Can We Raise a Sternochondral Joint Flap Based on Internal Thoracic Vessels for Temporomandibular Joint Reconstruction? A Preliminary Cadaveric Study

Abstract

Abstract Purpose The free fibula flap is the gold standard for reconstructing mandibular defects caused by trauma, tumors, dysplastic diseases, osteoradionecrosis, and atrophy, but it has not yet been shown to be the ideal method for condylar reconstruction. This anatomical study proposes a surgically pragmatic approach to temporomandibular joint and condylar reconstruction via defining sternochondral joint vascularity.Methods Six fixed cadavers were dissected to assess the suitability of the 4th rib for the planned procedure. The internal thoracic vessels and branches near the sternochondral joint were carefully identified. The sternochondral joint flap was then harvested, focusing on cartilaginous rib to preserve the joint surface and vascular network. After contouring to fit the temporomandibular joint and condylar deformity, the flap was securely placed. Additional pedicle length measurements were taken.Results Perforators of the internal thoracic artery and vein constituted the dominant pedicle. The mean pedicle length was sufficient to reach recipient vessels on the neck. The compatibility between the 4th sternochondral flap and the glenoid fossa was confirmed.Conclusion A multitude of therapeutic approaches have been employed in the past to reconstruct the temporomandibular joint and condyle, albeit with restricted efficacy owing to chondral graft resorption or size mismatch in three-dimension. In contrast, this study shows that the fourth sternochondral joint flap is a promising free flap with ideal pedicle positioning, length, and vascular size match at the anastomosis. This technique is suitable for reconstructing this inherently difficult region of the temporomandibular joint, thereby offering reconstructive surgeons another method in their armamentarium.