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de Las Fuentes Monreal M, Escorial Hernández V, García Jiménez T, Muñoz-Guerra MF. Revision of the Wolford protocol for managing infections in temporomandibular joint prostheses: an updated surgical approach. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00333-3. [PMID: 39232864 DOI: 10.1016/j.ijom.2024.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 08/16/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
The management of infected temporomandibular joint prostheses presents a surgical challenge. In certain instances, an intermediate approach involving biofilm debridement and local antibiotic instillation may obviate the need for prosthesis removal. This technical note describes an update of the technique outlined by Wolford for managing infections, in which improved materials are used to implement the technique.
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Affiliation(s)
| | - V Escorial Hernández
- Oral and Maxillofacial Surgery Department, University Hospital La Princesa, Madrid, Spain.
| | - T García Jiménez
- Oral and Maxillofacial Surgery Department, University Hospital La Princesa, Madrid, Spain.
| | - M F Muñoz-Guerra
- Oral and Maxillofacial Surgery Department, University Hospital La Princesa, Madrid, Spain.
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Dawoud BE, Hampson T, Barrow R, Mercuri LG. Antibiotic prophylaxis in alloplastic temporomandibular joint replacement surgery: A multi-national survey of temporomandibular joint surgeons. Br J Oral Maxillofac Surg 2024; 62:504-509. [PMID: 38685147 DOI: 10.1016/j.bjoms.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/19/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024]
Abstract
Temporomandibular disorders include a wide spectrum of extra-articular and intra-articular conditions affecting the temporomandibular joint (TMJ). In salvage cases involving intra-articular end-stage disease, alloplastic temporomandibular joint replacement (TMJR) is a management option which can be utilised to rehabilitate a disabled joint's function and form. Whilst post-TMJR infection is rare, it is one of the most serious complications. The principles governing TMJR surgery antibiotic prophylaxis have been based on those established in orthopaedic surgery literature. Antibiotic resistance due to antibiotic over-use is a significant concern, therefore antibiotic stewardship has been developed to deal with this world-wide public health concern. The TMJ's anatomical proximity to the external auditory canal and oral cavity creates the potential for bacterial contamination. The aim of this study was to explore the views of 39 sub-specialist TMJ surgeons across nine nations usual approach to antibiotic prophylaxis and their management of TMJR infection. To accomplish this, an international survey was developed and conducted using Google Forms. The results demonstrated that 97.4% of the respondents employ prophylactic antibiotics at TMJR surgery, 83.8% on discharge. Variability in antibiotic choice with additional antimicrobial perioperative practices were also reported. Opinions on the management of a TMJR infection also varied. This survey establishes there is an agreement on the use of antibiotic prophylaxis, However the variability in choice, timing, course, duration of antibiotic use as well as the management of a postoperative TMJR infection demonstrates the need for further study leading to development of standardised antibiotic prophylaxis and infection management protocols for TMJR surgery.
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Affiliation(s)
- B Es Dawoud
- Lancashire Teaching Hospitals NHS Foundation Trust, UK.
| | - T Hampson
- University of Manchester Medical School, UK
| | - R Barrow
- University of Manchester Medical School, UK
| | - L G Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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3
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Kulkarni R, Akintoye S. A Patient Who Recently Underwent Total Temporomandibular Joint Replacement Reporting for Endodontic Therapy. Dent Clin North Am 2023; 67:629-631. [PMID: 37714611 DOI: 10.1016/j.cden.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
A patient who underwent a recent total joint replacement (TJR) of the left temporomandibular joint presents for evaluation and management of #19. The diagnosis was consistent with irreversible pulpitis, and root canal therapy was recommended. Because of the recent TJR and limitations in opening, a bite block was used during the procedure.
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Affiliation(s)
- Roopali Kulkarni
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
| | - Sunday Akintoye
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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4
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Subash P, V VP, Iyer S, Nerurkar S, Krishnadas A, Pullan SG. Concomitant Microvascular Aided Extended Temporo-Mandibular Joint Replacement (ME-TJR) and Stock Temporo-Mandibular Joint Replacement (MS-TJR) During Mandibular Reconstruction. J Maxillofac Oral Surg 2023; 22:110-117. [PMID: 37041942 PMCID: PMC10082882 DOI: 10.1007/s12663-023-01896-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/02/2023] [Indexed: 04/13/2023] Open
Abstract
Background Disarticulation is indicated when pathologic process involves the condyle or when a body/ramus lesion extends into condylar process. The goal of reconstruction is to reinstate joint mechanism for function and also to restore facial symmetry. Aim Retrospective evaluation of functional and aesthetic outcomes in patients with disarticulation defects of mandible treated with concomitant alloplastic temporomandibular joint replacement and microvascular free flap reconstruction. Materials and Methods Nine patients (8 benign pathologies and 1 secondary reconstruction for malignant neoplasm), who underwent mandibular resection with condylar disarticulation and reconstruction with Free microvascular flap and Alloplastic total joint replacement between 2015 and 2022 were included in the study. A modified functional intra-oral Glasgow scale (FIGS)2 was used for quality of life (QOL) scoring. Speech, mastication, swallowing, VAS pain score, mouth-opening, occlusion, facial symmetry and overall patient satisfaction were assessed. Results 8 patients with benign pathology reported excellent outcome with a QOL score of 13-15 in terms of speech, chewing and swallowing. Pre-operative occlusion of native mandible was maintained in all dentulous patients. VAS score of 0-1 was reported. Mouth opening was adequate in all patients. 2 patients reported mild ipsilateral deviation of mandible. Mild facial asymmetry was reported by 2 patients with an overall satisfaction of 8-9. There were no significant intra/post-operative complications in patients with benign pathology. Failure of stock joint was observed in secondary reconstruction for malignant neoplasm. Conclusion Microvascular free flap aided stock or custom alloplastic replacement of temporomandibular joint (MS-TJR, ME-TJR) restores function and aesthetics following mandibular resection with disarticulation of condyle.
