TMJ Concepts Related Articles Page 1 of 14

Item Bibliography Entry Abstract / Summary

A retrospective study of 107 patients (male, n = 13; female, n = 94) with 163 joints previously treated with Proplast-Teflon (PT; Vitek, Inc, Houston, TX) implants was performed. The average time in situ for the PT was 59.8 months (range, 2 to 126 months). Average length of follow-up was 84.6 months (range, 59 to 126 months). Only 12% of joints showed no significant osseous changes radiographically. Forty-five patients (42%) continue to have in situ PT implants and 36% of them experience pain that requires medication; 25% have developed an Henry CH, Wolford LM: Treatment outcomes for temporomandibular joint anterior open bite and malocclusion; 9% have limited vertical opening; and 40% are asymptomatic. Temporomandibular joint (TMJ) reconstruction after PT implant failure was performed 1 reconstruction after Proplast-Teflon implant failure. J Oral Maxillofac Surg with five different autologous tissues or a total joint prosthesis. Autologous tissues used to reconstruct the TMJ and the rates of success were as follows: 1) 31% free temporalis fascia and 51:352-358, 1993 muscle graft with and 13% without sagittal split ramus osteotomy, 2) 8% dermis, 3) 25% conchal cartilage, 4) 12% costochondral grafts, and 5) 21% sternoclavicular grafts. The success rate decreased in all autologous tissue groups as the number of TMJ surgeries performed before reconstruction increased. Ankylosis was the most common cause of failure. Results of TMJ reconstruction with a total joint prosthesis were as follows: 1) 88% functional and occlusal stability of total joint prosthesis; 2) level of pain reduction was rated as 46% good, 38% fair, and 16% poor; and 3) an average interincisal opening of 27 mm at 24 months or less, and 33 mm at 25 months and beyond. A study of 56 patients (55 female, one male) with 100 reconstructed temporomandibular joints (TMJ) using the Techmedica custom-made total joint system (Techmedica Inc, Camarillo, CA) is presented. The patients ranged in age from 15 to 61 years (average, 39 years) and had 16 to 46 months' follow-up (average 30 months). Outcome groups were categorized as good, fair, or poor, based on clinical assessment. Results show that 35 patients (63%) with 58 joints (58%) had a good outcome, and 13 patients (23%) with 26 joints (26%) had a fair outcome, and 8 Wolford LM, Cottrell DA, Henry CH: Temporomandibular joint patients (14%) with 16 joints (16%) had a poor outcome. Patients with one or no previous temporomandibular joint surgeries had 86% in the good group, 14% in the fair group, and no 2 reconstruction of the complex patient with the Techmedica custom-made patients in the poor group. In patients with two or more previous surgeries, the success rate decreased to 55% with good results, 26% with fair results and 19% with poor results. Long-term total joint prosthesis. J Oral Maxillofac Surg 52:2-10, 1994 morbidity included five ramus prostheses that were removed or revised. Seventeen patients (30%) received further operations because of heterotopic bone formation, fibrosis, calcification, inflammation, and/or pain which occurred mostly in patients with previous Proplast/Teflon (Vitek, Inc, Houston, TX) implants. Continued pain has been associated with the poor group, which may be related to problems such as cervical neuropathy, sympathetic dystrophy, a residual inflammatory or immunologic reaction to Proplast/Teflon or silastic particles, fibrosis, calcification, heterotopic bone, or other unidentified factors. Purpose: The purpose was to test the outcome of a custom computer assisted design/computer assisted manufactured (CAD/CAM) total temporomandibular joint (rMJ) reconstruction system. There were 215 patients (13 males and 202 females); the average age at reconstruction was 40.9 ±10.3 years (range, 15 to 77 years). Patients and Methods: There were 363 joints placed, 296 bilateral and 67 unilateral. The patients had TMJ problems for an average of 10.3 ± 7.0 years (range, 1 to 44 years), and had undergone a mean of 5.4 ± 4.8 (range, 0 to Mercuri LG, Wolford LM, Sanders B, White D, Hurder A, Henderson W: 28) prior unsuccessful surgeries. Preoperative and postoperative data were collected for up to 48 