Alloplastic Temporomandibular Joint Reconstruction Research Articles

Bilateral alloplastic temporomandibular joint reconstruction with orthognathic surgery: a case report of idiopathic condylar resorption

Idiopathic condylar resorption (ICR) also known as cheerleader’s syndrome, progressive condylar resorption, idiopathic condylysis, and condylar atrophy can be defined as chronic ongoing changes of condylar shape and decrease in mass. It is characterized by an excessive physical stress to the articular structures of the temporomandibular joint (TMJ) that exceeds the normal adaptive capacity. Consequently, leading to decrease condylar head volume, decrease ramus height, progressive mandibular retrusion in adults, or decreased growth rate in adolescents. A case report of a 30-year-old female based on the history, clinical, and radiographic examination has class II skeletal relationship secondary to bilateral ICR, receded chin, vertical maxillary excess (VME) and canting. Surgical treatment plan was established using 3D Systems, Inc., (“3DS”) VSP® and case was managed by bilateral total alloplastic temporomandibular joint reconstruction (BATMJR) with orthognathic surgery to do LeFort I, bilateral condylectomy, genioplasty, and inferior border osteotomy. The case report includes one-year follow-up which shows stable outcome, emphasizing long-term success of comprehensive treatment strategy in addressing skeletal class II malocclusion associated with ICR.

Bilateral Temporomandibular Joint Reconstruction With Custom Alloplastic Implants for Pediatric Ankylosis.

For pediatric patients with refractory temporomandibular joint (TMJ) ankylosis, reconstruction with autologous techniques such as costochondral grafts or distraction osteogenesis has long been considered the gold standard. Many surgeons believed the use of alloplastic joint replacement to be contraindicated in pediatric patients due to concerns for growth restriction and the limited lifespan of the implants. However, recent data has supported TMJ prostheses in skeletally immature patients. This study aims to present a case series of pediatric patients undergoing bilateral TMJ reconstruction with custom-made implants and evaluate their postoperative results. A retrospective chart review was performed of all consecutive pediatric patients undergoing bilateral alloplastic TMJ reconstruction for refractory ankylosis. All patients underwent bilateral TMJ release and total joint replacement with custom-made implants. Preoperative and postoperative cephalometric and volumetric airway data was obtained using cone-beam computed tomography. Three patients, aged 8 to 17, underwent bilateral TMJ replacement with custom-made implants. There were no postoperative complications, and no implants required explantation or replacement. Postoperatively, all patients had increases in maximal interincisal opening, which was stable over months/years of follow-up. The patients also subjectively reported improved speech and mastication; 1 patient had significant improvements in sleep apnea symptoms. Volumetric airway analysis revealed an average airway size increase of 25.6%. Alloplastic TMJ reconstruction is a safe, effective solution for refractory ankylosis in pediatric patients and represents a promising new frontier in craniofacial surgery. Continued long-term evaluation will provide further evidence of the utility of this procedure.

Is the risk of chronic pain after total temporomandibular joint replacement independent of its indications? A prospective cohort study

Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up. The predictor variables were objective pressure pain thresholds (PPTs) at the ipsilateral joint(s) and muscle(s), functional parameters (incisal range of motion, maximum voluntary clenching), subjective oral health-related quality of life (OHRQoL), and demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 preoperatively to 10 at follow up. Self-reported TMJ pain was significantly reduced in the entire group (p = 0.001). Patients with moderate/severe pain at follow up were more restricted in their OHRQoL but did not differ in PPT and functional parameters from the no/mild pain group. Moderate/severe TMJ pain at follow up was associated with unilateral TMJR and more preoperative pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common and, in rare cases, may even worsen regardless of the original diagnosis. At follow up there was a close relation between OHRQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).