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Affiliation(s)
- Pramod Subash
- Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Vinanthi P. V
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Subramania Iyer
- Department of Head & Neck Surgery, Plastic & Reconstructive Surgery, Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Shibani Nerurkar
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Arjun Krishnadas
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Sony G. Pullan
- Oral & Maxillofacial Surgery, Royal Free NHS Foundation Trust, Barnet & Chase Farm Hospitals, Wellhouse Lane, Barnet, EN5 3DJ UK
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Total Customized Alloplastic Reconstruction for Treatment of Severe Temporomandibular Joint Pathologic Conditions: A Case Series of Combined Intraoral and Extraoral Approach. J Craniofac Surg 2022; 33:e250-e253. [DOI: 10.1097/scs.0000000000008068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bach E, Sigaux N, Fauvernier M, Cousin AS. Reasons for failure of total temporomandibular joint replacement: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2022; 51:1059-1068. [PMID: 35012826 DOI: 10.1016/j.ijom.2021.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/10/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk of revision surgery with stock or custom-fitted prostheses (the two most current TMJR prosthesis types). A systematic review was performed, with a search of PubMed, Google Scholar, and the Cochrane Library in November 2020. Overall, 27 articles were included in this study, describing Biomet and TMJ Concepts prostheses and including postoperative data on complications requiring a return to the operating room. A total of 2247 prostheses were analysed: 1350 stock Biomet prostheses and 897 custom-fitted TMJ Concepts and custom-fitted Biomet prostheses. The global revision rate was 1.19 per 100 prosthesis-years. The most common reason for revision was heterotopic bone formation. Stock prostheses appeared to have a lower risk of revision compared to custom prostheses: rate ratio 0.52 (95% confidence interval 0.33-0.81, P-value 0.003). Regarding causes of revision, the only significant difference between the types of devices was a higher rate of heterotopic bone formation for custom-made prostheses (P = 0.001). The results of this study revealed a low revision rate post TMJR revision, with stock devices even less prone to such risk. Nevertheless, these results can be explained by the fact that custom-made prostheses are more likely to be used for cases in which the anatomy is significantly abnormal or there is a history of multiple joint surgeries, which carry a greater risk of complications and heterotopic bone formation.
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Affiliation(s)
- E Bach
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France.
| | - N Sigaux
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
| | - M Fauvernier
- Department of Biostatistics, Lyon Sud Hospital, University of Lyon 1, Lyon, France
| | - A-S Cousin
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
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7
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Abstract
Purpose End-stage temporomandibular joint (TMJ) disease are not uncommon and affects quality of life. Multiple surgical procedures have been mentioned in literature for management of TMJ disease which ranges from conservative management to aggressive resection of involved joint and replacement with alloplastic total joint prosthesis. The purpose of the present paper was to provide an overview of the role of alloplastic total joint prosthesis in TMJ replacement. Methods and results Alloplastic total joint prosthesis is nowadays considered as a standard of care in the adult patients who require TMJ replacement. The requirement of alloplastic total prosthesis has increased in present era with the improvement in design and material of implants, surgical skills and reported victorious outcome along with improved quality of life after its use. It provides restoration of form and functions, improvement in quality of life, reduction in pain and maintenance of ramal height. Additionally, in TMJ ankylosis it reduces chances of re-ankylosis and allows facial asymmetry correction. Currently, enough evidence is however not available for replacement in skeletally immature patient. Conclusion The authors conclude that the total joint replacement is a standard procedure for end-stage TMJ disease. Every maxillofacial surgeon should be well-acquainted with TMJ replacement.
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Roistacher DM, Heller JA, Ferraro NF, August M. Is Penicillin Allergy a Risk Factor for Surgical Site Infection After Oral and Maxillofacial Surgery? J Oral Maxillofac Surg 2021; 80:93-100. [PMID: 34547269 DOI: 10.1016/j.joms.2021.08.147] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The selection of perioperative antibiotics for prevention of surgical site infection (SSI) is often limited by the presence of a reported penicillin allergy. The purpose of this study was to determine if oral and maxillofacial surgery patients who report allergy to penicillin are at an increased risk of developing SSI. METHODS A retrospective cohort study was performed of patients who underwent oral and maxillofacial surgical procedures in the operating room setting at a single institution between 2011 and 2018. The following categories of procedures were investigated: dentoalveolar, orthognathic, orthognathic with third molar extraction, pathology and reconstruction, and temporomandibular joint. The primary predictor and outcome variables were reported penicillin allergy and surgical site infection, respectively. Bivariate and multiple logistic regression analysis were performed. P < .05 was considered to be significant. RESULTS The cohort was composed of 2,058 patients of which 318 (15.5%) reported allergy to penicillin. Beta-lactam antibiotics were administered less frequently to penicillin allergic patients perioperatively compared with those without penicillin allergy (7.9 vs 97.1%, P < .001), while clindamycin was more commonly administered (76.4 vs 2.5%, P < .001). Clindamycin was associated with a higher SSI rate compared with beta-lactam antibiotics (5.6 vs 1.4%, P < .001). Penicillin allergy was significantly associated with SSI at an adjusted odds ratio of 2.61 (95% CI 1.51 to 4.49, P = .001). After holding perioperative antibiotic usage equal between the 2 groups, penicillin allergy per se was no longer associated with SSI (P = .901), suggesting that the outcome was mediated by antibiotic selection. CONCLUSIONS Penicillin allergy was associated with development of SSI due to receipt of non-beta-lactam antibiotics as perioperative prophylaxis. Formal allergy evaluation should be considered for patients with putative penicillin allergy.