months using a standardized data collection format. Subjective data related to pain, 3 Custom CAD/CAM total temporomandibular joint reconstruction system: function of the lower jaw, and diet, were obtained using a visual analogue scale. Objective measures of mandibular range of motion were made directly on the patient preoperatively and Preliminary multicenter report. J Oral Maxillofac Surg 53:106-115, 1995 postoperatively. Results: Preliminary analysis of these data reveals a statistically significant decrease in pain, an increase in function, and improvement in diet (P < .0001) from the preoperative measurements to 1 and 2 years postoperatively. There was also improvement in mandibular vertical range of motion. The number of previous surgeries was a strong predictor of postoperative pain, function, and diet scores, as well as of maximal interincisal opening. A life table analysis of failures indicates good durability of the prosthesis over time. Conclusions: These preliminary data indicate that this custom CAD/CAM total TMJ reconstruction system seems to be useful in the treatment of the multiply operated, and/or anatomically mutilated TMJ. James RB: Surgical treatment of temporomandibular dysfunction (revised 4 edition). Otolaryngology Vol. 3, Chapter 21, 1998 Patients with very advanced degenerative disease, ankylosis, post-traumatic condylar destruction, and multi-operated patients may be candidates for joint replacement with fossa and condylar prostheses. Great advances have been made in developing biocompatible materials, improved designs for patient-fitted prostheses. These devices have treated internal derangement cases after multiple surgical and nonsurgical treatment failures, as well as restoring form and function following the removal of failed Vitek Proplast-Teflon (Houston, Texas) Mercuri LG: Considering total alloplastic temporomandibular joint 5 containing temporomandibular joint implants. This paper will provide practitioners dealing with complex, debilitated, functionless temporomandibular joint (TMJ) patients with information replacement. Cranio 17:44-48, 1999 related to this treatment modality. They will then be able to address the indications for the use of alloplastic temporomandibular joint replacement devices, the devices presently available, the surgery involved in their placement, possible complications of implantation and post-operative outcomes and expectations with patients who would benefit from the implantation of these devices. Purpose: This study looked at prospective subjective and objective preoperative and postoperative outcome data from a set of multiply operated, anatomically mutilated, functionless, chronic temporomandibular joint (TMJ) pain patients who have undergone TMJ reconstruction with a custom-fitted prosthetic system. Patients and Methods: Two hundred fifteen patients (363 joints: 296 bilateral, 67 unilateral) who had undergone total TMJ reconstruction with a custom-fitted TMJ prosthesis (Techmedica; now TMJ Concepts, Camarillo, CA) made up the Mercuri LG: Subjective and objective outcomes in patients with a custom- subjects reviewed in this study. The mean follow-up period was 30.7 months. The patients were divided into 3 groups based on the number of prior unsuccessful TMJ arthrotomies they had 6 fitted alloplastic temporomandibular joint prosthesis. J Oral Maxillofac Surg undergone (group 1 = 0 to 2; group 2 = 3 to 8; and group 3 = 9 or more). Results: Subjective improvement ratio data indicated that postoperatively group 1 had a 61.3% improvement in 57:1427-1430, 1999 subjective parameters, group 2 had a 51.0% improvement, and group 3 had only a 27.5% improvement. Objective improvement ratio data showed that postoperatively group 3 had the largest increase in maximum interincisal opening, whereas the other groups had less improvement. Conclusion: The data from this study confirm, as previously reported in the literature, that the greater the number of surgical procedures performed on the TMJ, the less the chance of significant subjective improvement. Mercuri LG: The use of alloplastic prostheses for temporomandibular joint 7 reconstruction. J Oral Maxillofac Surg 58:70-75, 2000 Mercuri LG: The TMJ Concepts patient fitted total temporomandibular joint 8 