Aktuelle Aspekte zu resorptiven Kiefergelenkpathologien im Kontext der Dysgnathiechirurgie – ein chirurgisches Konzept

Classical surgical techniques for the treatment of pronounced retroposition of the mandible with or without temporomandibular joint (TMJ) pathologies have a significant recurrence rate. In extreme cases of this pathology, alloplastic TMJ reconstruction in combination with other procedures of dysgnathic surgery enables a safe and stable correction of mandibular malocclusions and simultaneous reconstruction of the TMJ, albeit with inherent invasiveness and risk profile. An alternative sequential treatment concept for three-dimensional distraction of the mandible in combination with Le Fort I osteotomy and Wing osteotomy in cases of pronounced mandibular retroposition and/or hypoplastic TMJs is presented. In approximately 900 cases operated on with the described technique, no clinically relevant recurrence rate has been observed to date. TMJ replacement that may become necessary later on is not compromised by the operations presented here.

Can Alloplastic Total Temporomandibular Joint Reconstruction be Used in the Growing Patient? A Preliminary Report

Although primarily reserved for adult patients, temporomandibular joint (TMJ) total joint reconstructive (TJR) surgery is rarely used in the pediatric population due to its many challenges; it is only performed after all other non-invasive or invasive procedures have been exhausted. Although autogenous grafting has been discussed in the literature, there is very little regarding synthetic or alloplastic materials. In this study, we performed alloplastic TMJ reconstruction on 5 patients with severe ankylosis due to various craniofacial deformities and prior traumatic injuries. This is a retrospective case series analysis of skeletally immature patients who received alloplastic TMJ reconstruction for recurrent and advanced ankylosis. Our inclusion criteria were as follows: less than 16 years of age, diagnosis of TMJ ankylosis, skeletally immature patients, and unilateral/bilateral total alloplastic TMJ reconstruction. We used the maximum incisal opening (MIO) changes as 1 component to assess for functional improvement. Since many of these cases involved gross discrepancies from the normal variants, it was difficult to quantitatively compare the patients with one another. Nevertheless, we used cephalometric analysis to compare pre- and postoperative results on each patient. For this study, we used MIO as our primary assessment: the preoperative average for MIO was 7.4 mm, and the postoperative average 24 mm. It is our experience that the use of alloplastic material will not result in harm to either the growth of the mandible or patient's ability to achieve an improved MIO based on our long- and short-term results. These results demonstrate that for even complex craniofacial deformities and traumatic injuries, our patients experienced a significant improvement in MIO, 1 of the main indicators for TMJ function. We conclude that the alloplastic joint can provide a predictable pathway to restore patient's MIO and obviate the need for repeated surgeries, which can be a more challenging alternative with poorer outcomes.

Custom Alloplastic Temporomandibular Joint Reconstruction: Expanding Reconstructive Horizons.

Custom alloplastic temporomandibular joint (TMJ) reconstruction has been well established for the management of end-stage TMJ disease. However, its use in congenital TMJ deformities is limited. Here, the authors present initial outcomes of skeletally mature patients who underwent custom alloplastic TMJ reconstruction and simultaneous orthognathic surgery.A retrospective case series of patients who underwent custom alloplastic TMJ reconstruction concurrent with orthognathic surgery between 2014 and 2019 was completed. Functional, aesthetic and orthodontic outcomes as well as complications were recorded.Seven TMJs in 5 skeletally mature patients (4 female, 1 male, ages 16-30) (2 bilateral, 3 unilateral) were replaced. All but 1 patient had previous attempts at reconstructive surgery with poor results. All cases were prepared using virtual surgical planning and underwent concomitant maxillomandibular orthognathic surgery. All patients demonstrated improved post-operative occlusions. Four of 5 patients achieved >30 millimeters of post-operative MIO. Complications included ear canal perforation and facial nerve dysfunction.There were no infections or other implant-related complications. Mean follow up was 2 years and 15 days. Alloplastic TMJ reconstruction at the time of skeletal maturity for patients with congenital mandibular TMJ defects is an alternative to existing management options. Further long-term prospective outcomes studies are ongoing.

