Is Autogenous Abdominal Fat Transplantation Into a Large Temporomandibular Joint Defect Following Removal of Failed Alloplastic Prosthesis a Definitive Treatment?

Purpose: To evaluate the long-term clinical outcome after the removal of failed major alloplastic temporomandibular joint (TMJ) implants and the placement of an autologous abdominal fat graft. Materials and Methods: A long-term clinical follow-up was performed in 4 patients who underwent removal of a failed alloplastic implant and insertion of an autologous abdominal fat graft under 1-stage surgical management. Postsurgical use of pain medication was documented and the vertical interincisal opening measurement was obtained at the follow-up visit. Long-term computed tomographic (CT) scans were available for 3 of 4 patients and evaluated for fat graft retention by a radiologist. Hounsfield units were used. Results: The study showed long-term(average, 4.7 years) clinical success, including normal jaw function (>= 30-mm vertical opening) and freedom from the use of pain-relieving medication. Long-term CT scans (average, 5 years after surgery) documented fat graft retention in 3 patients (-80 HU). Conclusion: Autogenous fat graft placement alone, after major TMJ alloplastic removal, provides excellent long-term clinical success. (C) 2014 American Association of Oral and Maxillofacial Surgeons