Craniomaxillofacial deformities/cosmetic surgeryTemporomandibular Joint Ankylosis Can Be Successfully Treated With TMJ Concepts Patient-Fitted Total Joint Prosthesis and Autogenous Fat Grafts
Section snippets
Patients and Methods
To address the research purposes, we designed and implemented a retrospective cohort study composed of all patients treated for TMJ ankylosis at a single private practice from 1992 to 2011. The Institutional Review Board at Baylor University Medical Center, Dallas, TX, reviewed and approved this study (reference No. 069220). The inclusion criteria were 1) radiographic evidence of bony ankylosis; 2) maximal, unassisted incisal opening of 25 mm or less; 3) minimum of 12 months' clinical and
Statistical Evaluation
The age distribution of patients at the time of surgery was described using the mean and standard deviation because this measure was normally distributed. None of the other variables were normally distributed, so they were summarized using medians and interquartile ranges (IQRs) and analyzed using nonparametric procedures. Within patients, preoperative values were compared with postoperative values at the longest follow-up using the Wilcoxon signed rank test. Between-group differences were
TMJ Concepts Total Joint Prosthesis
The TMJ Concepts patient-fitted total joint prosthesis was originally developed and marketed by Techmedica from 1990 through 1993. Computer-aided design–computer-aided manufacturing technology was used to produce an anatomically accurate 3D polymer model of the patient's jaws and TMJs. The surgeon performed preparatory surgery on the model, and Techmedica then manufactured a patient-fitted TMJ total joint prosthesis to fit the patient's specific anatomic requirements. TMJ Concepts began
Surgical Preparation
For the ankylosed TMJ, there are 2 basic approaches for preparation and manufacturing of the patient-fitted prosthesis: 1 surgical stage versus 2 surgical stages.
Results
There were 32 patients (22 female and 10 male patients) with 48 ankylosed TMJs (16 bilateral and 16 unilateral) who met the criteria for inclusion in this study, with a mean age of 39 years and SD of 15.6 years (range, 11 to 68 years). Four patients were classified as pediatric cases (aged <17 years). The median age of TMJ disease onset was 20 years (IQR, 13 to 26 years; range, 0 to 67 years). The median follow-up period was 59.5 months (IQR, 30 to 114 months; range, 12 to 168 months) (Table 2
Discussion
The purpose of this study was to evaluate treatment outcomes after managing TMJ ankylosis with a specific treatment protocol using TMJ Concepts/Techmedica patient-fitted TMJ total joint prostheses and fat grafts packed around the articulation of the prostheses. There were 48 ankylosed TMJs treated in 32 patients (16 bilateral and 16 unilateral) with a median of 60 months' follow-up with no reankylosis, although some heterotopic bone developed around the prostheses in 2 patients, identified at
Causes and Prevention of TMJ Ankylosis
The formation of fibrosis and heterotopic bone resulting in TMJ ankylosis can be related to various TMJ pathologies such as trauma, infection, reactive arthritis, osteoarthritis, inflammation, failed previous TMJ surgical procedures, and connective tissue/autoimmune diseases (juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, scleroderma, and so on); multiply operated joints; and failed TMJ autogenous grafts and alloplastic implants.33, 34, 46
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2023, International Journal of Oral and Maxillofacial SurgeryCitation Excerpt :The main characteristics of the studies are presented in Table 1. The studies were published between 1994 and 2022, and they were performed in 12 different countries, with 10 studies performed in Europe,1,19,21,25,26,28,30,33,35,40 11 in North America,10,15–18,23,24,27,32,34,36 two in Asia,31,38 one in Africa,37 and four in Oceania.20,22,29,39 The total sample included 1502 patients who received total TMJ prostheses (1922 prostheses; although two studies did not mention the total number of prostheses installed).
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