Quality of life outcomes one year after replacement of the temporomandibular joint using a modified SF36 questionnaire

Effect of duration of preoperative pain on outcomes of total temporomandibular joint replacement

The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (β = -0.27; 95% CI -0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.

A review of the use of patient reported outcome measures (PROMS) in temporomandibular joint (TMJ) surgery

Temporomandibular joint (TMJ) surgery accounts for a significant number of patient episodes in oral and maxillofacial surgery, and treatment effectiveness is commonly assessed using measures of pain and mouth opening. Patient-reported outcome measures (PROMs) enable assessment of the patient's perspective and perception of the diseases and treatment outcomes. The purpose of this review was to assess the use of PROMs in TMJ surgery. A review of 3 databases (PubMed, OVID, Trip) was carried out to assess the use of PROMs when reporting on TMJ surgical interventions. Studies were limited to the English language, involving humans and at least one surgical intervention of the TMJ. A total of 214 articles met the inclusion and exclusion criteria, of which only 28 used 18 PROMs among them. Half of these PROMs were single-question visual analogue scales or Likert scales on quality of life and disability. The Oral Health Impact Profile and the Helkimo Clinical Dysfunction Index were the second most used (n = 3). PROMs were used most in studies on internal derangement (n = 9) and in cohort study designs (n = 26), but this was not statistically significant. In the majority of research on TMJ surgery, no PROMs are used, and when one is, there is a tendency to use weaker single-question PROMs as opposed to multi-question PROMs to assess outcomes. With the increasing importance of PROMs for assessing patients' perception of treatment outcomes, further research is needed to establish valid and reproducible PROMs for TMJ surgery.

Does Emotional State Improve Following Temporomandibular Joint Total Joint Replacement?

BACKGROUND

Temporomandibular joint total joint replacement (TMJTJR) offers patients the opportunity for improved function and reduced pain. TMJTJR also has the potential to affect a patient's emotions in a positive or negative manner.

PURPOSE

The purpose of this study was to evaluate changes in emotional state for subjects undergoing TMJTJR.

STUDY DESIGN, SETTING, SAMPLE

The authors implemented a retrospective cohort study. Subjects who received TMJTJR were identified from the TMJ Inter Network, which is a study group comprising more than 130 temporomandibular joint surgeons. Subjects between the ages of 18 and 65 years with complete medical records and pre/post TMJTJR video/audio recordings were enrolled in the study.

PREDICTOR VARIABLE

The predictor variable was time (preoperative and postoperative).

MAIN OUTCOME VARIABLES

The primary outcome variable is change in the emotional state. All subjects had preoperative (T0) recorded interview as well as a postoperative (T1) interview at 3 to 6 months. The eight-category emotional state was classified as neutral, happy, sad, angry, fearful, disgusted, surprised, and bored. The three-category emotional state was classified as neutral, positive, and negative. The emotional state was measured using artificial intelligence at T0 and T1. The secondary outcome variable was pain score and maximal interincisal opening.

COVARIATES

The covariates are gender, age, diagnosis, prosthetic side, TMJTJR design, and TMJTJR type.

ANALYSES

The relationship between emotional state change and covariates was examined using both the χ2 test and the Kruskal-Wallis H test. The significance of the change in categorical data after surgery was examined using the McNemar-Bowker test. P values < .05 were considered statistically significant.

RESULTS

Thirty-three subjects were included in the study. The mean age was 30.09 ± 8.69 with 15 males (45%) and 18 females (55%). The percentage of subjects with preoperative neutral, happy, sad, angry, and fearful emotional states was 24, 15, 24, 9, and 27%, respectively. The percentage of subjects with postoperative neutral, happy, sad, angry, and fearful emotional states was 21, 39, 21, 12, and 6%, respectively. The change in emotional state was statistically significant (P = .037). There was no statistically significant relationship between covariates and emotional state changes (P > .05).

CONCLUSION

According to the assessment of artificial intelligence, TMJTJR improves the emotional state of patients.

Quality of Life After Total Temporomandibular Joint Prothesis Surgery

INTRODUCTION

Total temporomandibular joint (TMJ) prostheses are increasingly used in patients with joint destruction presenting significant pain and mouth opening limitation. This surgery can be considered as the last resort solution whose goal is to restore the mandible function. The aim of this study was to evaluate the patient quality of life (QoL) before and after TMJ replacement surgery with a total TMJ prosthesis, using a modified QoL scale.

MATERIALS AND METHODS

All patients with a total uni or bilateral TMJ prosthesis who could be contacted were included. All patients completed 2 retrospective questionnaires: once relative to the preoperative QoL and another for the post-operative QoL, including the assessment of mouth opening limitation, daily eating difficulties and also a QoL score, adapted from the TMJ-QoL questionnaire.