Alloplastic Temporomandibular Joint Reconstruction for Patients With Juvenile Idiopathic Arthritis

The purpose of this study was to assess the efficacy of alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) in patients with juvenile idiopathic arthritis (JIA). All patients with a formal diagnosis of JIA requiring a TMJ patient-specific TJR between 2010 and 2018 at The University of Texas-Health at San Antonio were retrospectively analyzed. To be included, patients must have had a formal diagnosis of JIA, complete records, and TMJ reconstruction with the TMJ Concepts patient-specific total joint prosthesis (TMJ Concepts, Ventura, CA). Clinical data acquisition was required at a minimum of 12months after surgery (longest follow-up [LFU]).Subjective and objective analyses were performed using a 10-point visual analog scale at the preoperative and LFU time points.Surgical data at the perioperative and LFU time points were recorded for comparison. Twenty patients with JIA met the inclusion criteria. The mean visual analog scale measurements for facial pain, TMJ pain, jaw function, diet, and disability were all significantly reduced at LFU. The maximal interincisal opening with pain was increased from 33.5mm preoperatively to 44mm at LFU, and the mean maximal interincisal opening without pain was increased from 31.1mm preoperatively to 43mm at LFU.None of the patients had complications from their TMJ TJR. Alloplastic TMJ reconstruction is a safe and efficacious treatment option for the surgical management of end-stage TMJ disease in JIA patients.

Predictability and Feasibility of Total Alloplastic Temporomandibular Joint Reconstruction using DARSN TM Joint Prosthesis for patients in Indian subcontinent–A prospective clinical study

PurposeThe aim of this study was to investigate the feasibility of a custom made alloplastic Temporomandibular Joint (TMJ) device design in patients undergoing temporomandibular (TM) Total Joint Reconstruction (TJR). ObjectiveTMJ disease with functional and anatomic distortion dictates the need for TJR. There are various materials to reconstruct a TMJ. However, various factors, such as cost, availability of prosthetic joint, limit its use to tertiary health care center. Hence, we have investigated the feasibility and efficacy of the custom made alloplastic TMJ prosthesis (DARSN TM Joint Prosthesis) with the advantage of being acceptable financially and the overall Quality of life (QoL) diagnosed with TMJ ankylosis and End Stage Joint Disease (ESJD) selected from the study population. Materials and methodsThe study group comprised of 20 patients with TMJ ankylosis or End Stage Joint Disease (ESJD) who needed TM TJR of which few subjects in the study population had history of failed previous surgery to the TMJ region. The patients underwent resection of the joint followed by TJR using the custom made alloplastic TMJ prosthesis. Various subjective and objective variables were evaluated such as the Jaw Function (JF), Inter-incisal opening (IO), Diet intake (DI), Quality of Life (QoL) using a Psychometric Modified Likert Scale and nutritional status of the patient using the Mid-Upper Arm Circumference (MUAC) as reference. ResultsAll the subjective and objective variables showed significant improvement in the postoperative period as compared to the preoperative period. The JF score increased with a mean score of 6.25 (P<0.00001). Postoperative mean DI score was 3.15 (P<0.00001) and IO increased up to 29–38mm in 95% of the study population. The study population exhibited an improved overall QoL and nutritional status post-operatively. Follow up period of 1 year showed significant functional improvement among the study population. ConclusionThe results shows that the custom made alloplastic joint replacement is safe and effective and reliable alternative to treat patients with TMJ disease which restricts the normal function to a greater degree requiring TM TJR.

A Retrospective Study of Patient Outcomes After Temporomandibular Joint Replacement With Alloplastic Total Joint Prosthesis at Massachusetts General Hospital

Disorders of the temporomandibular joint (TMJ) occur frequently, with a prevalence of 15 to 18%. Total joint replacement (TJR) surgery is indicated for severe joint damage associated with impaired function, pain, or occlusal change for which other treatments have been unsuccessful. The aim of this study was to assess changes in pain and range of motion (ROM), as well as postoperative complications and comorbidities, in patients receiving TJR surgery at Massachusetts General Hospital (MGH). This study is a retrospective review that describes the clinical variables in patients after alloplastic TMJ reconstruction performed at MGH from 2000 to 2015. Clinical variables included primary diagnosis; number of previous surgical procedures; comorbidities; preoperative and postoperative pain; preoperative, intraoperative, and postoperative ROM; and complications. Data were obtained from 95 patients undergoing a total of 108 surgical procedures, with an average follow-up period of 4.48±3.38years. The most common primary indications for TJR were ankylosis (44%) and inflammatory disease (23%). The maximum interincisal opening improved by a mean of 7.7±10.27mm, and pain decreased by a mean of 1.5±3.29 points on a visual analog scale. Transient facial nerve palsy (25%) was the most common postoperative complication; however, long-term complications were rare. The most frequent comorbidities were psychiatric disorders (56%) and gastrointestinal disease (46%). Psychiatric patients had similar preoperative pain scores (6.0±2.90) but significantly higher postoperative pain scores (4.7±2.58) compared with nonpsychiatric patients. Twenty-eight percent of patients had prior failed TMJ implant materials, specifically Proplast-Teflon (Vitek, Houston, TX). These patients were significantly older (50.4±8.26years) and had smaller preoperative ROM (21.7±8.85mm) and smaller postoperative ROM (28.3±9.59mm). Patients showed a statistically significant (P<.01) increase in ROM and reduction in pain. TJR is an effective treatment option in patients with limited mouth opening or severe pain.

