Problems of total temporomandibular joint prosthesis in oncologic patients: literature review

Abstract

The most common cause of total temporomandibular joint (TMJ) prosthesis is the terminal stage of degenerative dystrophic diseases. Patients with oncologic pathology usually undergo extended surgical interventions with TMJ exarticulation which in contrast to non-tumor pathology are characterized by resection of the whole ligamentous apparatus of the joint, the ramus of the mandible, and surrounding structures. Due to various causes, the use of traditional systems of open-type joint prosthesis (without fixation of the joint head in the glenoid fossa) frequently leads to loosening, luxation, and eventual dislocation of the joint head from the glenoid fossa. Currently, multiple different TMJ prosthetic systems have been proposed but only 2 are routinely used: TMJ Concepts (USA) and TMJ Biomet (USA). It should be noted that these systems are also open. We have studied the used constructions of total TMJ endoprostheses and haven’t found any that solve the problem of the condyloid component dislocation from the glenoid fossa after extended resections due to tumors of the TMJ. Moreover, analysis of the clinical outcomes after the use of such systems showed that even in cases of relatively limited resections of TMJ structures (11–30 %), joint prosthesis elements dislocation still occurs. Therefore, a promising solution for the problem of the joint head dislocation can be development of a closed total endoprosthesis with joint head fixation and preservation of joint mobility in all planes.