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 States
British Journal of Oral and Maxillofacial Surgery (Impact Factor: 1.08). 09/2002; 40(4):296-9. DOI: 10.1016/S0266-4356(02)00139-0
Source: PubMed


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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Available from: Niall M H Mcleod, Mar 28, 2014
    • "Secondly, following resection of the fused mass, interpositional arthroplasty,[121314151617181920] 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.[16] Costochondral is known to cause hyperplastic growth giving place for sternoclavicular joint grafts.[14] "
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    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.
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    • "Even though the majority of patients with TMDs are conservatively treated, true joint pathology of the TMJ occasionally warrants an artificial joint replacement [3]. TMJ replacement has been developed in cases of joint trauma, advanced degenerative disease, tumors, developmental anomalies, and ankylosis of the joint following injury [4]. 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. "
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    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.
    Full-text · Article · Mar 2012 · Advanced Materials Research
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    • "The temporomandibular joint (TMJ) is a load-bearing joint where forces are transmitted mainly during mastication. TMJ implants are used to rehabilitate patients with advanced forms of arthritis, ankylosis of the joint following trauma or infections and total joint reconstruction following excision of a tumor (Christensen, 1964 ; Saeed et al., 2002; Kashi et al., 2006). Stress distribution in TMJ implants and bone have been studied previously by other researchers (Chou et al., 2008; Lin et al., 2009; Ramos et al., 2010; Hsu et al., 2010). "
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    ABSTRACT: Finite element analysis is a useful analytical tool for the design of biomedical implants. The aim of this study was to investigate the behavior of temporomandibular joint implants with multiple design variables of the screws used for fixation of the implant. A commercially available implant with full mandible was analyzed using a finite element software package. The effects of different design variables such as orientation, diameter and stem length of the screws on the stress distribution in bone for two different surgical procedures were investigated. Considering the microstrain in bone as a principal factor, the acceptable ranges for screw diameter and length were determined. Parallel orientation of the screws performed better from a stress point of view when compared to the zig-zag orientation. Sufficient contact between the implant collar and mandibular condyle was shown to reduce the peak stresses which may lead to long term success. The distance between screw holes in the parallel orientation was much closer when compared to the zig-zag orientation. However, the stresses in bone near the screw hole area for the parallel orientation were within acceptable limits.
    Full-text · Article · Aug 2011 · Journal of Biomechanics
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