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Affiliation(s)
- Daniel M Roistacher
- Resident, Oral and Maxillofacial Surgery, Mount Sinai Health System, New York, NY.
| | | | - Nalton F Ferraro
- Instructor, Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA
| | - Meredith August
- Attending Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
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Roychoudhury A, Yadav P, Bhutia O, Mane R, Yadav R, Goswami D, Jose A. Alloplastic total joint replacement in management of temporomandibular joint ankylosis. J Oral Biol Craniofac Res 2021; 11:457-465. [PMID: 34295642 PMCID: PMC8282594 DOI: 10.1016/j.jobcr.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
Both autogenous and alloplastic material have been used in management of temporomandibular joint (TMJ) ankylosis. Second surgical site, donor site morbidity, possibility of over/undergrowth, graft fracture or resorption and increased surgical time are the disadvantages of autogenous graft. Alloplastic total joint replacement (TJR) has become a promising technique in management of adult temporomandibular joint ankylosis (TMJA). This paper intends to present the role of alloplastic TJR in management of TMJA. There is significant current evidence of the role of alloplastic TJR in the management of TMJA. Results in TMJA are excellent with sustained improvement in pain free mouth opening, correction of facial asymmetry, reduction in recurrence and improved quality of life. TMJ TJR is becoming the gold standard of care in the management of TMJA, although costs can sometime preclude access to this mode of therapy.
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Affiliation(s)
- Ajoy Roychoudhury
- Corresponding author. Room No 111, Department of Oral & Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | | | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Mane
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devalina Goswami
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anson Jose
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Mertens F, Dormaar JT, Vander Poorten V, Vranckx JJ. Objectifying growth of vascularized bone transfers after mandibular reconstruction in the pediatric population. J Plast Reconstr Aesthet Surg 2021; 74:1973-1983. [PMID: 34187765 DOI: 10.1016/j.bjps.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autologous vascularized bone transfer is the preferred strategy for the reconstruction of mandibular defects in a pediatric population. The principal argument is the theoretical postoperative growth potential of the neomandible, which uses vascularized donor tissues. OBJECTIVES The purpose of this study was to objectify the veritable growth potential of vascularized bone transfers in children. METHODS A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, revealing 57 patients younger than or equal to 18 years who had undergone a mandibular reconstruction with a vascularized free flap. Only studies using postoperative imaging were included. Outcomes regarding growth and postoperative corrections and complications were analyzed. RESULTS Neomandibular growth was observed in 63.2% of all included patients. The proportion of growth was higher in patients with condylar preservation (95.7%) than that of patients with condylar involvement (41.2%). Reconstruction of the condyle by a free flap, which includes an epiphyseal growth plate or cartilage increased postoperative growth potential (77.8%) but did not reduce the need for later orthognathic surgery. CONCLUSION After mandibular reconstruction with a vascularized bone transfer, the majority of pediatric patients shows neomandibular growth. Condylar preservation, the inclusion of epiphyseal growth plates or cartilage, and the patients age at the time of reconstruction are essential defining parameters.
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Affiliation(s)
- Fien Mertens
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and OMFS-IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium; ORL Head & Neck Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Department of Plastic and Reconstructive Surgery, University Hospital of Leuven, 49 Herestraat, Herestraat 3000 Leuven, Belgium
| | - Jakob Titiaan Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and OMFS-IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium.
| | - Vincent Vander Poorten
- ORL Head & Neck Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Jan Jeroen Vranckx
- Department of Plastic and Reconstructive Surgery, University Hospital of Leuven, 49 Herestraat, Herestraat 3000 Leuven, Belgium.
