Reconstruction of the Temporomandibular Joint Autogenous Compared with Alloplastic
Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana, United StatesBritish Journal of Oral and Maxillofacial Surgery (Impact Factor: 1.08). 09/2002; 40(4):296-9. DOI: 10.1016/S0266-4356(02)00139-0
The aims of and indications for temporomandibular joint (TMJ) reconstruction are well-established but the method of reconstruction is controversial. We describe a retrospective, two-centre audit of 49 patients treated with costochondral grafting and 50 patients treated with alloplastic joints. The characteristics of the patients were similar in both centres and the minimum follow-up period was 2 years. For each patient a number of variables were recorded including both subjective scores (pain and interference with eating) and objective data (interincisal distance). Patients in both groups showed an improvement in symptoms but more patients required reoperation in the autogenous group.
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[Show abstract] [Hide abstract] ABSTRACT: Background: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles. Patients and Methods: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry) and function (occlusion, Jaw movements). Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations. Results: There were a total of 27 procedures done either on the condyle or ramus in 23 (100%) patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6%) patients, 14 (60.9%) patients had Ameloblastoma, 1 (4.3%) had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6%) patients, five procedures for ankylosis in 3 (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.
- "Secondly, following resection of the fused mass, interpositional arthroplasty, using autografts, (chondro-chondral from rib, chondro-osseous grafts from iliac bone, sternoclavicular, metatarsal, metatarsal phalangeal grafts, dermis, temporal superficial fascia or myofacial flap), allografts (lyophilized dura) or alloplasts (silicon, Teflon and vitamin graft) is better than gap arthroplasty, although with variable outcomes. Interposition reduces the chances of re-union coupled with prolonged mouth opening jaw exercises. Costochondral is known to cause hyperplastic growth giving place for sternoclavicular joint grafts. "
[Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to determine the behavior of Temporomandibular joint implant made of different materials when it is subjected to loads resulted of daily movements. A three dimensional model of a lower mandible of a human were developed from a CT scan dataset. A commercial Temporomandibular joint implant and fixation screws were modeled. Three dimensional finite element models of implanted mandible analyzed under static loading of five clunching tasks. The investigation went to study on two materials of titanium and Cobalt-chromium alloy for implant. The equivalent strain of whole structure was computed and utilized for evaluation of implant design. The safety factor results showed that both materials were capable to carry the applied complex loads.
- "Even though the majority of patients with TMDs are conservatively treated, true joint pathology of the TMJ occasionally warrants an artificial joint replacement . TMJ replacement has been developed in cases of joint trauma, advanced degenerative disease, tumors, developmental anomalies, and ankylosis of the joint following injury . Alloplastic replacement of the TMJ generally involves the use of a condylar implant with an articulating glenoid fossa component in which the suffered joint has been replaced by TMJ prosthesis. "
[Show abstract] [Hide abstract] ABSTRACT: Ankylosing spondylitis (AS) is a chronic autoimmune disease mainly involving the axial skeleton. The pathology of the disease is usually found at the sacroiliac joint, and half of the patients experience cervical spine invasion, but eventually, the whole spine is affected. The involvement of the temporomandibular joint (TMJ) in AS has not been investigated very well. A review of the literature revealed that there are only a few studies of TMJ involvement in AS that combined clinical and radiographic examinations. These studies show widely different results, ranging between 4% and 32%. We experienced Bilateral osseous ankylosis of the jaw treated by total alloplastic joint replacement in AS, and offer a case report.
- "In addition, the costochondral graft is often accompanied by bony ankylosis, particularly if the articular disc has been destroyed. Various flaps and materials have been used to replace the missing or destroyed disc but none have been particularly successful. Total alloplastic replacement of the TMJ has become a viable option for many people who suffer from TMJ disease where surgical reconstruction is indicated. Degenerative joint diseases such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, TMJ ankylosis, malunited condylar fractures and tumours can be successfully treated using this technique . "