Experimental study of reconstruction of the temporomandibular joint using a bone transport technique

Purpose: This study investigated the applicability of transport distraction osteogenesis with an internal appliance for reconstruction of the temporomandibular joint (TMJ). Materials and Methods: Fifteen millimeters of the ascending ramus, including the condyle and intra-articular disc, was extirpated in 42 white rabbits (3.0 kg weight). After an L-osteotomy was performed from the anterior border of the coronoid process to the posterior border of the mandible, an internal distraction appliance was applied. The transport segment was advanced 0.9 mm/day for 14 days after a 14-day healing period. During a 24-week period after the completion of the lengthening, the rabbits were killed at various intervals. Results: Eight weeks after the completion of the lengthening, the distraction gap between the transport segment and the preexisting mandible was indistinguishable in the radiographs. New bone and a large amount of cartilage were observed microscopically in the distraction gap. New bone was also observed at the leading edge of the transport segment. This bone seemed to form from the surrounding periosteum. At 8 weeks after the completion of lengthening, the mature cortical bone was reconstructed. A collagenous-like structure formed a cap over the leading edge of the transport segment. This cap may substitute for an articular disc. The new bone remodeled and resembled the condyle. Conclusion: The bone transport technique is promising for the reconstruction of TMJ. (C) 2000 American Association of Oral and Maxillofacial Surgeons.