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11
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Chauvel-Picard J, Kreutzer K, Heiland M, Kreusch T, Ebker T, Beck-Broichsitter B. One stage microvascular mandible reconstruction by using scapula chimeric flap combined with computer-aided-design and computer-aided-manufacturing plate including bilateral alloplastic TMJ prosthesis: A case report. Microsurgery 2020; 41:263-269. [PMID: 33103294 DOI: 10.1002/micr.30669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/01/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022]
Abstract
This report focuses a defect comprising the complete mandible due to osteonecrosis, including both condyles, that required bilateral temporomandibular joint (TMJ) reconstruction with complete mandibular corpus using a computer-aided-design and computer-aided-manufacturing(CAD-CAM) planning to harvest a scapula chimeric free flap combined with plate including bilateral alloplastic TMJ prosthesis. This procedure was realized in one and the same surgery. A 73 year-old-man developed an osteoradionecrosis of the total mandible including both condyles after radiation therapy for a squamous cell carcinoma of the tongue base(cT4aN2bM0G3). A CAD-CAM reconstruction was planned with a plate extended by bilateral individual TMJ prosthesis, individual fossa components and combined with a composite free flap originating from the subscapular vessel system including scapula(circumflex subscapular artery) for reconstruction of the mandibular corpus which was osteotomized in three segments with a resection guide, the parascapular skin paddle (descending branch of circumflex subscapular artery) for compensation of the soft tissue deficiency of the cervical skin and latissimus dorsi muscle(thoracodorsal artery) for the inner mucosal lining and intraoral reconstruction. The subscapular artery was anastomosed to the external carotid artery and two concomitant veins were sutured end-to-side to the internal jugular vein. The patient was discharged without feeding tube and tracheostomy. No complications have been observed after 6 months follow-up. The patient was able to tolerate soft diet and had comprehensible speech. Thus, a total mandibular reconstruction including both condyles using alloplastic and autoplastic reconstruction in one and the same stage is a valid option and may be considered in comparably severe cases.
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Affiliation(s)
- Julie Chauvel-Picard
- Department of Oral and Craniomaxillofacial Surgery, Centre Hospitalo-Universitaire Nord, Saint-Etienne, France.,Jean Monnet University, Saint-Etienne, France
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Kreusch
- Department of Oral and Maxillofacial Plastic Surgery and Dentistry, Head and Neck Center, Hamburg, Germany
| | - Tobias Ebker
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Milic T, Raidoo P, Gebauer D. Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review. Br J Oral Maxillofac Surg 2020; 59:633-642. [PMID: 34016464 DOI: 10.1016/j.bjoms.2020.09.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022]
Abstract
Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients' risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients.
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Affiliation(s)
- T Milic
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
| | - P Raidoo
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
| | - D Gebauer
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
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Roychoudhury A, Yadav P, Alagarsamy R, Bhutia O, Goswami D. Outcome of Stock Total Joint Replacement With Fat Grafting in Adult Temporomandibular Joint Ankylosis Patients. J Oral Maxillofac Surg 2020; 79:75-87. [PMID: 32866483 DOI: 10.1016/j.joms.2020.07.214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/04/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Adult temporomandibular joint ankylosis (TMJA) lacks a uniform management protocol. The purpose of the study was to evaluate the outcome of stock total joint replacement (TJR) along with fat grafting around the joint in adult TMJA patients. Specific aim was to find out whether TJR can be a definitive management for adult TMJA. METHODS The investigators implemented a prospective study on adult TMJA patients treated with ostearthrectomy of ankylosis and stock temporomandibular joint (TMJ) TJR with fat grafting. Concomitant orthognathic correction of facial asymmetry was performed in some unilateral cases. Follow-up was carried out at regular intervals for assessing primary outcome variable of maximal incisal opening (MIO) and reankylosis. Secondary outcome variable included demographic data, etiology, duration of ankylosis (DOA), correlation between DOA and preoperative and postoperative MIO, occlusion and complications of hemorrhage, facial nerve paresis, periprosthetic joint infection, dislocation, and implant failure. RESULTS The study sample was composed of 41 patients (54 joints) (bilateral, n = 13; unilateral, n = 28 [right side, n = 12; left side, n = 16]). The number of recurrent cases was 15. Trauma as etiology of ankylosis was seen in n = 30 (73.2%), infection in n = 7 (17.1%), unknown in n = 3 (7.3%), and ankylosing spondylitis in n = 1 (2.4%) cases. Mean DOA was 11.95 years. Paired t test revealed a statistically significant difference between preoperative and follow-up MIO (P < .001). None of the cases showed reankylosis in the follow-up period. Pearson correlation revealed statistically negative correlation between DOA and postoperative MIO. CONCLUSIONS The result of this study suggests that stock TMJ TJR along with fat grafting around the joints provides adequate mouth opening without any sign and symptoms of reankylosis. Stock TMJ TJR with fat grafting can be considered as a definitive treatment modality in adult TMJA with minimum comorbidity.
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Affiliation(s)
- Ajoy Roychoudhury
- Professor and Head, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Poonam Yadav
- Scientist, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ragavi Alagarsamy
- Junior Resident, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devalina Goswami
- Additional Professor, Department of Anesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Evaluation of complications following stock replacement of the temporomandibular joint performed between the years 2006 and 2015: a retrospective study. Oral Maxillofac Surg 2020; 24:373-379. [PMID: 32328836 DOI: 10.1007/s10006-020-00840-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Alloplastic total temporomandibular joint replacement (TMJR) is now considered to be a standard procedure for temporomandibular joint (TMJ) reconstruction. TMJR can improve mandibular mobility, restore the dental occlusion and improve facial aesthetics. The purpose was to assess the presence of intraoperative and post-operative complications, including the presence of post-operative chronic pain. METHODS This retrospective study evaluated the use of 62 stock TMJR devices implanted in 45 patients who underwent surgery between the years 2006 and 2015 by the same surgeon at the Department of Oral and Maxillofacial Surgery, Stomatology Clinic, General Teaching Hospital (VFN) Charles University, Prague, Czech Republic. RESULTS Intraoperative and post-operative complications recorded were facial nerve dysfunction (14-22%), open bite/malocclusion (2-3.2%), condylar component dislocation (1-1.6%), infection requiring revision surgery (1-1.6%) and (27-43%) reported chronic pain 24 months after surgery. CONCLUSIONS As with any surgical procedure, TMJR can have complications. The results of this study demonstrate that the most common post-operative complication was continued pain. Chronic pain after TMJR was more common in patients with a preoperative diagnosis of degenerative joint disease. Also, the incidence of post-operative TMJR pain increased with the duration of symptoms prior to TMJR, leading to a question of the best timing for TMJR.
