Evaluation of Discectomy and DermisYFat Grafting on the Contralateral Side Celal Candirli, DDS, PhD,* Alparslan Esen, DDS, PhD,Þ Fatih Taskesen, DDS,* Salih Celik, DDS, PhD,* and Banu Cakir, MD§ Purpose: We investigated the effects of unilateral discectomy with an abdominal dermisYfat graft of the temporomandibular joint (TMJ) on the contralateral side. Patients and Methods: A total of 14 patients who underwent uni- lateral TMJ discectomy and dermisYfat grafting for severe internal derangement in 2009 and 2010 were included. Clinical parameters, such as maximum mouth opening and lateral movements of the mandible, were recorded preoperatively and at 1 year postoperatively. Preoperative and 1-year postoperative magnetic resonance imaging was conducted to determine the duration of the operated and unop- erated TMJs. Results and Conclusions: All 14 patients showed improvement in the mandibular mobility and function. However, postsurgical disc displacement without reduction was observed on the unoperated TMJ in 1 patient. Another patient complained of crepitus on the operated TMJ. Primary occlusal contact on the operated side of occlusion was observed in 2 other patients. Maximum mouth opening and measured lateral movements had increased in all patients at 1 year after the operation. Key Words: DermisYfat grafting, discectomy, temporomandibular joint (J Craniofac Surg 2012;23: 1654Y1657) C onventional nonsurgical or conservative techniques, such as occlusal splints and arthrocentesis, are usually inadequate to treat severe internal derangement of the temporomandibular joint (TMJ). As a result, open surgery of the TMJ becomes inevitable. 1 Numerous types of open joint surgery have been developed to address intraarticular disorders. Discectomy and dermisYfat graft- ing have been performed for severe internal derangement of the TMJ. 2 Dimitroulis et al 2Y4 made an unrivalled contribution by developing this technique. We have demonstrated the successful use of the procedure by performing experimental, radiologic, and clinical studies. Structural changes can occur in the unoperated TMJ owing to effects of the operated side. 5 As a result of the altered joint loading after discectomy, altered radiologic morphology can occur in both the operated and unoperated sides. 6 To our knowledge, no studies have reported the clinical and radiologic effects of discectomy and dermisYfat grafting on the unoperated TMJ in humans. The goal of this study was to demon- strate the effects of unilateral discectomy and dermisYfat grafting of the TMJ on the contralateral side based on magnetic resonance imaging findings and clinical observations. PATIENTS AND METHODS The study population included patients who underwent uni- lateral TMJ discectomy and dermisYfat grafting in 2009 and 2010 at the Fatih University Hospital in Ankara, Turkey. All patients had se- vere pain on 1 side of their TMJ, and all had previously received conservative treatments such as arthrocentesis and occlusal splints. Internal derangement of TMJs was determined by magnetic resonance imaging (MRI) investigations and clinical examinations. All surgeries were performed by the same surgeon. Of the patients, 14 underwent unilateral discectomies and dermisYfat grafting (Fig. 1). Four patients were male, and the mean age of patients was 34 (range, 19Y52) years. Of the joint surgeries, 9 were on the left and 5 were on the right side. All patients were moni- tored for at least 1 year. Maximum mouth opening, size of the lateral mandibular movements, and visual analog scale functional pain scores were recorded preoperatively and after 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. At each cycle, pa- tients were asked about the function of their unoperated joints, such as clicking, crepitus, and pain. All patients were scanned before and 1 year after therapy using a 1.5 T MRI scanner (Achieva; Philips Medical Systems, Best, the Netherlands) with a multi- channel head coil. Both joints were imaged in all patients. First, an axial scout section was used to localize the mandibular con- dyle. Then, oblique sagittal T1-weighted spin echo sequences were acquired (repetition time [TR], 450 ms; echo time [TE], 15 ms; matrix: 180 Â 320; slice thickness, 3 mm; field of view [FOV], 130 mm, number of excitation [NEX], 3) in a closed-mouth position. Eight sagittal images were obtained for each joint. Next, oblique sagittal T1 three-dimensional water-only WATS images (TR, 30 ms; TE, 3.9 ms; matrix, 180 Â 256; slice thickness, 1 mm; FOV, 130 mm; NEX, 3; flip angle: 20-) were acquired in a closed-mouth position. In total, 25 images were acquired for each TMJ. Finally, oblique ORIGINAL ARTICLE 1654 The Journal of Craniofacial Surgery & Volume 23, Number 6, November 2012 What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article. From the *Department of Oral and Maxillofacial Surgery, Faculty of Den- tistry, Karadeniz Technical University, Trabzon, Turkey; †Department of Oral and Maxillofacial Surgery, Antalya Oral and Health Center, Antalya, Turkey; ‡Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mustafa Kemal University, Hatay, Turkey; and §Department of Radiology, Fatih University Hospital, Ankara, Turkey. Received January 23, 2012. Accepted for publication May 9, 2012. Address correspondence and reprint requests to Dr Celal C ¸ andırlı, Karadeniz Teknik U ¨ niversitesi Dis ¸ Hekimli?i Faku ¨ltesi C ¸ ene Cerrahisi, Trabzon, Turkey; E-mail: drcandarli@hotmail.com The authors report no conflicts of interest. Copyright * 2012 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e318260ef99 Copyright © 2012 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.