reconstruction prosthesis. Oral Maxillofac Surg Clinics North Am 12:73-91, 2000 Jaw joint (temporomandibular joint or TMJ) disease is estimated to affect 30 million Americans, with approximately 1 million new patients diagnosed each year (1). Although many of these patients can be managed with nonsurgical therapies, some patients require surgical intervention. The TMJ is a unique joint in that it does not function independently but works in tandem with its contralateral joint. Therefore, disease affecting 1 joint can either directly or indirectly affect the functioning and health of the contralateral joint. When surgical intervention of the TMJ is Wolford LM, Mehra P: Custom-made total joint prostheses for required, the joint can often be reconstructed with autogenous tissues. However, certain TMJ conditions and pathology require reconstruction with a total joint prosthesis for predictable 9 temporomandibular joint reconstruction. Bayl Univ Med Cent Proc 13:135- treatment outcomes. Some of these conditions include ≥2 previous TMJ surgeries; previous TMJ alloplastic implants containing Proplast/ Teflon (PT), Silastic, acrylic, or bone cements; 138, 2000 inflammatory or resorptive TMJ pathology; connective tissue or autoimmune disease (i.e., rheumatoid arthritis, psoriatic arthritis, scleroderma, Sjögren’s syndrome, lupus, and ankylosing spondylitis); fibrous or bony ankylosis; absence of TMJ structures due to pathology, trauma, or congenital deformity; and tumors involving the condyle and mandibular ramus area. Currently, the only TMJ total joint prosthesis approved by the Food and Drug Administration (FDA) is the custom-made device manufactured by TMJ Concepts, Inc. (Camarillo, Calif). The device was manufactured by the same company under the name Techmedica, Inc. from 1989 to 1993. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms Quinn P: Pain management in the multiply operated temporomandibular 10 of such damage.”One of the most difficult challenges facing oral and maxillofacial surgeons in evaluating multiply operated patients, aside from considering reconstructive options, is joint patient. J Oral Maxillofac Surg 58:12-14, 2000, Suppl 2 ascertaining appropriate pain management for these patients.

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Item Bibliography Entry Abstract / Summary Surgical reconstruction with a total joint prosthesis is sometimes required in patients with temporomandibular joint (TMJ) problems. In the 1980s, the Vitek-Kent TMJ total joint prosthesis and Vitek alloplastic articular disc (Vitek Inc, Houston, TX) were commonly used in TMJ reconstruction, but both these devices contained Proplast-Teflon (PT; Vitek Inc) as part of their components. Early reports regarding these products were very promising, with 91% of 5,070 procedures reported to have produced satisfactory results. However, continued long-term follow-up on these patients showed the PT implants had a very high failure rate. These implants fragmented and promoted a foreign body giant cell reaction (FBGCR), which continued to Wolford LM, Mehra P: Simultaneous temporomandibular joint and increase with time. Serious complications in the TMJ from PT implants included localized destruction of bone and soft tissues, unstable occlusion, lymphadenopathy, severe pain, mandibular reconstruction in an immunocompromised patient with 11 headaches, perforation into the middle cranial fossa, immunologic dysfunction, and other systemic problems lems.3 The FBGCR may continue after removal of the implants, despite rheumatoid arthritis: A case report with 7-year follow-up. J Oral Maxillofac multiple debridements. This case report illustrates the long-term successful outcome of TMJ reconstruction in a rheumatoid arthritis patient with severe bilateral TMJ and mandibular Surg 59:345-350, 2001 destruction from PT in previously used Vitek-Kent total joint prostheses that resulted in significant functional and aesthetic facial deformity, severe facial pain, and sleep apnea. The patient was treated using a technique developed by the senior author (L.M.W.), using cranial bone grafts for mandibular ramus reconstruction and bilateral custom-made total TMJ prostheses (TMJ Concepts Inc, Camarillo, CA; formerly Techmedica Inc) for simultaneous