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Yoda T, Ogi N, Yoshitake H, Kawakami T, Takagi R, Murakami K, Yuasa H, Kondoh T, Tei K, Kurita K. Clinical guidelines for total temporomandibular joint replacement. JAPANESE DENTAL SCIENCE REVIEW 2020; 56:77-83. [PMID: 32612715 PMCID: PMC7310689 DOI: 10.1016/j.jdsr.2020.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
Total joint replacement (TJR) of the temporomandibular joint (TMJ) is a promising surgical procedure and device for treating end-stage diseases of the TMJ. For the functional and aesthetic reconstruction of the oral and maxillofacial head and neck region, TMJ TJR significantly helps maintain the patient's quality of life in terms of a better diet, mastication, speech and social interaction. TMJ TJR was approved by regulatory authorities in 2019 in Japan, thus enabling the clinical application of the TJR system. However, the surgery demands particularly difficult and high-risk procedures, necessitating the prudent selection of indicated patients. The joint committee of the Japanese Society of Oral and Maxillofacial Surgeons and Japanese Society for Temporomandibular Joint is working together to develop an appropriate clinical guideline for TMJ TJR.
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Affiliation(s)
- Tetsuya Yoda
- Joint Committee of Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society for the Temporomandibular Joint for Clinical Guidelines for Total Temporomandibular Joint Replacement, Japan.,Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Nobumi Ogi
- Joint Committee of Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society for the Temporomandibular Joint for Clinical Guidelines for Total Temporomandibular Joint Replacement, Japan.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Japan
| | - Hiroyuki Yoshitake
- Joint Committee of Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society for the Temporomandibular Joint for Clinical Guidelines for Total Temporomandibular Joint Replacement, Japan.,Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tetsuji Kawakami
- Joint Committee of Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society for the Temporomandibular Joint for Clinical Guidelines for Total Temporomandibular Joint Replacement, Japan.,Department of Oral and Maxillofacial Surgery, Nara Medical University, Japan
| | - Ritsuo Takagi
- Joint Committee of Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society for the Temporomandibular Joint for Clinical Guidelines for Total Temporomandibular Joint Replacement, Japan.,Division of Oral and Maxillofacial Surgery, Niigata University, Graduate School of Medical and Dental Sciences, Japan
| | - Kenichiro Murakami
- Joint Committee of Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society for the Temporomandibular Joint for Clinical Guidelines for Total Temporomandibular Joint Replacement, Japan.,Department of Oral and Maxillofacial Surgery, Ako City Hospital, Japan
| | - Hidemichi Yuasa
- Joint Committee of Japanese Society of Oral and Maxillofacial Surgeons and the Japanese Society for the Temporomandibular Joint for Clinical Guidelines for Total Temporomandibular Joint Replacement, Japan.,Department of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical Center, Japan
| | - Toshirou Kondoh
- Department of Maxillofacial Surgery, Nihon University School of Dentistry at Matsudo, Japan
| | - Kanchu Tei
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine and Graduate, School of Dental Medicine, Hokkaido University, Japan
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Japan
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Temporomandibular joint total replacement using the Zimmer Biomet Microfixation patient-matched prosthesis results in reduced pain and improved function. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:572-580. [DOI: 10.1016/j.oooo.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/02/2019] [Accepted: 04/22/2019] [Indexed: 11/21/2022]
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17
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A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery. Infection 2019; 47:519-555. [DOI: 10.1007/s15010-019-01303-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/27/2019] [Indexed: 01/23/2023]
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18
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Navarro SM, Haeberle HS, Sokunbi OF, Frankel WC, Wera GD, Mont MA, Ramkumar PN. The Evidence Behind Peroxide in Orthopedic Surgery. Orthopedics 2018; 41:e756-e764. [PMID: 30321442 DOI: 10.3928/01477447-20181010-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023]
Abstract
Peroxide is a strong oxidizing agent and disinfectant frequently used in orthopedic surgery. The authors conducted a systematic literature review of peroxide in orthopedic surgery, evaluating use, complications, efficacy, and appropriate concentrations. One hundred seventy-five reports were identified, with 24 being eligible for analysis. Orthopedic surgeons used peroxide for irrigation and bacterial reduction in various procedures. Complications included cytotoxicity, allergic reactions, suture damage, and inflammation. Use of the standard concentration of 3% peroxide and standard time in situ are without evidence. Laboratory studies suggest that diluted concentrations retain the benefit of bacterial decolonization without increasing the risk for complications. [Orthopedics. 2018; 41(6):e756-e764.].
