Craniomaxillofacial deformities/cosmetic surgery
Temporomandibular Joint Ankylosis Can Be Successfully Treated With TMJ Concepts Patient-Fitted Total Joint Prosthesis and Autogenous Fat Grafts

https://doi.org/10.1016/j.joms.2016.01.017Get rights and content

Purpose

To measure and identify factors associated with treatment outcomes for patients with temporomandibular joint (TMJ) ankylosis treated with TMJ Concepts patient-fitted total joint prostheses and autogenous fat grafts.

Patients and Methods

This retrospective cohort study evaluated records of patients with TMJ ankylosis from a single private practice, treated from 1992 to 2011, who met the following inclusion criteria: 1) radiographic evidence of bony ankylosis, 2) limited incisal opening, 3) minimum of 12 months' follow-up, and 4) treatment with TMJ Concepts (Ventura, CA)/Techmedica (Camarillo, CA) total joint prostheses and fat grafts. For each patient, the number of previous TMJ surgical procedures, as well as the estimated age of ankylosis onset, age at surgery, and length of postoperative follow-up, was recorded. Subjective evaluations were made with Likert-like scales (from 0 to 10) for 1) TMJ pain, 2) headache and facial pain, 3) jaw function, 4) diet, and 5) disability. Objective evaluations included maximal incisal opening and excursion movements. Nonparametric statistics were used for analysis.

Results

There were 32 patients (22 female and 10 male patients) with 48 ankylosed TMJs (16 bilateral and 16 unilateral) in this study, with a mean age of 39 years (range, 11 to 68 years), 2 or more previous TMJ surgical procedures in 69%, and a mean follow-up period of 68 months (range, 12 to 168 months). Trauma was the major etiology of TMJ ankylosis, occurring in 17 of 32 patients (53%). The following improvements occurred: The median value for TMJ pain changed from 8.0 preoperatively to 1.5 at longest follow-up; headache, from 8 to 3.5; facial pain, from 8 to 4; jaw function, from 8 to 2.5; diet, from 7 to 3; and disability, from 7 to 1.5. The median incisal opening was 14.5 mm (interquartile range, 6.3 to 20 mm) preoperatively and 35 mm (interquartile range, 30 to 40 mm) at longest follow-up. The median left lateral excursion improved from 0.5 to 2 mm, and the median right lateral excursion improved from 1 to 1.3 mm. All of these improvements were highly significant (P < .001, Wilcoxon tests). Equally favorable outcomes were found in patients with 12 to 48 months of maximal follow-up and patients with more than 48 months of maximal follow-up.

Conclusions

The treatment of TMJ ankylosis with the TMJ Concepts patient-fitted total joint prosthesis in combination with fat grafting around the articulation area of the prosthesis is a viable and predictable method for improving pain levels, function, and quality of life, as well as prevention of reankylosis of the TMJ.

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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      Citation 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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