RESULTS

A total of 17 patients were included: 13 temporomandibular ankylosis, 3 condylar resorptions and 1 congenital malformation. Mouth opening limitation and daily eating difficulties were significantly reduced after surgery (P < 0.001). Nine of the 11 QoL questions showed a significant decrease in score and thus an improvement of the QoL after surgery: having a conversation (P = 0.006), eating (P < 0.001), yawning (P < 0.001), sleeping (P= 0.043), recreational activities (P = 0.005), relaxing (P= 0.021), feeling depressed because of TMJ problems (P = 0.032), daily activities (P = 0.008) and patient self-assessment of QoL (P = 0.003). Two showed no significant difference: taking analgesics, and social life. Total score of QoL showed a significant improvement (P= 0.003).

CONCLUSIONS

Quality of life, mouth opening, and daily eating were significantly improved after total TMJ prosthesis, in agreement with the litterature. The TMJ prosthesis could be considered ealier in the management of end-stage temporomandibular disease.

Comparison in clinical performance of surgical guides for mandibular surgery and temporomandibular joint implants fabricated by additive manufacturing techniques

Additive manufacturing (AM) offers great design freedom that enables objects with desired unique and complex geometry and topology to be readily and cost-effectively fabricated. The overall benefits of AM are well known, such as increased material and resource efficiency, enhanced design and production flexibility, the ability to create porous structures and on-demand manufacturing. When AM is applied to medical devices, these benefits are naturally assumed. However, hard clinical evidence collected from clinical trials and studies seems to be lacking and, as a result, systematic assessment is yet difficult. In the present work, we have reviewed 23 studies on the clinical use of AM patient-specific surgical guides (PSGs) for the mandible surgeries (n = 17) and temporomandibular joint (TMJ) patient-specific implants (PSIs) (n = 6) with respect to expected clinical outcomes. It is concluded that the data published on these AM medical devices are often lacking in comprehensive evaluation of clinical outcomes. A complete set of clinical data, including those on time management, costs, clinical outcomes, range of motion, accuracy of the placement with respect to the pre-operative planning, and extra complications, as well as manufacturing data are needed to demonstrate the real benefits gained from applying AM to these medical devices and to satisfy regulatory requirements.

Do patient-reported outcome measures correlate with clinical follow-up after arthroscopic treatment of internal derangement of the temporomandibular joint?

INTRODUCTION

Arthroscopic treatment of the temporomandibular joint (TMJ) has traditionally been evaluated with clinical measurements. Additional recordings of patient reported outcome measures (PROM) is expected to make the evaluation more complete. The aim of the study was to evaluate if PROM correlates with clinical follow-up measures after arthroscopic treatment of internal derangement of the TMJ.

MATERIAL AND METHODS

Patients with temporomandibular dysfunction (TMD), treated with arthroscopic lysis and lavage of the TMJ, were followed with a PROM questionnaire; Jaw Functional Limitation Scale 20 (JFLS-20) and a review of patient medical records. Out of 239 patients treated, 134 were eligible for inclusion to the study.

RESULTS

91 subjects, 21 males and 70 females, with mean age 42.6 years completed the follow-up. The JFLS-20 mean score was 25.43 (range: 0-148). A correlation was found between JFLS and mouth opening. The JFLS-20 score was decreased by 1.48 (p = 0.0001) for ever millimeter larger mouth opening and with 1.16 (p = 0.001) for every gained millimeter of mouth opening after arthroscopic treatment of the TMJ. The mean maximal mouth opening was 38.43 mm preoperatively (15 to 75 mm) compared to 42.19 mm postoperatively (range: 21-75 mm). A total of 80 subjects with TMD associated pain preoperatively was reduced to 25 postoperatively (p = 0.0001).

DISCUSSION

Advantageous treatment effect with arthroscopic lysis and lavage was presented. The outcome of the JFLS-20 questionnaire indicates a correlation with the clinical findings. Future studies will focus on larger cohorts and using PROM with a case-control setting.

Quality of life, chronic pain, insomnia, and jaw malfunction in patients after alloplastic temporomandibular joint replacement: a questionnaire-based pilot study

Studies of patients undergoing alloplastic total temporomandibular joint replacement seldom report on quality of life (QoL) and sleep. The aim of this pilot study was to assess these factors in such a patient cohort using validated psychometric questionnaires. Data were collected via online surveys comprising the following six questionnaires: Short Form-12 Health Survey (SF-12), Patient Health Questionnaire-15, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Insomnia Severity Index, Graded Chronic Pain Scale, and Jaw Disability List. Pain intensity, limitation in nutrition, and treatment satisfaction were assessed using numerical rating scales. Mouth opening was measured at follow-up. The SF-12 Physical Composite Score was markedly lower than that of the age-matched general population, whereas the Mental Composite Score did not differ significantly. Participants indicated a low somatization level and low level of disability due to pain, but reduced QoL. Clinically relevant insomnia was reported by 36% of participants. In conclusion, the results of this pilot study indicate that QoL and sleep in patients with a total temporomandibular joint replacement differ from those in the general population, indicating the need for a comprehensive outcome assessment utilizing validated psychometric tools in accordance with the current biopsychosocial model of chronic disorders.