TMJ reconstruction and a large mandibular advancement, along with maxillary osteotomies for correction of the iatrogenically induced severe dentofacial deformity. Purpose: The purpose of this study was the assessment of the long-term safety and effectiveness of the Techmedica (Camarillo, CA) CAD/CAM Total Temporomandibular Joint Reconstruction System (now called the TMJ Concepts Patient Fitted Total Temporomandibular Joint Reconstruction System, Ventura, CA). Patients and Methods: A survey was mailed to the available addresses of 170 (79%) of the 215 patients who had been implanted with the Techmedica System devices between 1990 and 1994. Seventy-nine (46%) surveys were returned by the US Postal Service as undeliverable. Three patients (1.4%) were reported as deceased in returns from relatives. Therefore, of the remaining 91 possible responses, 60 (65.9%) were returned. Fifty-eight (58) surveys, considered complete and valid (96.7%), representing 97 (39 bilateral, 19 unilateral) devices with a mean follow-up of 107.4 ±15.5 months Mercuri LG, Wolford LM, Sanders B, White D, Gobbie-Hurder A: Long- (range, 60 to 120 months) were analyzed. Subjective data related to pain, mandibular function, diet consistency, and present quality of life were collected using visual analog scales. 12 term follow-up of the CAD/CAM patient fitted total temporomandibular joint Objective measures of mandibular interincisal opening and lateral excursions were obtained from direct measurements using the Therabite (Therabite, Philadelphia, PA) measuring scale reconstruction system. J Oral Maxillofac Surg 60:1440-1448, 2002 provided in the survey with instructions as to its use. Results: Analysis of the subjective data at 10 years revealed a 76% reduction in mean pain scores and a 68% increase in mean mandibular function and diet consistency scores (P <.0001). Analysis of objective data revealed a 30% improvement in mandibular range of motion after 10 years (P = .0009). Long-term quality of life improvement scores were statistically related to the number of prior temporomandibular joint operations the patients had undergone. Conclusion: These data indicate that the CAD/CAM Patient Fitted Total Temporomandibular Joint Reconstruction System has proved to be a safe and effective long-term management modality in the patient population surveyed for this study. This prospective study evaluated the 5 to 8 year subjective and objective results of 42 consecutive patients who had TMJ reconstruction using the TMJ Concepts/Techmedica custom made total joint prosthesis. Criteria for use of the prosthesis included the following TMJ conditions: (1) multiply operated, (2) previous alloplastic implants, (3) osteoarthritis, (4) inflammatory or resorptive arthritis, (5) connective tissue or autoimmune disease, (6) ankylosis, and (7) absent or deformed structures. Thirty-eight of 42 patients (90%) with 69 TMJs reconstructed using the TMJ Concepts/Techmedica total joint prosthesis had appropriate data for inclusion in the study. The average age at surgery was 36 years and average follow-up was 73.5 months. The Wolford LM, Pitta MC, Reiche-Fischel O, Franco PF: TMJ entire group and three subgroups were objectively evaluated for incisal opening, lateral excursions, and occlusal stability, while subjectively assessed for pain and jaw function. Paired t-test 13 Concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year and comparison analyses were used to assess outcomes. For the group of 38 patients, there was statistically significant improvement in incisal opening (P=0.001), jaw function (P=0.001), follow-up study. Int J Oral Maxillofac Surg 32:268-274, 2003 and pain level (P=0.0001). Lateral excursion movements significantly decreased (P=0.04). The occlusion remained stable in all cases. Complications occurred in six patients. Comparison analysis of the three groups demonstrated significantly better outcomes for patients with fewer previous TMJ surgeries and without exposure to Proplast-Teflon or Silastic TMJ implants. This study demonstrated that the TMJ Concepts/Techmedica total joint prosthesis is a viable technique for TMJ reconstruction as a primary procedure and for patients with previous multiple TMJ surgeries and mutilated anatomy of the TMJ.

