Minimally Invasive Approach for Total Temporomandibular Joint Replacement

Abstract

<h3>Purpose</h3> This article describes a novel technique for replacing the temporomandibular joint (TMJ) with a prosthesis. The technique applies a simple endaural incision to approach the temporomandibular joint in order to place a total joint prosthesis. This is followed by small trochar site incisions for plating of the prosthesis. The technique was performed on 4 patients (8 TMJs). The potential benefits and complications of this approach are discussed throughout the article. <h3>Methods</h3> The single endaural approach was performed to replace bilateral TMJs in 4 patients in the Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio. All 4 patients were followed up and examined once immediately after the procedure on postoperative day 1, 1 week postoperatively, and at varied times for up to 6 months. <h3>Results</h3> Postoperative exams were scheduled for 1-week and consecutive 1-month evaluations until symptoms resolved. Full head and neck exams were performed at each appointment. All patients had increased maximal interincisal opening (MIO) with very minimal swelling on day 1 of postoperative evaluation. They also reported a decrease in myofascial pain and headache. All 4 patients had temporary bilateral frontal and zygomatic facial nerve dysfunction that resolved with a mean time of 110 days. <h3>Conclusion</h3> All 4 patients in the research study had complications presenting as temporary bilateral frontal and zygomatic facial nerve dysfunction resolving within 4 months postsurgery. Directly after procedures were performed, the patients demonstrated increased function including greater mouth opening and conveyed experiencing diminished pain sensations. Although the preauricular endaural combined with a submandibular approach is considered the standard for temporomandibular joint (TMJ), the endaural only approach was adequate in this case providing immediate increases in MIO and decreases in patient perceived disability after the procedure. The single endaural method only created minor small incisions through the skin to extend to and increase the visibility of the appropriate area. It is a less invasive technique resulting in minimal tissue disturbance with immediately functional and aesthetically preferable results.