Prosthetic temporomandibular joint reconstruction in a cohort of adolescent females with juvenile idiopathic arthritis

Abstract

Background: Temporomandibular joint (TMJ) arthritis and involvement is commonly seen in Juvenile Idiopathic Arthritis (JIA). Therapy includes conservative measures, but also includes intraarticular corticosteroid injections (IASI) and systemic immunosuppressive therapy. Despite aggressive medical therapy, some patients develop arthritic changes and frank TMJ ankylosis that can result in persistent pain and limitation in range of motion (ROM). A surgical option is prosthetic TMJ replacement with concurrent correction of dentofacial deformities, which can be performed simultaneously. The objective of this study was to evaluate the outcomes of prosthetic TMJ replacement in a cohort of adolescent females with JIA and severe TMJ involvement. Methods: This is a retrospective case series that took place at one tertiary care center. Patients with a diagnosis of JIA who also underwent alloplastic TMJ replacement were identified through electronic medical record system (EMR) and reviewed. Chart review included analysis of all documents in the EMR, including demographic data, JIA history, surgical complications, ROM of TMJ measured by maximal incisal opening in millimeters (mm) and TMJ pain scores (4-point Likert scale: none, mild, moderate, severe) obtained pre-and postoperatively. Results: Five female patients, ages 15-17 year when TMJ replacement was performed, had nine total joints replaced with a post-operative follow-up period of 12-30 months. All patients had polyarticular, seronegative JIA and were treated with IASI and multiple immunosuppressive therapies without resolution of TMJ symptoms. One patient had bilateral TMJ ankylosis. Three of the five patients demonstrated significant dentofacial deformities, and all underwent simultaneous or staged orthognathic surgery. All patients had improvement in TMJ pain with most (80%) reporting no pain, and all had similar or improved ROM of their TMJ postoperatively. There was one delayed postoperative infection with Cutibacterium Acnes that presented 15 months after surgery and required removal and reimplantation of prosthesis.

Alloplastic total joint reconstruction for severe temporomandibular joint ankylosis in the skeletally immature patient: a narrative review

“…The titles and abstracts were then screened, and 240 studies did not meet the eligibility criteria and were excluded, resulting in 48 studies included for full-text reading. After full-text reading 15 articles were found with at least 1 report of skeletally immature patients with ankylosis treated with alloplastic TMJR (1,2,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Index of Body Inflammation for Maxillofacial Surgery Purpose-to Make the Soluble Urokinase-Type Plasminogen Activator Receptor Serum Level Independent on Patient Age

“…The suPAR protein was found in 1991 as a marker of cancer progression. Up to these days several studies have shown the association of the protein with chronic diseases, including cardiovascular, renal, hepatic, and pulmonary diseases, and that it's level is an independent predictor of a negative outcome of various infectious diseases, sepsis, and in critically ill patients [30][31][32][33]. As the protein is expressed mainly on immune cells, suPAR reflects the level of chronic inflammation.…”

Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint

“…Not surprisingly, the superiority of alloplastic TMJ TJR in non-rheumatic end-stage joint disease patients has been found to translate to the autoimmune population as well [137]. Outcomes of alloplastic TMJ TJR in RA, PsA, AS, SSc, and JIA patients have been reported, showing consistent improvement in associated pain and dysfunction [138][139][140][141][142][143][144][145][146][147]. The literature nearly unanimously suggests that patients with appropriate indications for TMJ TJR have seen improved, durable outcomes.…”