Extended total temporomandibular joint replacement with occlusal adjustments: Pitfalls, patient-reported outcomes, subclassification, and a new paradigm

Abstract

Context: Alloplastic temporomandibular joint (TMJ) replacement is a treatment strategy for segmental mandibular defects with occlusal abnormalities. Aims: To describe our experience with extended total TMJ replacement (eTMJR) by reporting operative obstacles, complications, and patient-reported outcomes, as well as to suggest a subclassification system and paradigm shift. Setting and Design: University hospital and private clinic; case series with retrospective follow-up. Methods and Materials: Five patients (6 eTMJRs) were followed for more than 1 year after surgery. Patient-reported outcomes were assessed using FACE-Q™ “Satisfaction with Outcome” questionnaires (sum and corresponding transformed Rasch scores). Statistical Analysis: Descriptive analyses were performed. Results: Problems were related to contralateral mandibular osteotomy healing (if performed), keying the prosthetic condyle into the fossa component, intra- and postoperative prosthetic lag, and intraoperative proper establishment of the occlusion when unilateral replacement was performed. Patients reported high satisfaction with the outcome, with a mean Rasch score of 89.2/100. Conclusions: Unilateral eTMJR obstacles related to three-dimensional rotational repositioning of the remaining mandible. We suggest a paradigm shift, considering primary alloplastic replacement instead of microvascular osseous transplantation for reconstruction when radiotherapy is not required. This can avoid donor site morbidity and long reconstructive surgery. An autologous osseous transplant is still available in case of implant failure. A subclassification system is proposed for eTMJR, which accounts for contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy.

Custom-made Total Joint Replacement After Segmental Resection of Recurrent Follicular Ameloblastoma

“…This paradigm shift leaves the autologous replacement as a salvage procedure for implant failure. 22 In the specific case of post-resection reconstruction of an ameloblastoma with custom-made total joint replacement, our case is part of the few cases reported in the literature until 2020. 23…”

“…This paradigm shift leaves the autologous replacement as a salvage procedure for implant failure. 22…”

Management of failed autogenous tissues temporomandibular joint reconstruction: case series and literature review

“…Considering the MIO results it must be considered that previous surgeries and long standing ankylosis generates a lot of scar in the periarticular soft tissues. This, as stated by Westermark and Aagard, reduces the stretching capabilities of all surrounding tissue components (29,30) making unrealistic to restore a full range of motion of the jaws. Thus, a MIO greater than 25 mm and maintained permanently without recurrence of ankylosis could be considered a satisfactory clinical outcome (3) than 25 mm and maintained permanently could be considered a success (3).…”

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

“…Very few reports and studies are available in the literature. The biggest case series to date includes four cases by Westermark and his team, who reported good results in Goldenhar syndrome and hemifacial microsomia 17 and five cases in a very recent publication by Mommaerts et al 18 Here, the authors report of thirteen extended temporomandibular joint replacements (TMJe) conducted on twelve patients with at least 2 year follow-up. Our aims of this case series with retrospective follow-up are to report our experience and observations on this surgery as well as difficulties and complications, which may help to guide future surgeries to prevent pitfalls.…”