Abstract: Customized Alloplastic Temporomandibular Joint Reconstruction: Expanding the Reconstructive “Net”

PURPOSE: Customized alloplastic temporomandibular joint (TMJ) reconstruction has been well established for refractory ankyloses and arthroses,1 trauma and end-stage TMJ disease in adult patients. However, its use in congenital absence or deficiency of the TMJ in younger patients is not well defined.2,3 The goal of this study was to present outcomes of patients with congenital mandibular defects who underwent customized alloplastic TMJ reconstruction simultaneous with orthognathic surgery. METHODS: A retrospective case series of patients who underwent customized alloplastic TMJ reconstruction concurrent with virtual surgical planning-guided orthognathic surgery (2014–2017) was completed. Anatomic, functional, and complication outcomes were documented. RESULTS: Five TMJs in 4 patients (1 bilateral, 3 unilateral) were reconstructed. Causes of TMJ absence included Goldenhar Syndrome (2), idiopathic bilateral condylar resorption (1), and post-oncologic in a patient with Gorlin Syndrome (1). The two patients with Goldenhar Syndrome had previous attempts at reconstructive surgery with poor results (distraction, bone grafting, alloplastic implants). All patients were skeletally mature at the time of surgery, had virtual surgical planning and had concomitant maxillomandibular orthognathic surgery at the time of TMJ reconstruction. All patients had improved post-operative occlusal results. Three of 4 patients had >30 millimeters post-operative maximal incisal opening. Complications included revision of implant position (1), ear canal perforation (1), and frontal branch of facial nerve injury requiring secondary brow lift (1). There were no infections or other implant-related complications. Mean follow up was 1.32 years (range, 0.46–2.74 years). CONCLUSION: We present a growing series of patients with congenital mandibular defects who underwent successful custom alloplastic TMJ reconstruction with pre-operative virtual surgical planning. Such reconstruction at the time of skeletal maturity for patients with congenital mandibular TMJ defects may present an alternative to existing treatment options, such as mandibular distraction, bone grafting, and prosthesis completed during skeletal immaturity.2,4,5

Clinical outcome of total alloplastic temporomandibular joint reconstruction in cases of recurrent ankylosis with emphasis on pitfalls: A retrospective analysis

AimThe present study is designed to evaluate the pitfalls and complications in treatment of recurrent TM Joint Ankylosis cases using total alloplastic joint replacement. Materials and methodsData was analyzed retrospectively in terms of maximum mouth opening, deviation during opening of mouth, heterotrophic bone formation, peri-joint infection, and intraoral exposure of joint, post-surgery malocclusion, contralateral TMJ pain. Results12 patients (15 joints) of TMJ ankylosis were treated with TMJ replacement in our department. Mean pre-operative maximum inter-incisal mouth opening was 3.92 mm (SD ± 1.73). Post op mean inter-incisal opening three month, six month and one year were 31.59 mm, (SD ± 3.15) 32.25 mm(SD ± 1.82), 32.67 mm (SD ± 2.19)respectively. There were 2 cases of malocclusion, 1 case of infection and 1 case of intra-oral exposure of joint. ConclusionThe success rate available in literature for use of alloplastic joint replacement in treatment of end stage TMJ disorders which includes a large area of different types of temporomandibular joint disorders cannot be implicated. In our study we found complication free success rate of 67%. A large study focusing specifically on use of alloplastic joints in recurrent ankylosis cases is needed for the subcontinent.

