How Does a Unilateral Temporomandibular Joint Replacement Affect Bilateral Masseter and Temporalis Muscle Activity?—A Prospective Study

Abstract

Total alloplastic temporomandibular joint replacement (TMJR) requires the detachment of the masseter muscle (MM) at its insertion to the lateral ramus and often the resection of the coronoid process (insertion of the temporalis muscle). There is little literature on how a detachment affects the muscles. The present study evaluates the long-term masticatory muscle activities and maximum voluntary bite force (MVC) in patients with unilateral TMJR. Surface electromyography of the MM and anterior temporalis muscle during bite force testing and MVC were evaluated bilateral preoperatively (T0), 1 (T3), 2 (T4), 3 (T5), and 4years (T6) postoperatively. The percentage overlapping coefficient (index of the symmetric distribution of muscular activity) was calculated. Differences between stock or custom devices were evaluated. Fourteen patients were enrolled, 4 males and 10 females, age 47.3±14.3years at TMJR placement. In 11 patients, the coronoid process was resected, 5 patients received stock, and 9 custom prostheses. After surgery, a trend in the improvement of bilateral surface electromyography activities and MVC was found without statistical significance for the side comparison or the time of the investigation. The percentage overlapping coefficient values showed postoperatively relative (>72%) symmetry in both muscles. Up to T5 on the TMJR side, MM showed higher activity when custom prostheses were used. There was no significant difference between stock and custom prostheses. The vertical (anterior) fibers of the temporalis muscle are preserved despite the resection of the coronoid process. The anterior temporalis muscle, as a synergist of the MM on the TMJR side, postoperatively partially assumes its abduction function. The detached MM appears to reattach. Generally, the bilateral increase in muscle activity and MVC of both muscles suggests regeneration of the investigated muscles. Custom prostheses seem to have an initial advantage for the reattachment of the MM compared with stock prostheses.