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19
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Mercuri LG. Prevention and detection of prosthetic temporomandibular joint infections-update. Int J Oral Maxillofac Surg 2018; 48:217-224. [PMID: 30316660 DOI: 10.1016/j.ijom.2018.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
Prosthetic joint infections are not only distressing complications for patients and surgeons, but also have an enormous financial impact on healthcare systems. The reported incidence of prosthetic joint infection is likely underestimated due to difficulties in their diagnosis. This unfortunate complication has challenged joint replacement surgeons for years, despite all the advances made in this surgical discipline. Since eradication of these infections can be very difficult, prevention remains the primary objective. Identifying recipient risk factors, adopting a proper surgical technique, appropriate wound care, optimizing the operating room environment, and appropriate postoperative care have become some of the core elements that can help to minimize the overall incidence of this complication. The purpose of this article is to provide the temporomandibular joint replacement surgeon with an update on the prevention and detection of prosthetic joint infections based on a review of the most recent information published in the orthopedic and surgical literature.
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Affiliation(s)
- L G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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20
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Undt G, Jahl M, Pohl S, Marlovits S, Moser D, Yoon HH, Frank J, Lang S, Czerny C, Klima G, Gentleman E, Ewers R. Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:117-128. [PMID: 29653815 PMCID: PMC6057608 DOI: 10.1016/j.oooo.2018.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/07/2018] [Accepted: 02/25/2018] [Indexed: 12/13/2022]
Abstract
Objective Matrix-associated chondrocyte transplantation is routinely used in joints of the extremities but not in the temporomandibular joint (TMJ). Study Design We report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resurfacing both the mandibular condyle and the articular eminence/glenoid fossa with a commercially available collagen sponge seeded with autologous cells stabilized within a fibrin matrix. To facilitate healing, we temporarily employed a silicone membrane to protect the engineered tissues. The indications for surgery were posttraumatic fibro-osseous ankylosis, ankylosing osteoarthritis, or late-stage osteoarthritis. Results Six of the patients were recalled for follow-up after 3 years 6 months to 12 years 1 month. The maximum incisal opening was 18.2 ± 9.2 mm (range, 9-33 mm) before and 31.2 ± 13.6 mm (range, 12-47 mm) at the latest follow-up. Histologic specimens taken at 4 months showed beginning differentiation of fibrocytes into chondrocytes, whereas at 3 and 11 years, mature hyaline cartilage—not typical for the TMJ—was present. Conclusions We conclude that the reconstruction of TMJ surfaces by matrix-associated chondrocyte transplantation may become a routine method for cartilage regeneration in the TMJ in the future.
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Affiliation(s)
- Gerhard Undt
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Michael Jahl
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sebastian Pohl
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Marlovits
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris Moser
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Hyang-Hee Yoon
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jimmy Frank
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Susanna Lang
- Clinical Institute of Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Czerny
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Guenter Klima
- Clinical Institute of Pathology, Medical University of Innsbruck, Muellerstrasse 44, 6020 Innsbruck, Austria
| | - Eileen Gentleman
- Centre for Craniofacial and Regenerative Biology, King's College London, London, SE1 9RT, United Kingdom
| | - Rolf Ewers
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Riegel R, Sweeney K, Inverso G, Quinn PD, Granquist EJ. Microbiology Alloplastic Total Joint Infections: A 20-Year Retrospective Study. J Oral Maxillofac Surg 2018; 76:288-293. [DOI: 10.1016/j.joms.2017.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 01/28/2023]
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Dang RR, Mehra P. Alloplastic reconstruction of the temporomandibular joint. J Istanb Univ Fac Dent 2017; 51:S31-S40. [PMID: 29354307 PMCID: PMC5750826 DOI: 10.17096/jiufd.87994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022] Open
Abstract
Temporomandibular joint reconstruction (TMJR) is
often necessary for patients with severe and/or refractory
TMJ disease who have failed conservative treatment. TMJR
aids to improve masticatory function and is associated with
improved quality of life outcomes. Currently, alloplastic
reconstruction is considered as the treatment of choice
in most severe TMJ disorders due to its many advantages
inclusive but not limited to early mobilization, stable longterm
results, and significant improvement in jaw function.
Broadly speaking, two types of TMJR prostheses are
available for reconstruction: 1) stock, and, 2) custommade
prostheses. The purpose of this article is to provide
the reader with a brief overview of the basic principles
and fundamentals of TMJR while referencing pertinent
existing literature.
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Affiliation(s)
- Rushil R Dang
- BDS, DMD Resident, Dept. of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA, USA
| | - Pushkar Mehra
- BDS, DMD, FACS Professor and Chairman, Dept. of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA, USA
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Salcedo-Gil C, Morey-Mas MÁ, Hamdan-Hamdan H, Iriarte-Ortabe JI. Management of an infected temporomandibular joint prosthesis and the use of bone cement with antibiotics. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.maxilo.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McKenzie W, Louis P. Temporomandibular total joint prosthesis infections: a ten-year retrospective analysis. Int J Oral Maxillofac Surg 2017; 46:596-602. [DOI: 10.1016/j.ijom.2017.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/22/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
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Malachovsky I, Janickova M, Stasko J, Kasaj M, Sadlonova V, Novakova E, Gengelova P, Smatanová M, Statelová D. Pseudomonas Infection of the Temporomandibular Joint (TMJ) Health and Public Health Issues. ACTA MEDICA MARTINIANA 2017. [DOI: 10.1515/acm-2017-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The authors describe a case of a rare infectious disease of intra-articular tissues of the temporomandibular joint caused mainly by Pseudomonas aeruginosa. In scientific literature, under the heading invasive (malignant) external otitis, we can find cases of an infectious disease of the external acoustic meatus caused by a microbial agent of Pseudomonas aeruginosa which can subsequently penetrate into structures. However, a primary affliction of the abovementioned structures has not been described. Localisation and severity of the infection requires long-term and massive treatment with antibiotics.
