Changes in condylar position and morphology after mandibular reconstruction by vascularized fibular free flap with condyle preservation

Haoliang Chen; Yongheng Li; Yawei Sun; Xin Chen; Yumei Pu; Guowen Sun

doi:10.1007/s00784-023-05225-6

Changes in condylar position and morphology after mandibular reconstruction by vascularized fibular free flap with condyle preservation

Clin Oral Investig. 2023 Oct;27(10):6097-6109. doi: 10.1007/s00784-023-05225-6. Epub 2023 Aug 26.

Authors

Haoliang Chen¹, Yongheng Li², Yawei Sun¹, Xin Chen¹, Yumei Pu¹, Guowen Sun³

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, People's Republic of China.
² School of Biological Science & Medical Engineering, Southeast University, Nanjing, China.
³ Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, People's Republic of China. guowensun@yahoo.com.

PMID: 37632578
DOI: 10.1007/s00784-023-05225-6

Abstract

Objects: Changes in condylar position and morphology after mandibular reconstruction are important to aesthetic and functional rehabilitation. We evaluated changes in condylar position and morphology at different stages after mandibular reconstruction using vascularized fibular free flap with condyle preservation.

Materials and methods: A total of 23 patients who underwent mandibular reconstruction with fibular flap were included in this retrospective study. CT data of all patients were recorded before surgery (T0), 7 to 14 days after surgery (T1), and at least 6 months after surgery (T2). Five parameters describing the condylar position and 4 parameters describing the morphology were measured in sagittal and coronal views of CT images. The association between clinical characteristics and changes in condylar position and morphology was analyzed. A finite element model was established to investigate the stress distribution and to predict the spatial movement tendency of the condyle after reconstruction surgery.

Results: The condylar position changed over time after mandibular reconstruction. The ipsilateral condyles moved inferiorly after surgery (T0 to T1) and continually move anteriorly, inferiorly, and laterally during long-term follow-up (T1 to T2). Contrary changes were noted in the contralateral condyles with no statistical significance. No morphological changes were detected. The relationship between clinical characteristics and changes in condylar position and morphology was not statistically significant. A consistent result was observed in the finite element analysis.

Conclusion: Condylar positions showed obvious changes over time after mandibular reconstruction with condylar preservation. Nevertheless, further studies should be conducted to evaluate the clinical function outcomes and condylar position.

Clinical relevance: These findings can form the basis for the evaluation of short-term and long-term changes in condylar position and morphology among patients who have previously undergone mandibular reconstruction by FFF with condyle preservation.

Keywords: Condyle; Fibula; Mandibular reconstruction; Morphology; Position.