Purpose: The study goal was to evaluate the comparative outcomes of patients treated with temporomandibular joint (TMJ) total joint prostheses, using either the Christensen prosthesis (TMJ Inc, Golden, CO) (CP) or the TMJ Concepts prosthesis (TMJ Concepts Inc, Camarillo, CA; formerly Techmedica Inc) (TP). Patients and Methods: Forty-five consecutive patients treated with either CP or TP total joint prostheses were evaluated. The CP group consisted of 23 patients (40 prostheses; average patient age, 38.8 years). The TP group consisted of 22 patients (38 prostheses; average patient age, 38.5 years). The average number of previous operations for the CP group was 3.9, whereas it was 2.6 for the TP group. The CP and TP groups had an average follow-up of 20.8 and 33.0 months, respectively. Patients were evaluated for incisal opening and occlusal and skeletal stability. A visual analog scale was used for Wolford LM, Dingwerth DJ, Talwar RM, Pitta MC: Comparison of 2 subjective assessment of TMJ pain (0 = no pain, 10 = worst pain), jaw function (0 = normal function, 10 = no function), and diet (0 = no limitations, 10 = liquids only). Statistical analysis was 14 temporomandibular joint total joint prosthesis systems. J Oral Maxillofac performed using an independent t test, and a value of P <.05 was considered significant. Results: The average postsurgical incisal opening for the CP group was 30.1 mm (increase of 6.7 Surg 61:685-690, 2003 mm), and that for the TP group was 37.3 mm (increase of 9.9 mm), indicating significant increase of the TP group (P =.008). The average postsurgical pain level for the CP group was 6.0, a decrease of 1.8, and that for the TP group was 4.1, a decrease of 3.1, indicating significant improvement for the TP group (P =.042). Postsurgical average jaw function for CP was 5.5, an improvement of 1.2. The postsurgical TP average was 3.9, an improvement of 3.0, showing significant improvement for the TP group (P =.008). Average postsurgical diet rating for the CP group was 5.4, an improvement of 1.8. The TP group average was 3.9, an improvement of 2.0, indicating significant improved eating ability for the TP group (P =.021). Skeletal and occlusal stability were good in both groups. Conclusion: The TP group had statistically significant improved outcomes compared with the CP group relative to postsurgical incisal opening, pain, jaw function, and diet. Both groups showed good skeletal and occlusal stability.

Mercuri LG, Anspach WE III: Principles for the revision of total alloplastic 15 TMJ prostheses. Int J Oral Maxillofac Surg 32:353-359, 2003 Wolford LM: Concomitant temporomandibular joint and orthognathic 16 surgery. J Oral Maxillofac Surg 61:1198-1204, 2003

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Item Bibliography Entry Abstract / Summary

Total alloplastic temporomandibular joint (TMJ) reconstruction is often necessary because of the significant bony destruction resulting from failed Proplast-Teflon (Vitek, Houston, TX) and/or Silastic (Dow Corning, Arlington, TX) foreign body inflammatory reactions. Multiply operated and functionless, TMJ patients likewise have undergone total alloplastic reconstruction. Many of these patients were also exposed to failed TMJ implant materials. It was the purpose of this study to evaluate a population representative of both these groups of patients reconstructed with the Techmedica (now, TMJ Concepts, Ventura, CA) Total TMJ System to determine whether the long-term subjective and objective outcomes were affected by either the presence of the previously failed TMJ implant materials, the number of prior procedures, or both. One hundred ninety-eight patients who had been implanted with 332 Techmedica System total joints between 1990 and 1994 where divided into 4 groups based on their prior exposure to failed TMJ implant materials: group I, Proplast-Teflon (82 patients, 135 joints); group II, Silastic (28 patients, 46 joints); group III, both Proplast-Teflon and Silastic (25 patients, 46 joints); and group IV, no prior exposure to Proplast-Teflon or Silastic (63 patients, 105 joints). The mean follow- Mercuri LG, Giobbie-Hurder A: Long-term outcomes after total alloplastic up was 