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Affiliation(s)
- I. Malachovsky
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Janickova
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - J. Stasko
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Kasaj
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - V. Sadlonova
- Institute of Microbiology, Comeniu University, Jessenius Faculty of Medicine, Martin , Slovakia
| | - E. Novakova
- Institute of Microbiology, Comeniu University, Jessenius Faculty of Medicine, Martin , Slovakia
| | - P. Gengelova
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Smatanová
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - D. Statelová
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Kollarova Str.N. 2,036 59, Martin , Slovak Republic
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Guillier D, Moris V, See LA, Girodon M, Wajszczak BL, Zwetyenga N. [Custom-made implant for complex facial reconstruction: A case of total replacement of temporo-mandibular joint, zygomatic arch and malar bone]. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:52-56. [PMID: 28330577 DOI: 10.1016/j.jormas.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/27/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Total prosthetic replacement of the temporo-mandibular joint (TMJ) has become a common procedure, but it is usually limited to the TMJ itself. We report about one case of complex prosthetic joint reconstruction extending to the neighbouring bony structures. CASE A 57-year-old patient, operated several times for a cranio-facial fibrous dysplasia, presented with a recurring TMJ ankylosis and a complexe latero-facial bone loss on the right side. We performed a reconstruction procedure including the TMJ, the zygomatic arch and the malar bone by mean of custom made composite prosthesis (chrome-cobalt-molybdenum-titanium and polyethylene). Five years postoperatively, mouth opening, nutrition, pain and oral hygiene were significantly improved. DISCUSSION Nowadays technical possibilities allow for complex facial alloplastic reconstructions with good medium term results.
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Affiliation(s)
- D Guillier
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | - V Moris
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | - L-A See
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | - M Girodon
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | - B-L Wajszczak
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | - N Zwetyenga
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France; Lipids nutrition cancer team NuTox UMR866, university Bourgogne Franche-Comté, boulevard Jeanne-d'Arc, 21000 Dijon, France.
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Lotesto A, Miloro M, Mercuri L, Sukotjo C. Status of alloplastic total temporomandibular joint replacement procedures performed by members of the American Society of Temporomandibular Joint Surgeons. Int J Oral Maxillofac Surg 2017; 46:93-96. [DOI: 10.1016/j.ijom.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/06/2016] [Accepted: 08/01/2016] [Indexed: 11/28/2022]
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Does the Amount of Screw Fixation Utilized for the Condylar Component of the TMJ Concepts Total Temporomandibular Joint Reconstruction Predispose to Hardware Loss or Postoperative Complications? J Oral Maxillofac Surg 2016; 74:1741-50. [DOI: 10.1016/j.joms.2016.03.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 11/20/2022]
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Bénateau H, Chatellier A, Caillot A, Diep D, Kün-Darbois JD, Veyssière A. [Temporo-mandibular ankylosis]. ACTA ACUST UNITED AC 2016; 117:245-55. [PMID: 27481673 DOI: 10.1016/j.revsto.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
Ankylosis of the temporomandibular joint is defined as a permanent constriction of the jaws with less than 30mm mouth opening measured between the incisors, occurring because of bony, fibrous or fibro-osseous fusion. Resulting complications such as speech, chewing, swallowing impediment and deficient oral hygiene may occur. The overall incidence is decreasing but remains significant in some developing countries. The most frequent etiology in developed countries is the post-traumatic ankylosis occurring after condylar fracture. Other causes may be found: infection (decreasing since the advent of antibiotics), inflammation (rheumatoid arthritis and ankylosing spondylitis mainly) and congenital diseases (very rare). Management relies on surgery: resection of the ankylosis block in combination with bilateral coronoidectomy… The block resection may be offset by the interposition temporal fascia flap, a costochondral graft or a TMJ prosthesis according to the loss of height and to the impact on dental occlusion. Postoperative rehabilitation is essential and has to be started early, to be intense and prolonged. Poor rehabilitation is the main cause of ankylosis recurrence.
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Affiliation(s)
- H Bénateau
- Service de chirurgie maxillofaciale et plastique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Laboratoire EA 4652 microenvironnement cellulaire et pathologies, équipe BioconnecT, université de Caen Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France; Faculté de médecine de Caen, université de Caen Basse-Normandie, 2, rue des Rochambelles, 14032 Caen cedex 5, France
| | - A Chatellier
- Service de chirurgie maxillofaciale et plastique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Caillot
- Service de chirurgie maxillofaciale et plastique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Faculté de médecine de Caen, université de Caen Basse-Normandie, 2, rue des Rochambelles, 14032 Caen cedex 5, France
| | - D Diep
- Service de chirurgie maxillofaciale et plastique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - J-D Kün-Darbois
- Service de chirurgie maxillofaciale et plastique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Veyssière
- Service de chirurgie maxillofaciale et plastique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Laboratoire EA 4652 microenvironnement cellulaire et pathologies, équipe BioconnecT, université de Caen Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France; Faculté de médecine de Caen, université de Caen Basse-Normandie, 2, rue des Rochambelles, 14032 Caen cedex 5, France.