Temporomandibular joint reconstruction after condylar fracture complication related to osteosynthesis material

Total condylar resorption and the failure of bone synthesis material as postoperative complications of condyle fracture are seldom reported in the literature. When these occur, they may severely limit temporomandibular joint (TMJ) function. In such cases, a reconstruction of the joint is indicated, which can be achieved by means of an alloplastic prosthesis. This article reports a rare case of impaction of osteosynthesis material in the region of the base of the skull associated with a mandibular condyle fracture treated with rigid internal fixation, which resulted in complications. There was progression to condylar resorption, requiring an alloplastic TMJ reconstruction, which was performed in a single surgical session.

Is Alloplastic Temporomandibular Joint Reconstruction a Viable Option in the Surgical Management of Adult Patients With Idiopathic Condylar Resorption?

Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR. A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse. Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6years (range, 22 to 32yr) and mean follow-up was 6.2years (range, 5 to 12yr). Mean mandibular advancement at the B point was 24.3mm and mean change in occlusal plane was -10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions. Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.

A prospective, single-centre study on patient outcomes following temporomandibular joint replacement using a custom-made Biomet TMJ prosthesis

This study describes the clinical variables in 61 patients following total alloplastic temporomandibular joint reconstruction (TJR) in which the Biomet Microfixation Patient-Patient-Matched TMJ Implant was used. All patients were classified using the Wilkes classification. The visual analogue scale score for jaw pain intensity, the maximum inter-incisal opening (MIO), and the frequency of adverse events were recorded during follow-up; the mean follow-up was 14.2±8.6 months. Significant improvements were found in the MIO (P<0.0005), except at the 3-year follow-up. Additionally, a significant reduction in pain was observed both short and long term (P<0.0005). The incidence of adverse events was low (seven of the 81 alloplastic joints); two joints needed revision. TJR appears to be a relevant treatment option in patients with a broad range of temporomandibular joint disorders in whom none of the joint components are salvageable because of significant disease. Our patients gained an almost normal range of mouth opening and experienced a significant reduction in pain. Our results are promising, however TJR is associated with some side effects. TJR should be considered when less invasive procedures fail and a comprehensive presurgical work-up has been performed. Ongoing prospective studies are needed to consolidate the possible significant treatment outcomes.

Total Alloplastic Temporomandibular Joint Reconstruction for Management of TMJ Ankylosis.

Temporomandibular joint (TMJ) ankylosis involves the fusion of the mandibular condyle to the glenoid fossa, the skull base. The dilemma with regards to treatment planning whether distraction is done before gap arthroplasty or as a simultaneous procedure or after gap arthroplasty is still a controversy. In an attempt to carry out both the procedures simultaneously there is loss of vector control of the distal segment and the risk of pseudoarthrosis at the osteotomy site. This combined problem could be overcome by the use of total alloplastic joint prosthesis which offers a firm posterior stop for the proximal segment and negates aggressive physiotherapy. The reference literatures were retrieved from Pub Med and Science Direct database. Three case reports of bilateral recurrent TMJ ankylosis successfully treated with custom made total TMJ by the authors are illustrated. The purpose of this article is to review the world literature on various alloplastic joints available for TMJ reconstruction and to introduce our indigenous total joint prosthesis in the management of recurrent ankylosis.

Maximum voluntary bite force in patients with alloplastic total TMJ replacement – A prospective study

Alloplastic temporomandibular total joint replacement (TJR) for end-stage disease, congenital disorders and following ablative oncological surgery has been shown to reduce pain and improve function. The purpose was to assess the maximum voluntary bite force and maximum interincisal opening (MIO) in patients undergoing alloplastic total temporomandibular joint replacement (TJR).Seventeen patients with different diagnoses resulting in condylar hypomobility (8 patients; 15 joints) and condylar instability (9 patients; 12 joints) had undergone alloplastic TMJ reconstruction. Maximum voluntary bite force and MIO were measured at pre-operatively (T0), 2 (T1), 6 (T2) and 12 (T3) months. For ordinal data comparison at different time-points, the Wilcoxon signed-ranks test was used.There was a significant improvement in maximum voluntary bite force for both, patients with condylar hypomobility (P = 0.003) and condylar instability (P = 0.007). Analysis of MIO revealed a significant improvement at T3 (P = 0.002).Alloplastic TJR would appear to increase maximum voluntary bite force and MIO. Biomechanical integrity of the stomatognathic system and the ability of the patient to triturate food could be improved by alloplastic temporomandibular joint (TMJ) replacement.

