Sternoclavicular Joint Graft in Temporomandibular Joint Reconstruction for Ankylosis

Surgical management of temporomandibular joint ankylosis with mersilene mesh interpositional arthroplasty: A case series study

Ankylosis of the temporomandibular joint (TMJ) is one of the most prevalent TMJ disorders in patients who have experienced trauma. Due to the high risk of recurrence, gap arthroplasty without interpositional material has been gradually discontinued as a treatment for TMJ ankylosis. After arthroplasty surgery, various interposition materials have been used to prevent a recurrence. Reporting on the effectiveness of TMJ bony ankylosis treatment using Mersilene mesh interpositional arthroplasty is the purpose of this study.This was a retrospective study carried out on five patients of TMJ ankylosis. All patients were treated through a Mersilene mesh interpositional arthroplasty procedure from January 2016 to April 2022 in Dr. Soetomo General Hospital and Universitas Airlangga General Hospital and evaluated 3 months postoperatively for the functional stability of TMJ. The result is preoperative mouth opening ranged between 0.7 and 13 mm. The patients achieved the interincisal opening between 27 and 40 mm postoperatively and had no complications for 3 months. In conclusion, Mersilene mesh interpositional arthroplasty is a very effective surgical treatment for TMJ bony ankylosis to achieve maximum mouth opening and avoid recurrences. The prevention of ankylosis recurrence necessitates thorough rehabilitation.

Autogenous grafts for reconstruction arthroplasty in temporomandibular joint ankylosis: A systematic review and meta-analysis

Autogenous methods for reconstruction arthroplasty (RA) for the surgical management of the temporomandibular joint (TMJ) have been extensively reported. The present review was aimed to systematically review and pool data on clinical outcomes of autogenous grafts for RA in subjects with TMJ ankylosis. Major electronic databases and prominent subject-specific journals were searched up to December 2020. Randomised controlled trials (RCT), cohort studies, and retrospective studies reporting outcomes of autogenous grafts for RA in TMJ ankylosis were included. A total of 35 studies with 700 subjects was included. The most commonly employed grafts were costochondral grafts (CCG) and coronoid process grafts. Postoperative change in maximum incisor opening (MIO) was comparable amongst all grafts and was in the clinically acceptable range (27.21-31.38 mm). The recurrence rate was comparable for all grafts and was ≈ 8% except for coronoid grafts, where the recurrence rate was 2.98%. Growth assessment for CCG revealed that 55.89%, 30.89%, and 13.24% of subjects depicted optimal growth, overgrowth, and undergrowth, respectively. Within the limitations of the present review, the recurrence rate for all grafts was comparable except for coronoid graft, which depicted least recurrence rate and resultant postoperative change in MIO was in the clinically acceptable range.

A single-stage computer-guided gap arthroplasty with simultaneous patient-specific total joint replacement with a novel flat fossa design: A case report

INTRODUCTION AND IMPORTANCE

The computer-guided approach for the patient-specific TMJ replacement is considered an ultimate reliable option in advanced cases. However, dislocation of the condylar head could happen with the concave fossa design. A flat design was described and used in this case.

CASE PRESENTATION

A 15 years old male patient with mandibular asymmetry and class IV recurrent ankylosis of the right TMJ received a patient-specific artificial joint with computer-guided gap arthroplasty and orthognathic corrective mandibular surgery for the left side. The fossa component was made entirely flat, and the patient was followed up over the next year.

CLINICAL DISCUSSION

Customized TMJ prosthetic solutions are reliable in advanced cases, especially when facial corrections are indicated; however, the commonly used concave design showed reported dislocations requiring some design modifications as proposed in the presented case.

CONCLUSION

The flat fossa design of the artificial TMJ secures the same results as the anatomical fossa design without the incidence of dislocation.

Role of Custom-Made Prosthesis for Temporomandibular Joint Replacement in Unilateral Ankylosis - An Evaluative Study

Introduction

Ankylosis is a physically and psychologically distressing condition to a patient. The aim of this study was to evaluate the efficiency of custom-made temporomandibular joint (TMJ) prosthesis (fossa-condyle component) in patients with unilateral ankylosis in restoring the form and functions of the TMJ.

Materials and Methods

This retrospective study was conducted in ten patients with unilateral TMJ ankylosis who had undergone TMJ reconstruction with custom-made TMJ prosthesis. Clinical parameters assessed were maximal mouth opening, lateral movements, improvement of the pain levels, and dietary efficiency of the patient. The data were analyzed using SPSS version 20 (IBM Corporation, SPSS Inc.; Chicago, IL, USA).

Results

The mean preoperative mouth opening was 5.70 ± 3.62 mm. After gap arthroplasty, it was 32.50 ± 3.31 mm. The postoperative mouth opening after the reconstruction of TMJ using alloplastic joint prosthesis was 34.90 ± 2.69 mm, and after a mean follow-up period of 4 years, the mean postoperative mouth opening was 34.60 ± 2.50 mm. The mean preoperative movement toward the right and left side was 0.9 ± 1.2 mm and 1.3 ± 1.25 mm, respectively. The mean right and left lateral movements of the TMJ after reconstruction were 3.5 ± 0.97 mm and 3.70 ± 1.06 mm, respectively. There was decrease in deviation of the unaffected jaw during mouth opening and closure. Functional occlusion was maintained postoperatively. There was no appreciable change in the visual analog pain scales. The dietary efficiency improved from a scale of 10 (liquids) to a scale of 0 (no restriction to diet) in eight patients and 1 in two patients. The dietary score improved significantly after alloplastic reconstruction (P = 0.000). No evidence of facial nerve paralysis or foreign body reactions was noted in the patients during the follow-up period. Radiographic assessment revealed good positioning and adaptation of the fossa component and the condylar ramal component both postoperatively and after a mean 4-year follow-up period. There was no evidence of screw loosening or prosthesis breakage during the follow-up period.

Discussion and Conclusion

The custom-made TMJ-total joint replacement (TJR) devices provide stable, improved long-term results, thereby increasing the quality of life of the patient. The custom-made alloplastic TMJ-TJR prosthesis proves to be the optimal surgical procedure to reconstruct the TMJ in comparison to the autogenous grafts (to avoid complications) in severe degenerated and ankylosed joints. However, long-term clinical and radiological studies on a larger sample size are imperative to establish the versatility of this procedure.