Temporomandibular Joint Disc Replacement by Autogenous Composite Tissue Transplantation (Sandwich Method) in the Treatment of TMJOA With Perforation: A Preliminary Study.

Temporomandibular joint (TMJ) disc replacement is a treatment option for severe temporomandibular joint osteoarthritis (TMJOA) with disc perforation, yet there is still a lack of an ideal disc substitute. This retrospective study evaluated the "sandwich method," using a temporal myofascial flap (TMF) and auricular cartilage graft (ACG) as a composite tissue flap for disc replacement in patients treated at Peking University School of Stomatology between January 2021 and November 2023. Clinical assessments, including a maximum interincisal opening (MIO) and joint pain changes, and MRI and CBCT imaging of the TMJs were performed preoperatively and postoperatively (with a follow-up period of over 6 mo). A total of 5 patients were included in the study, with an average of 29.2 months of the course of disease. The average follow-up interval was 10.8 months. The mean preoperative and postoperative MIO was 29.9 and 38.0 mm. All 5 patients experienced relief from joint pain postoperatively, and condylar bone repair was observed (P<0.05). No complications were observed during the follow-up. This study introduces an effective method for treating TMJOA with disc perforation using TMF and ACG as a composite tissue flap (the sandwich method) for disc replacement, demonstrating favorable clinical outcomes.