GP2d - Application of Modern Tissue Engineering Concepts for the Reconstruction of Mandibular Condyles and Muscle Reattachment for Full Function

Abstract: Background: Reconstruction of the maxillofacial skeleton is inherently complex, with defects often arising from trauma or pathology. The mandibular condyle presents distinct reconstructive considerations owing to its role in transmitting functional loads, coordinating articulation, and preserving occlusal relationships. Conventional approaches, including autogenous iliac crest grafts and alloplastic prostheses, are limited by donor site morbidity, prolonged recovery, and long-term mechanical challenges. Recent advances in mandibular tissue engineering using bone marrow aspirate concentrate (BMAC), recombinant human bone morphogenetic protein-2 (rhBMP-2), and particulate allogeneic bone scaffolds have demonstrated reliable regeneration and functional stability in mandibular body defects. Despite this progress, the application of these regenerative modalities to the condyle remains underexplored and extending them to this site could address critical limitations in existing reconstructive options. This study evaluates the feasibility and outcomes of tissue-engineered condylar reconstruction.

Methods: A retrospective case series of 5 patients undergoing mandibular reconstruction with condylar resection was performed at a single institution. Reconstruction was completed using a tissue-engineered construct consisting of autologous BMAC, rhBMP-2 delivered via collagen carrier, and an allogeneic fibula scaffold. Postoperative evaluation included clinical assessment and radiographic analysis using CBCT and MRI to assess bone regeneration, condylar morphology, and functional muscle attachment over a follow-up period as far out as up to 2 years. Outcomes assessed included bone regeneration and neo-condyle formation, mandibular function, and postoperative complications.

Results: Four of 5 patients demonstrated successful reconstruction with progressive osseous regeneration and formation of a neo-condylar structure. MRI evaluation demonstrated reattachment of the lateral pterygoid muscle to the neo-condyle. One patient experienced postoperative soft tissue dehiscence but maintained graft integrity and demonstrated continued structural stability at 1-year follow-up without graft failure. Functional outcomes demonstrated restoration of mandibular motion, with at least 1 patient achieving a maximal incisal opening of approximately 40 mm. Radiographic findings demonstrated progressive bone maturation, integration of the graft, and adaptive remodeling consistent with load-bearing function.

Conclusion: Tissue-engineered reconstruction of the mandibular condyle using BMAC, rhBMP-2, and allogeneic scaffold demonstrates the potential for biologic joint regeneration. This approach enables neo-condyle formation and functional muscle reattachment, addressing key limitations of traditional reconstructive techniques. These findings support tissue engineering as a promising alternative to autogenous grafts and alloplastic prostheses for condylar reconstruction.


References

1. Melville, J. C., Rethman, B., Kaleem, A., Patel, N., Marx, R. E., Tursun, R., Shum, J., Wong, M. E., & Young, S. (2023). Tissue Engineering for Mandibular Reconstruction. Atlas of the oral and maxillofacial surgery clinics of North America, 31(2), 165-176. https://doi.org/10.1016/j.cxom.2023.04.001


2. Kaur, K., Bhutia, O., Manchanda, S., Bhalla, A. S., Yadav, R., Bhatt, K., & Roychoudhury, A. (2026). Does Lateral Pterygoid Muscle Reattach After Ramus-Condyle Unit Reconstruction in Temporomandibular Joint Ankylosis Patients?. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 84(2), 162-173. https://doi.org/10.1016/j.joms.2025.10.001