Functional reconstruction of the glenoid fossa utilizing a pedicled temporal osteomuscular flap

Current techniques in management of end stage pathology of the temporomandibular joint (TMJ) include the use of alloplastic joint reconstruction. A polyethylene glenoid fossa prosthesis is a necessity of this treatment as it provides a stable platform for function of the metal alloy condylar head. Additionally, the fossa prosthesis limits superior and posterior movement of the reconstructed joint which prevents complications such as migration of the condylar prosthesis into the middle cranial fossa and ear, ankylosis, and pain. When a pathologic process affects the glenoid fossa alone, alloplastic joint reconstruction becomes a less desirable treatment option. Lack of osseous structure along the temporal bone and zygomatic arch can impact the surgeon's ability to fixate a glenoid fossa prosthesis. Additionally, resection of an uninvolved condylar head in situations where there is no advanced pathology would provide a functional solution, but may be overly aggressive and potentially unnecessary. The following is our experience with utilizing a pedicled temporal osteomuscular flap to reconstruct an acquired defect of the glenoid fossa in a 42-year-old male with a diffuse-type tenosynovial giant cell tumor. In this case the mandibular condyle was not affected by the pathology.