Novel approach to the study of jaw kinematics in an alloplastic TMJ reconstruction

Total alloplastic temporomandibular joint (TMJ) reconstruction is a reliable treatment modality in patients with severely diseased TMJ with good clinical behaviour. TMJ mandibular function after alloplastic reconstruction has scarcely been analysed as a biomechanical parameter and investigation has generally been limited to interincisal measurements without deeper insight into joint kinematics. Dynamic stereometry to assess condylar movements relative to the fossa was performed at the 5 year follow-up of a patient who underwent condylar resection of the right TMJ followed by total alloplastic joint reconstruction to treat pigmented villonodular synovitis. The patient could achieve wide mouth opening, but overall mandibular kinematics showed a strong deviation towards the prosthetic side due to the lack of mandibular translation caused by the absence of the lateral pterygoid attachment. Possible overloading of the joint contralateral to the TMJ prosthesis might be prevented by optimizing replacement joint design.

Total alloplastic temporomandibular joint reconstruction combined with orthodontic treatment in a patient with idiopathic condylar resorption

This case report describes the successful treatment of an adult patient with skeletal Class II open-bite malocclusion secondary to idiopathic condylar resorption. Total alloplastic joint reconstruction and counterclockwise rotation of the maxillomandibular complex combined with orthodontic treatment provided a satisfying outcome with maximum functional and esthetic improvement.

Analysis of mandibular motion following unilateral and bilateral alloplastic TMJ reconstruction

The purpose of this study was to analyse the masticatory patterns and range of motion (maximal incisal opening (MIO), protrusion and lateral excursion) in patients who have had unilateral and bilateral temporomandibular joint (TMJ) replacement with an alloplastic prosthesis, and compare them to each other and to normal controls. Mandibular motion was examined in 18 patients, who had undergone alloplastic TMJ reconstruction, 13 with a bilateral prosthesis and 5 with a unilateral prosthesis, and in 13 normal controls. A statistically significant difference (P<0.01) for MIO and maximum lateral excursion was observed between the bilateral group and the control group. Maximum protrusion was only statistically significantly different (P<0.05) between the bilateral group and the control group. For the unilateral group, a statistically significant difference (P<0.01) was seen only with maximum contralateral excursion when compared with controls. No statistically significant difference existed in MIO and protrusion between the unilateral and bilateral groups. Even though maximum ipsilateral lateral excursion was greater for the unilateral group than either left or right maximum lateral excursion by the bilateral group, this difference was not statistically significant. This study provided an in vivo analysis of mandibular motion following alloplastic TMJ reconstruction.

Post-surgical neuromas in patients with total alloplastic temporomandibular joint reconstruction: a retrospective case series

This study evaluated pain scores and maximal incisal opening (MIO) in patients with total alloplastic temporomandibular joints found to have post-surgical neuromas following revision arthroplasty, compared with patients who underwent revision arthroplasty without neuromas. 19 cases were reviewed of which 11 had neuromas excised. Data were available for 8 cases in the immediate postoperative period and 7 cases had follow-up data. 8 patients had revision arthroplasty with excision of scar tissue (7 with postoperative, 4 with long-term data). Follow-up ranged from 2 months to 5.9 years (mean 1.2 years). 6 of 8 patients obtained clinically significant pain reduction in the immediate postoperative period when their neuromas were excised, compared with 3 of 7 patients without neuromas. On long-term follow-up, 3 of 7 patients in the neuroma group had clinically significant pain reduction, 3 reported lower pain scores, 1 had no pain change. No patients had increased pain. 1 of 4 patients in the scar revision group had clinically significant pain reduction, 2 had no change, 1 reported increased pain. Mean MIO was 23 mm preoperative and 28 mm postoperative in patients with neuromas, compared with 27.75 mm and 31.25 mm, respectively, in patients without neuromas.