33:755–760

    Article  CAS  PubMed  Google Scholar 

  22. Kumar P, Rattan V, Rai S (2015) Do costochondral grafts have any growth potential in temporomandibular joint surgery? A systematic review. J Oral Bio Craniofac Res 5(3):198–202

    Article  Google Scholar 

  23. Lexer E (1910) Freie fett transplantation. Dtsch Med Wochenschr 36:640

    Google Scholar 

  24. Merikanto JE, Alhopuro S, Ritsilä VA (1987) Free fat transplant prevents osseous reunion of skull defects A new approach in the treatment of craniosynostosis. Scand J Plast Reconstr Surg Hand Surg 21(2):183–188

    CAS  PubMed  Google Scholar 

  25. Saunders MC, Keller JT, Dunsker SB, Mayfield FH (1981) Survival of autogenous fat grafts in humans and in mice. Connect Tissue Res 8:85–91

    Article  CAS  PubMed  Google Scholar 

  26. Yamaguchi M, Matsumoto F, Bujo H et al (2005) Revascularization determines volume retention and gene expression by fat grafts in mice. Exp Biol Med 230:742–748

    Article  CAS  Google Scholar 

  27. Qi Z, Li E, Wang H (1997) Experimental study on free grafting of fat particles. Zhonghua Zheng Xing Shal Shang Wai Ke Za Zhi 13:54–56

    CAS  Google Scholar 

  28. Wolford LM, Karras SC (1997) Autologous fat transplantation around temporomandibular joint total joint prostheses: preliminary treatment outcomes. J Oral Maxillofac Surg 55:245–251

    Article  CAS  PubMed  Google Scholar 

  29. Wolford L, Movahed R, Teschke M, Fimmers R, Havard D, Schneiderman E (2016) Temporomandibular joint ankylosis can be successfully treated with TMJ concepts patient-fitted total joint prosthesis and autogenous fat grafts. J Oral Maxillofac Surg 74(6):1215–1227

    Article  PubMed  Google Scholar 

  30. Dimitroulis G, Trost N, Morrison W (2008) The radiological fate of dermis-fat grafts in the human temporomandibular joint using magnetic resonance imaging. Int J Oral Maxillofac Surg 37(3):249–254

    Article  CAS  PubMed  Google Scholar 

  31. Thangavelu A, Thiruneelakandan S, Prasath CH, Chatterjee D (2015) Fate of free fat dermis graft in tmj interpositional gap arthroplasty: a long term MRI study. J Maxillofac Oral Surg 14(2):321–326

    Article  CAS  PubMed  Google Scholar 

  32. Gengehy El, Ali S, Abdel-Moneim HS (2019) Costochodral graft with abdominal fat as interpositinal graft versus costochodral graft alone for reconstruction of temporomandibular joint in bilateral ankylosis in adults: randomized controlled clinical trial. Egyptian Dental J 65:1025–1033

    Article  Google Scholar 

  33. Rattan V (2006) A simple technique for use of buccal pad of fat in temporomandibular joint reconstruction. J Oral Maxillofac Surg 64(9):1447–1451

    Article  PubMed  Google Scholar 

  34. Gaba S, Sharma RK, Rattan V, Khandelwal N (2012) The long-term fate of pedicled buccal pad fat used for interpositional arthroplasty in TMJ ankylosis. J Plast Reconstr Aesthet Surg 65(11):1468–1473

    Article  PubMed  Google Scholar 

  35. Rattan V, Rai S, Vaiphei K (2008) Use of buccal pad of fat to prevent heterotopic bone formation after excision of myositis ossificans of medial pterygoid muscle. J Oral Maxillofac Surg 66(7):1518–1522

    Article  PubMed  Google Scholar 

  36. Sharma VK, Rattan V, Rai S, Malhi P (2019) Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: a prospective study. Int J Oral Maxillofac Surg 48(11):1448–1455

    Article  CAS  PubMed  Google Scholar 

  37. Sharma VK, Rattan V, Rai S, Malhi P (2020) Assessment of paediatric quality of life in temporomandibular joint ankylosis patients after interpositional arthroplasty: a pilot study. Int J Oral Maxillofac Surg 49(2):244–249

