Alloplastic Total Temporomandibular Joint Reconstruction: A 10-Year Experience of the University of the Witwatersrand, Johannesburg.

Abstract

This study aimed to retrospectively analyze our 10-year experience with total alloplastic reconstruction of the temporomandibular joint prostheses. Indications and clinical outcomes were also evaluated.Methodology: This was a cross-sectional study in which 31 patients who had alloplastic total Temporomandibular Joint prosthesis implanted between 2007 and 2017 were reviewed. Outcomes (maximum mouth opening distance and occlusion), subjective outcomes (pain, diet consistency and chewing, quality of life), and complications were evaluated. There were 16 females and 15 males with a mean age of 36.94 years (range 11-72 years). In total, 51 prostheses (20 bilateral, 11 unilateral) were implanted. The stock prostheses were used in 28 patients (90.32%) and only 3 (9.68%) were of custom-made type. Fifty-eight percent of patients were diagnosed with temporomandibular joint ankylosis, 22.58% had degenerative conditions, 9.68% had pathology (hemifacial microsomia, synovial chondromatosis, and osteochondroma), and 9.68% had malocclusion.The results showed that there was a significant improvement in maximum mouth opening distance (P-value < 0.0001), particularly in patients who had ankylosis.There was improvement in diet consistency (P-value < 0.0001) and quality of life (P-value 0.013). Postoperative complications ranged from facial nerve injuries (n = 4), keloids (n = 2), and heterotopic bone formation (n = 2). TMJ alloplasts provide satisfactory clinical and functional outcomes for patients with end-stage TMJ diseases, evidenced by overall improvement in maximum mouth opening, chewing ability and quality of life and reduction in pain. Previously operated joints and a preoperative diagnosis of ankylosis increase the risk of occurrence of complications postimplantation of total alloplastic joints.