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Are Oral and Maxillofacial Surgery Residents Trained Adequately in Alloplastic Total Temporomandibular Joint Replacement? J Oral Maxillofac Surg 2016; 74:712-8. [DOI: 10.1016/j.joms.2015.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 11/22/2022]
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Mercuri L. Temporomandibular joint replacement periprosthetic joint infections: a review of early diagnostic testing options. Int J Oral Maxillofac Surg 2014; 43:1236-42. [DOI: 10.1016/j.ijom.2014.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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Aagaard E, Thygesen T. A prospective, single-centre study on patient outcomes following temporomandibular joint replacement using a custom-made Biomet TMJ prosthesis. Int J Oral Maxillofac Surg 2014; 43:1229-35. [DOI: 10.1016/j.ijom.2014.05.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
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Landes C, Korzinskas T, Dehner JF, Santo G, Ghanaati S, Sader R. One-stage microvascular mandible reconstruction and alloplastic TMJ prosthesis. J Craniomaxillofac Surg 2014; 42:28-34. [DOI: 10.1016/j.jcms.2013.01.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 01/11/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022] Open
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Mommers XA, Wajszczjak L, Zwetyenga N. [Functional results after temporomandibular joint reconstruction using a total joint prosthesis (part II)]. ACTA ACUST UNITED AC 2013; 115:10-4. [PMID: 24035523 DOI: 10.1016/j.revsto.2013.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Temporomandibular joint (TMJ) disorders are usually managed medically. But partial or total reconstruction may be indicated according to the severity and the functional impairment. We assessed the functional results after total TMJ reconstruction using the Biomet Microfixation® prosthesis (Jacksonville, FL, USA). MATERIAL AND METHODS We reviewed the files of patients having undergone reconstruction, between 2009 and 2010, with a total TMJ prosthesis. We analyzed the pre- and postoperative mouth opening, the pre- and postoperative occlusion, pre- and postoperative pain according to a simple spoken scale ranging from 0 (no pain) to 4 (severe pain). RESULTS Twelve total TMJ prostheses were placed in five women and three men (mean age 49.2 years). Restriction of mouth opening was the first cause of consultation. The etiology was trauma for four patients. Three patients had preoperative malocclusion. Four patients had bilateral reconstruction. Preoperative pain ranged between 2 and 4. The average initial mouth opening was 17.8mm. There was neither infection nor any major complication. No prosthesis was removed. The mean follow-up was 18.5 months. At the end of the study, pain ranged between 0 and 2. All patients with preoperative malocclusion resumed an Angle class I postoperatively. The average postoperative mouth opening was 39.5mm. DISCUSSION Total TMJ reconstruction with the Biomet Microfixation® prosthesis improves mouth opening and reduces pain.
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Affiliation(s)
- X A Mommers
- Service de chirurgie maxillo-faciale, chirurgie plastique, reconstructrice, esthétique et chirurgie de la main, faculté de médecine, université de Bourgogne, CHU, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | - L Wajszczjak
- Service de chirurgie maxillo-faciale, chirurgie plastique, reconstructrice, esthétique et chirurgie de la main, faculté de médecine, université de Bourgogne, CHU, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | - N Zwetyenga
- Service de chirurgie maxillo-faciale, chirurgie plastique, reconstructrice, esthétique et chirurgie de la main, faculté de médecine, université de Bourgogne, CHU, boulevard de Lattre-de-Tassigny, 21000 Dijon, France.
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Abstract
Condyle fractures are a common injury, but only a few of these injuries require immediate or late reconstruction. The complications that most frequently necessitate condylar reconstruction include proximal segment degeneration, malunion, and ankylosis. Costochondral grafts and total joint prostheses, both stock and custom, remain the most common methods of reconstruction. Reconstruction plates with condylar extensions should only be used temporarily as an unacceptable number cause serious complications. Distraction osteogenesis may have an occasional role in reconstructing the posttraumatic condyle.
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Affiliation(s)
- Ben Davis
- Department of Oral and Maxillofacial Sciences, Dalhousie University, Halifax, NS B3H 1W2, Canada.
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Vega LG, González-García R, Louis PJ. Reconstruction of Acquired Temporomandibular Joint Defects. Oral Maxillofac Surg Clin North Am 2013; 25:251-69. [DOI: 10.1016/j.coms.2013.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Current world literature. Curr Opin Infect Dis 2012; 25:718-28. [PMID: 23147811 DOI: 10.1097/qco.0b013e32835af239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mercuri LG. Avoiding and Managing Temporomandibular Joint Total Joint Replacement Surgical Site Infections. J Oral Maxillofac Surg 2012; 70:2280-9. [DOI: 10.1016/j.joms.2012.06.174] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 05/31/2012] [Accepted: 06/03/2012] [Indexed: 11/29/2022]
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Mercuri LG. Alloplastic temporomandibular joint replacement: rationale for the use of custom devices. Int J Oral Maxillofac Surg 2012; 41:1033-40. [PMID: 22771166 DOI: 10.1016/j.ijom.2012.05.032] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/20/2012] [Accepted: 05/31/2012] [Indexed: 11/16/2022]
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