Custom Alloplastic Temporomandibular Joint Reconstruction: Expanding Reconstructive Horizons

Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement

The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery, underscored by its relatively infrequent occurrence and the lack of comprehensive clinical guidelines. This review aims to elucidate the available approaches for TMJ reconstruction, with a particular emphasis on recent groundbreaking advancements. The current spectrum of TMJ reconstruction integrates diverse surgical techniques, such as costochondral grafting, coronoid process grafting, revascularized fibula transfer, transport distraction osteogenesis, and alloplastic TMJ replacement. Despite the available options, a singular, universally accepted 'gold standard' for reconstructive techniques or materials remains elusive in this field. Our review comprehensively summarizes the current available methods of TMJ reconstruction, focusing on both autologous and alloplastic prostheses. It delves into the differences of each surgical technique and outlines the implications of recent technological advances, such as 3D printing, which hold the promise of enhancing surgical precision and patient outcomes. This evolutionary progress aims not only to improve the immediate results of reconstruction but also to ensure the long-term health and functionality of the TMJ, thereby improving the quality of life for patients with end-stage TMJ disorders.

Total temporomandibular joint reconstruction prosthesis in hemifacial microsomia: A systematic review

Hypoplastic asymmetry due to hemifacial microsomia (HFM) often represents the most difficult reconstruction in the craniomaxillofacial clinic. Although autogenous grafts are generally used for temporomandibular joint reconstruction (TMJR), the use of TMJR prostheses is not well established. The aim of this review was to identify, collect and analyse the use of extended TMJR (eTMJR) prostheses in patients with HFM, describing clinical features, surgical procedures and postoperative complications. Online searches of all major databases were performed according to PRISMA guidelines. All studies with HFM patients treated with the eTMJR prostheses were included. Descriptive statistics were used for data analysis. A total of 19 studies, including 08 case studies, 06 case series and 05 retrospective cohort studies, met the inclusion criteria, where a total of 42 HFM patients were reported from 18 countries, mostly from the United States (05; 26%). Fifteen of the 42 cases (~36%) were male. The mean ± SD (range) age of patients in all studies was 19.79 ± 5.81 (9-36) years. The mean ± SD (range) of patient follow-up was 41.30 ± 35.50 (6-136) months. A total of 5 (10.6%) patients were implanted with bilateral eTMJR prostheses. The Pruzansky classification was used in 18 (~89.5%) studies, OMENS classification in 01 (~5%) study, whereas no classification was reported in one study. Only 01 (7.1%) study had documented the eTMJR classification for the prosthesis used. In growing patients with or without a history of failed autogenous tissues, TMJR prostheses may provide a viable alternative. Randomized studies with large cohorts are warranted to validate these preliminary results.

Extended total temporomandibular joint reconstruction prosthesis: A comprehensive analysis

Alloplastic total temporomandibular joint replacement (TMJR) is the treatment of choice for end-stage temporomandibular joint diseases. Extended TMJR (eTMJR) is a modification of the standard alloplastic fossa-condyle joint that includes components extending further to the skull base or the mandible. The aim of this study is to review the use of the eTMJR prosthesis for the treatment of large craniomaxillofacial defects. Data mining was performed according to the PRISMA statement using online search in databases such as PubMed (Medline), Google Scholar, Dimensions, Semantic Scholar and Web of Science. A total of 19 case reports, 08 case series and 03 retrospective studies were identified. A total of 49 patients were presented in the case reports and case series, who were implanted with 56 eTMJR prostheses (07 bilateral and 42 unilateral procedures). The mean age of the patients was 36.02±16.54 years, the male to female patient ratio was 1:1.72 and the mean follow-up time was 23.74 ± 19.83 months. The eTMJR prosthesis was most frequently used to treat ameloblastoma and hemifacial microsomia. Analysis of the retrospective studies was performed in three domains: the baseline characteristic of patients, treatment outcomes in terms of functional variables and complications after eTMJR prostheses implantation. This study concluded that the implantion of the eTMJR prosthesis was uncommon, that appropriate class of eTMJR prosthesis was not reported, and that the width of the mandibular component (like the length) of eTMJR prosthesis has substantial variations.

