Extended Total Temporomandibular Joint Replacement – A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint

Abstract

Introduction Alloplastic temporomandibular joint replacement has been established as a standard technique for end-stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Methods and patients In this retrospective case series, the authors report the results, surgical techniques, pitfalls and outcome of more than 2 years follow-up with reference to thirteen extended TMJ-replacements (TMJe) including twelve patients. The most common diagnosis was ameloblastoma of the mandibular ramus. Discussion The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Conclusion Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.

An Overview of Clinical Conditions and a Systematic Review of Personalized TMJ Replacement

“…In 226 patients, 310 TMJ prostheses were installed, 168 bilaterally and 142 unilaterally. In four studies, condylectomy and coronoid resection were used [ 35 , 36 , 37 , 38 ]; in two studies, only condylectomy was performed [ 39 , 40 ]; in one article, the osteotomy was performed in the glenoid fossa and in the mandibular ramus [ 41 ]; and in one study, an analysis of the orthognathic surgery was performed at the same time [ 35 ].…”

“…In all the articles, a 3D image was used (for the TMJ design). Biomet TMJ was used in three articles [ 36 , 37 , 41 ]; the TMJ Concepts System was used in two articles [ 35 , 41 ]; and OMX TMJ Prosthesis [ 39 ], TMJ Yang’s System [ 40 ], and DARSN TM joint prosthesis were used in the other articles [ 42 ]. In one article, the manufacturer was not described.…”

“…Pinto et al [ 35 ] showed a reduction in terms of lateral movement by 60% after 40 months of follow-up. Schlabe et al [ 41 ] showed minimum data observing only the diagnosis and surgical treatment, and the measurement after surgery was based on mandibular movement.…”