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Bhargava D. Hybrid total alloplastic temporomandibular joint replacement prosthesis: a pilot study to evaluate feasibility, functional performance and impact on post-operative quality of life. Oral Maxillofac Surg 2024; 28:767-777. [PMID: 38153609 DOI: 10.1007/s10006-023-01203-0] [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: 09/24/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE The aim of the present study was to investigate the clinical efficiency of hybrid alloplastic temporomandibular joint (TMJ) prosthesis in patients undergoing TMJ total alloplastic joint replacement (TMJR). The prosthesis utilized for this study for TMJR is a hybrid variant with combination of stock prototype design and a partial customization of components. MATERIALS AND METHODS A prospective clinical study was conducted involving five patients with unilateral TMJ ankylosis or end-stage joint disease (ESJD) indicated for and requiring TMJR. The patients underwent resection of the joint or gap arthroplasty followed by TMJR using the hybrid alloplastic TMJ prosthesis. The subjective and objective variables that included the jaw function (JF), inter-incisal opening (IO), diet intake (DI) and quality of life (QoL) were assessed using the psychometric modified Likert scale. The nutritional status of the patients was evaluated using the mid-upper arm circumference (MUAC) as reference. RESULTS The assessed study variables demonstrated functional and observational improvement in the post-operative follow-up when compared to the pre-operative period. The patients showed an improvement in overall QoL and nutritional status post-operatively. The follow-up period showed subjective and objective improvement in the parameters assessed among the study population. CONCLUSION There is a technical and clinical feasibility to utilize the hybrid alloplastic TMJ prosthesis as a reliable alloplastic option for treating patients requiring TMJR, with prudent indications.
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Affiliation(s)
- Darpan Bhargava
- Oral and Maxillofacial Surgery, TMJ Consultancy Services, Bhopal, Madhya Pradesh, India.
- DAMER, Bhopal, India.
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Anwar Z, McLeod NMH, Van den Bosch P, Cairns M. A review of the use of patient reported outcome measures (PROMS) in temporomandibular joint (TMJ) surgery. J Craniomaxillofac Surg 2024; 52:181-187. [PMID: 38143160 DOI: 10.1016/j.jcms.2023.11.005] [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: 07/20/2023] [Revised: 10/09/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
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.
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Affiliation(s)
- Zuhair Anwar
- Department of Oral and Maxillofacial Surgery, Barts Health NHS trust, UK.
| | - Niall M H McLeod
- Department of Oral & Maxillofacial Surgery, University Hospitals Coventry and Warwickshire, UK; Department of Oral and Maxillofacial Surgery, Barts Health NHS trust, UK.
| | - Peter Van den Bosch
- Department of Oral and Maxillofacial Surgery, Manchester Foundation Trust, UK.
| | - Mark Cairns
- Department of Oral and Maxillofacial Surgery, Barts Health NHS trust, UK.
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Olate S, Ravelo V, Huentequeo C, Parra M, Unibazo A. An Overview of Clinical Conditions and a Systematic Review of Personalized TMJ Replacement. J Pers Med 2023; 13:533. [PMID: 36983715 PMCID: PMC10053320 DOI: 10.3390/jpm13030533] [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: 02/10/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023] Open
Abstract
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.
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Affiliation(s)
- Sergio Olate
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
- Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco 4811230, Chile
| | - Víctor Ravelo
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
| | - Claudio Huentequeo
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
| | - Marcelo Parra
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
- Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco 4811230, Chile
| | - Alejandro Unibazo
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
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Bhargava D, Sharma Y, Beena S. Infinitesimal Peri-angular Pterygomasseteric Transectioning Approach (IPPTA) for the Base Fractures of the Mandibular Condyle: A Preliminary Study. J Maxillofac Oral Surg 2021; 20:657-664. [PMID: 34776700 DOI: 10.1007/s12663-020-01446-4] [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: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022] Open
Abstract
Purpose To investigate a reliable and safe surgical access to the condylar base region with minimal surgical trauma to the surrounding anatomic structures. In an attempt to do so, to describe Infinitesimal Peri-angular Pterygomasseteric Transectioning Approach (IPPTA) for the management of base fractures of the mandibular condyle. Materials and Method A preliminary clinical study involving 20 patients was undertaken to treat patients with unilateral condylar base fracture of the mandible using IPPTA under general anaesthesia (GA). Various parameters assessed were adequacy of surgical access, wound healing at the incision site, marginal mandibular nerve injury, diet intake and complications post-operatively. Result This method provided adequate exposure to fractured condylar base for open reduction and internal fixation (ORIF) with uneventful post-operative recovery phase. There was no limitation to function which was identified by restoration of normal pre-trauma diet intake by 14th post-operative day in more than 50% of the study patients. No complications were observed in any patients among the study population. Discussion The peri-angular approach has been discussed in the literature. The IPPTA highlights the use of a smaller incision providing an adequate exposure to the condylar base region for ORIF.