An Overview of Clinical Conditions and a Systematic Review of Personalized TMJ Replacement

The temporomandibular joint (TMJ) is a complex structure in the cranio-maxillomandibular region. The pathological changes of the joint cause deficiencies at different levels, making its replacement necessary in some cases. The aim of this article is to analyze the current indications, treatment and criteria, and follow-up using a systematic review and case series. A systematic review was carried out, identifying the indications for the use of a customized TMJ prosthesis and evaluating criteria and validation in the international literature. After review and exclusion, 8 articles were included with a minimum follow-up of 12 months. The age of the subjects was between 18 and 47 years old. In 226 patients, 310 TMJ prostheses were installed, 168 bilaterally and 142 unilaterally. In most of the articles, a good condition in the follow-up was observed, with a reduction in pain and better conditions of mandibular movement and function. TMJ prosthesis and replacement is a protocolized, defined, stable, and predictable procedure. Indications and criteria must be evaluated by specialists and patients related to the pathology involved in TMJ deformity or degeneration. Randomized research with an accurate diagnosis and follow-up is necessary to obtain the best indication for this treatment.

A five-year review of the OMX temporomandibular prosthetic total joint replacement system

PURPOSE

The aim of this study was to undertake a 5-year review of the OMX temporomandibular prosthetic total joint replacement system (OMX-TMJ).

METHODS

Data was collected from patients who had an OMX-TMJ implanted between May 2015 and November 2020 at Epworth-Freemasons and St. Vincent's hospitals in Melbourne, Australia. The data points included patient demographics, primary diagnosis, and clinical outcomes in terms of visual analogue scale (VAS) for pain, maximum inter-incisal mouth opening, and complication events.

RESULTS

There were 206 OMX-TMJ devices implanted in 151 patients over the 5-year study period. The vast majority were female patients (n = 137, 90.7%) with a mean age of 44.8 years (range 20-76 years) at the time of surgery. Most patients presented with primary (idiopathic) osteoarthritis (119 joints-57.8%) that failed to respond to conservative measures. Based on a mean follow-up period of 36 months (range 12 months to 73 months), the average mouth opening improved from 30.8 mm pre-surgery to an average of 39.1 mm following OMX-TMJ surgery (p < 0.05). Joint pain (VAS: 0-10) significantly improved from 6.14 pre-surgery to 0.87 following OMX-TMJ surgery (p < 0.001). Twenty-one patients (13.9%) experienced device-related complications which resulted in explantation of 7 (3.4%) OMX-TMJ devices over the 5-year period.

CONCLUSION

This study shows that the OMX-TMJ prosthetic total joint replacement system is a reasonably safe, versatile, and reliable implant that effectively improves mandibular opening and reduces joint pain across a broad range of end-stage TMJ disorders.

Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection

ABSTRACT

Ameloblastomas are benign tumors that most commonly affecting the mandible. The current standard of treatment for ameloblastomas is resection followed by reconstruction that has historically been accomplished through the use of a microsurgical vascularized flaps taken from the iliac crest or fibula. Alloplastic reconstruction methods have gained popularity over recent years with success reported in the reconstruction of many pathologies, including ankylosis, condylar fracture, neoplasia involving extensive resection, severe inflammatory/degenerative temporomandibular joint (TMJ) disease, and congenital TMJ abnormalities. The authors present a patient who successfully underwent ameloblastoma resection and TMJ reconstruction with a custom TMJ Concepts alloplastic implant. The authors also present a review of the literature on alloplastic TMJ reconstruction following ameloblastoma resection. To our knowledge, this is the second report in the literature on the use of a TMJ Concepts implant after ameloblastoma resection.

Patient specific total temporomandibular joint reconstruction: A review of biomaterial, designs, fabrication and outcomes

Purpose

The aim of this article was to systematically review the available literature on patient specific total temporomandibular joint total joint replacement (PS-TMJR) implants for their biomaterial, designs, fabrication techniques and their outcomes.

Methods

A literature review was conducted using PubMed, and science direct databases using the key words three-dimensional printing, 3D printing, CAD CAM, computer aided designing, computer aided manufacturing, additive technology, custom made implants, patient specific implants in combination with Temporomandibular joint, TMJ surgery.

Results

The search revealed 2760 articles, of which 374 were in English and discussed TMJ reconstruction. Further filtering shortlisted 74 articles that discussed PS-TMJR. Duplicates were removed and additional added from article references. 39 articles describing biomaterial, designing and fabrication of PS-TMJR implants and their outcomes were selected for analysis.

Conclusions

Although PS-TMJR implants allow a better anatomical fit, improved fixation, and safeguard various structures such as the inferior alveolar nerve, they vary in designs, material and fabrication techniques. However, PS-TMJR printed with SLM and EBM technologies have yet to be compared with the conventional ones in terms of mechanical strength, and clinical outcome. With emerging bioprinting technologies, even newer biomaterials should be considered for 3D printing of PS-TMJR devices designed to achieve harmony in function between the joint device, bone and masticatory muscles.