Modified total alloplastic temporomandibular joint reconstruction and evaluation of efficiency

Abstract

Abstract: PURPOSE: To introduce modified surgical techniques of total alloplastic temporomandibular joint (TMJ) reconstruction and evaluate the clinical outcomes. METHODS: In 2006, we began to use the Biomet-Lorenz (Jacksonville, FL) stock replacement, and made some modifications regarding to surgical techniques as follows: ①The eminence or condyle bone was used for filling the fossa to make it flat and ensure the stability of the retention of the fossa prosthesis; ②The disc was filled into the condylar prosthesis to prevent heterotopic bone; ③Free fat graft was obtained from the submandibular approach to avoid abdominal incision. Postoperative follow-up was made based on panoramic radiographs (PR) or CT to observe the position of the prostheses and the surrounding bone structure for 6 months and 1 year, respectively. SAS 9.12 software package was used for data analysis. RESULTS: Twelve patients (14 sides) were followed up. The average follow-up period was 26.08 months (4 to 48 months). Thirteen fossa prostheses (11 cases) were fitted with bone graft: the bone in 7 cases (10 sides) was from the eminence, 2 cases (2 sides) from the condyle, 1 case (2 sides) from the mandibular notch; The discs in 5 cases (5 sides) were reserved to fill into the condylar prostheses; Free fat graft in 10 cases (10 sides) was obtained via the submandibular approach. Postoperative imaging examination (PR or CT) at 6-month and 1-year showed the position of fossa and mandibular prostheses was good in all patients and the periprosthetic bone structure showed no abnormalities. All patients showed postoperative occlusal stability and no phenomenon of prostheses loosening. CONCLUSIONS: Modified total alloplastic TMJ reconstruction can help to improve the stability of prostheses, to reduce postoperative heterotopic bone, and to avoid additional surgical incision, which is worth of wide application.

Key words: Total alloplastic reconstruction, Temporomandibular joint, Modified techniques

CLC Number:

R782.6

LIU Huan, ZHANG Xiao-hu, YANG Chi, ZHANG Shan-yong, CHEN Min-jie, HE Dong-mei, QIU Ya-ting.. Modified total alloplastic temporomandibular joint reconstruction and evaluation of efficiency[J]. China Journal of Oral and Maxillofacial Surgery, 2014, 12(4): 318-322.

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