    Article  CAS  PubMed  Google Scholar 

  38. Mokhtar EA, Rattan V, Rai S, Jolly SS, Lal V (2021) Analysis of maximum bite force and chewing efficiency in unilateral temporomandibular joint ankylosis cases treated with buccal pad of fat interpositional arthroplasty. British J Oral and Maxillofac Surg. https://doi.org/10.1016/j.bjoms.2021.07.007

    Article  Google Scholar 

  39. Malhotra VL, Singh V, Rao JD et al (2019) Lateral arthroplasty along with buccal fat pad inter-positioning in the management of Sawhney type III temporomandibular joint ankylosis. J Korean Assoc Oral Maxillofac Surg 45(3):129–134

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bansal V, Bansal A, Mowar A, Gupta S (2015) Ultrasonography for the volumetric analysis of the buccal fat pad as an interposition material for the management of ankylosis of the temporomandibular joint in adolescent patients. Br J Oral Maxillofac Surg 53(9):820–825

    Article  PubMed  Google Scholar 

  41. Roychoudhury A, Acharya S, Bhutia O, Seith Bhalla A, Manchanda S, Pandey RM (2020) Is there a difference in volumetric change and effectiveness comparing pedicled buccal fat pad and abdominal fat when used as interpositional arthroplasty in the treatment of temporomandibular joint ankylosis? J Oral Maxillofac Surg 78(7):1100–1110

    Article  PubMed  Google Scholar 

  42. Trevor PB, Martin RA, Saunders GK, Trotter EJ (1991) Healing characteristics of free and pedicle fat grafts after dorsal laminectomy and durotomy in dogs. Vet Surg 20(5):282–290

    Article  CAS  PubMed  Google Scholar 

  43. Mercuri LG, Ali FA, Woolson R (2008) Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint. J Oral Maxillofac Surg 66:1794–1803

    Article  PubMed  Google Scholar 

  44. Thangavelu A, Santhosh Kumar K, Vaidhyanathan A, Balaji M, Narendar R (2011) Versatility of full thickness skin-subcutaneous fat grafts as interpositional material in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 40(1):50–56

    Article  CAS  PubMed  Google Scholar 

  45. Singh V, Dhingra R, Sharma B, Bhagol A, Kumar P (2011) Retrospective analysis of use of buccal fat pad as an interpositional graft in temporomandibular joint ankylosis: preliminary study. J Oral Maxillofac Surg 69(10):2530–2536

    Article  PubMed  Google Scholar 

  46. Singh V, Dhingra R, Bhagol A (2012) Prospective analysis of temporomandibular joint reconstruction in ankylosis with sternoclavicular graft and buccal fat pad lining. J Oral Maxillofac Surg 70(4):997–1006

    Article  PubMed  Google Scholar 

  47. Ko EC, Chen MY, Hsu M, Huang E, Lai S (2009) Intraoral approach for arthroplasty for correction of TMJ ankylosis. Int J Oral Maxillofac Surg 38(12):1256–1262

    Article  CAS  PubMed  Google Scholar 

  48. Gandhiraj S, Chauhan S, Prakash, (2013) Efficacy of abdominal dermis fat graft as the interpositional material in the management of temporomandibular joint ankylosis in children-an original study. IOSR J Dental Med Sci 3(6):7–11

    Article  Google Scholar 

  49. Karamese M, Duymaz A, Seyhan N, Keskin M, Tosun Z (2013) Management of temporomandibular joint ankylosis with temporalis fascia flap and fat graft. J Craniomaxillofac Surg 41(8):789–793

    Article  PubMed  Google Scholar 

  50. Hegab AF (2015) Outcome of surgical protocol for treatment of temporomandibular joint ankylosis based on the pathogenesis of ankylosis and re-ankylosis a prospective clinical study of 14 patients. J Oral Maxillofac Surg 73(12):2300–2311

    Article  PubMed  Google Scholar 

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Rai, S. Autogenous Fat as an Ideal Interpositional Material in Temporomandibular Joint Surgery. J. Maxillofac. Oral Surg. 20, 527–533 (2021). https://doi.org/10.1007/s12663-021-01648-4

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