Outcomes of Total Alloplastic Replacement With Periarticular Autogenous Fat Grafting for Management of Reankylosis of the Temporomandibular Joint

Abstract

The purpose of this investigation was to review the subjective, objective, and quality of life outcomes in a group of temporomandibular joint (TMJ) reankylosis patients managed by total alloplastic replacement surgery with a patient fitted system augmented with periarticular autogenous fat grafts to prevent the reformation of heterotopic bone. A review of the literature regarding the use of autogenous fat as evidence for its efficacy in such cases is also presented. All 20 TMJ reankylosis patients (4 males, 16 females) who had undergone total TMJ replacement with the TMJ Concepts (Ventura, CA) Patient-Fitted Total TMJ Prosthesis System were studied. Thirteen patients had bilateral, 7 unilateral for a total of 33 joint replacements. All patients had autogenous fat harvested from the abdomen and grafted around the articulating portion of the prostheses at implantation. The patients' subjective variable outcomes of TMJ pain, mandibular function, diet consistency, quality of life since the reconstruction, and objective variable of maximal interincisal opening were obtained in a detailed questionnaire and follow-up phone calls. Analysis of the subjective outcomes data showed improvement in reported pain, increased jaw function, and diet consistency. Further, a significant number of these patients reported improvement in their quality of life after surgery. Analysis of the objective outcomes data showed a significant increase in the maximum interincisal opening postreplacement that was maintained. In the patients followed over the course of this study, total alloplastic replacement with a patient-fitted prosthesis seemed to provide a safe and effective management for reankylosis of the TMJ. Autogenous fat transplantation seems to be a useful adjunct as its use seems to minimize the recurrence of joint heterotopic calcification, consequently providing improved and consistent range of mandibular motion.