Alloplastic total temporomandibular joint reconstruction: a 10 year Wits experience

Sekhoto, Mmathabo Gloria
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Introduction: The anatomical structure and function of the temporomandibular joint (TMJ) can be altered by trauma, pathology, degenerative or inflammatory processes resulting in endstage TMJ diseases which necessitates TMJ reconstruction. The reconstruction (autogenous or alloplastic) aims to restore the anatomy, altered joint mechanics and to improve the quality of life. Innumerable studies have reported on the results of TMJ reconstruction with costochondral graft (CCG). There is however paucity of studies that have reported on the outcome of alloplastic TMJ reconstruction. Aim: This study aimed to report on the objective outcomes (maximum mouth opening distance and occlusion), subjective outcomes (pain, diet consistency and chewing, quality of life) and complications after alloplastic total TMJ reconstruction. Methodology: This was a retrospective cross-sectional study in which 31 patients who had alloplastic total TMJ prosthesis implanted at the Wits Oral Health Centre (between 2007 and 2017) were reviewed. Inclusion criteria was any patients who had total prosthetic TMJ joint placement with a minimum of 6 months post-operative follow-up. Patients who failed to return for follow-up, had less than 6 months follow-up period and with missing records were excluded from the study. Pre-operative and post-operative findings were analysed statistically. Results: There were 16 females and 15 males with a mean age of 36.94 years (range 11 – 72 years). Patients had a mean follow-up period of 58.8 months (range 6 – 122 months). In total, 51 prostheses (20 bilateral, 11 unilateral) were implanted. The stock prostheses were used in 28 patients (90.32%) and only 3 (9.68%) were of custom-made type. Fifty eight percent of patients were diagnosed with temporomandibular joint ankylosis, 22.58% had degenerative conditions, 9.68% had pathology and 9.68% had malocclusion. The results showed that there was improvement in maximum mouth opening distance (MMO) (P-value <0.0001) which showed trends of improving significantly at 3 months after surgery but decreased approximately 12 months post-operatively before it could stabilize, particularly in patients who had ankylosis. There was reduction in pain reported (P-value <0.0001) and improvement in diet consistency (P-value <0.0001) and quality of life (QoL) (P-value 0.013). Post-operative complications ranged from facial nerve injuries (N= 4), keloids (N= 2) and heterotopic bone formation (N= 2). One out of 4 patients who had nerve injury had permanent paralysis of the temporal branch of facial nerve while the other 3 patients resolved completely in 3 to 6 months. Conclusion: TMJ alloplasts provide satisfactory clinical and functional outcomes for patients with endstage TMJ diseases, evidenced by overall improvement in MMO, chewing ability and quality of life. An aggressive physiotherapy regimen is however imperative for successful rehabilitation and maintenance of the improved MMO, especially in TMJ ankylosis patients. An association exists between previous TMJ surgery and occurrence of complications postimplantation of total alloplastic joints.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master in Dentistry (MDent) in the branch of Maxillo-Facial and Oral Surgery Johannesburg, March 2019
Sekhoto, Mmathabo Gloria (2019) Alloplastic total temporomandibular joint reconstruction:a 10 year Wits experience, University of the Witwatersrand, Johannesburg, <>