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Affiliation(s)
- Darpan Bhargava
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Center, People's University, Bhanpur, Bhopal, Madhya Pradesh 462037 India.,TMJ Consultancy Services (South East Asia), H-3/2, B.D.A Colony, Nayapura, Lalghati, Airport Road, Bhopal, Madhya Pradesh 462 001 India
| | - Yogesh Sharma
- Department of Dentistry, Netaj Subhash Chandra Bose Medical College, Tilwara Road, Doctors Colony, Medical College Colony, Jabalpur, Madhya Pradesh 482003 India
| | - Sivakumar Beena
- TMJ Consultancy Services (South East Asia), H-3/2, B.D.A Colony, Nayapura, Lalghati, Airport Road, Bhopal, Madhya Pradesh 462 001 India
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Mehrotra D, Kumar S, Mehrotra P, Khanna R, Khanna V, Eggbeer D, Evans P. Patient specific total temporomandibular joint reconstruction: A review of biomaterial, designs, fabrication and outcomes. J Oral Biol Craniofac Res 2021; 11:334-343. [PMID: 33786297 DOI: 10.1016/j.jobcr.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
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.
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Affiliation(s)
- Divya Mehrotra
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Sumit Kumar
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Pankhuri Mehrotra
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Richa Khanna
- Dept of Preventive and Paediatric Dentistry, King George's Medical University, Lucknow, India
| | - Vikram Khanna
- Dept of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | | | - Peter Evans
- Healthcare Consultant in Maxillofacial Prosthetics, Maxillofacial Laboratory, Morriston Hospital, Swansea, Wales, UK
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Alagarsamy R, Roychoudhury A, Bhutia O, Lal B, Yadav R, Bhalla AS. Evaluation of fit feasibility of stock total joint replacement in temporomandibular joint ankylosis patients. Br J Oral Maxillofac Surg 2020; 59:792-797. [PMID: 34261611 DOI: 10.1016/j.bjoms.2020.11.016] [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: 08/04/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
Long standing adult temporomandibular joint ankylosis (TMJA) results in smaller ramal height, and warped and undulated ramus. Despite the efforts made to standardise the sizes available in stock joint (Zimmer Biomet®), the system causes fit challenges in TMJA patients. The aim of the study was to evaluate the virtual feasibility of stock prostheses in TMJA patients. The data included amount of bone contouring for fossa placement, available ramal length, length discrepancy if placed straight, angulation of mandibular component required to adapt to the bone, and mediolateral fit discrepancy. CT data of 50 TMJA patients (71 joints; unilateral, n=29; bilateral, n=21; male, n=33; female, n=17) with mean age of 24.26±8.88 years were included. 53 joints required more than 3mm lateral bone reduction for fossa placement. The ramal length were categorised into ranges 35-40mm (n=15), 41-45mm (n=14), 46-50mm (n=28) and >50mm (n=14). Correlation between the age of occurrence of ankylosis and ramal length using the Pearson correlation coefficient revealed a positive correlation (r=0.38, p=0.001). Length discrepancy, angulation of mandibular component, and mediolateral fit discrepancy decreases as the ramal length increases. Only 14 joints had appropriate fit of stock prostheses while the remaining 57 joints warranted compromised placement. Even the smallest available stock mandibular component (45mm) had a compromised fit in terms of length and adaptability on the lateral aspect of ramus. The study concludes that a short ramus is mostly limiting factor in using stock prosthesis in TMJA patients. There is a need for still smaller size stock prostheses.
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Affiliation(s)
- Ragavi Alagarsamy
- Department of Oral & Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Babu Lal
- 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
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Koneru G, Bhargava D, Somuri AV, Manoj M, Nesan J, Pillai AK, Beena S. Temporomandibular joint alloplastic reconstruction of post-traumatic joint degeneration with Sawhney Type I ankylosis using 3D-custom GD-condylar cap prosthesis to restore condylar form and function. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:315-318. [PMID: 32977036 DOI: 10.1016/j.jormas.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Temporomandibular Joint (TMJ) ankylosis as a sequelae following hemarthrosis from trauma, middle ear infection and progressive debilitating arthritis of various etiologies has been well understood, but challenges always arise in terms of choosing least morbid procedure with maximum functional outcome. Total joint replacement (TJR) is the common final stage correction mandating extensive surgical exposure with good technical expertise with its limitations of risk of failure and complications. A case of post-traumatic TMJ degeneration with ankylosis reconstructed using a customised GD-condylar cap prosthesis is described. The patient had an uneventful post-operative period with an acceptable functional outcome. CONCLUSION: The condylar cap prosthesis is a bio-compatible and biomechanically designed in such a way that it can be used for indicated cases by performing minimally invasive surgical technique to achieve an optimal functional and aesthetic outcome.
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Affiliation(s)
- G Koneru
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India.
| | - D Bhargava
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Center, People's University, Bhanpur, Bhopal 462 037, Madhya Pradesh, India.
| | - A V Somuri
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India.
| | - M Manoj
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India.
| | - J Nesan
- Center for Technology Assisted Reconstructive Surgery, Santhome, Chennai, India.
| | - A K Pillai
- Department of Oral and Maxillofacial Surgery, People's Dental Academy, People's University, Bhanpur, Bhopal 462 037, Madhya Pradesh, India.
| | - S Beena
- TMJ Consultancy Services, Bhopal 462 001, Madhya Pradesh, India.
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