60.2 40.3 months (range, 2 to 120 months). To determine whether exposure to either or both failed implant materials affected the long-term subjective and objective outcome 17 temporomandibular joint reconstruction following exposure to failed variables, the groups were compared statistically using multivariate mixed modeling with age, sex, number of prior operations, years with TMJ problem, prior implant type, and implant sides materials. J Oral Maxillofac Surg 62:1088-1096, 2004 as independent variables, and the relevant baseline measure as covariates. Results: For the subjective variables, patients exposed to Proplast-Teflon or Silastic had significantly higher mean pain scores long-term. The type of prior failed TMJ implant material was not statistically significant with regard to function. Patients exposed to Proplast-Teflon reported poorer diet consistency scores long-term. Objectively, patients with 5 or fewer prior TMJ surgeries exposed to neither failed implant or Silastic reported better long-term mean maximum interincisal opening than did those patients exposed to Proplast-Teflon or both failed materials. However, for patients with 6 or more prior TMJ surgeries, those exposed to Proplast-Teflon or both failed materials reported less decrease in mean maximum interincisal opening over time. These data confirm what has been observed clinically, that in the population studied, multiply operated patients previously exposed to failed Proplast-Teflon alone or both failed Proplast-Teflon and Silastic have poorer reported long-term outcomes with alloplastic reconstruction. However, the total alloplastic TMJ reconstruction devices used in this study remained functional. Westermark A, Koppel D, Leiggener C: Condylar replacement alone is not Prosthetic reconstruction of the temporomandibular joint (TMJ) is a controversial method of treatment. This paper presents 2 cases that illustrate the problem with prosthetic reconstruction 18 sufficient for prosthetic reconstruction of the temporomandibular joint. Int J of the condylar head with no fossa reconstruction. In both cases, severe erosion and heterotopic bone formation occurred, and the patients underwent installation of total TMJ prostheses to Oral Maxillofac Surg 35:488-492, 2006 replace the previous, partial ones. In joint reconstruction, the techniques and materials that provide the best outcomes for patients have been debated. The main points of controversy relate to the use of hemiarthroplasties versus total joint prostheses with metal-on-metal versus metal-on-polyethylene articulations. This article investigates these areas as well as the applicability of the techniques and materials Wolford LM: Factors to consider in joint prosthesis systems. Bayl Univ Med 19 and the complications that can occur. Hypersensitivity to materials used in joint prostheses is relatively common but often unrecognized. Although the discussion applies to all joints, the Cent Proc 19:232-238, 2006 temporomandibular joint (TMJ) is emphasized. For TMJ reconstruction, metal-on-polyethylene articulation in total joint prostheses provides better treatment outcomes than metal-on-metal articulation. This article reviews past surgical treatments for TMJ and their rationale. Because of poor outcomes with alloplastic materials in the 1980s, many experts believed TMJ surgery had failed. Indresano AT, Mobati D: History of temporomandibular joint surgery. Oral 20 Those who advocated nonsurgical treatment condemned the entire discipline without recognizing the benefits of many surgical approaches. Only after 20 years of "good science" has TMJ Maxillofac Surg Clinics North Am 18:283-289, 2006 surgery reemerged with many procedures proven highly effective. The functional goals of temporomandibular joint (TMJ) reconstruction are the same regardless of whether they are accomplished with autogenous tissues or alloplastic materials. Which of these reconstruction modalities is best suited for an individual case should depend on the nature of the defect, the pathology that created that defect, the history of the course of the Mercuri LG: Total joint reconstruction–Autologous or alloplastic. Oral 21 patient's prior nonsurgical and surgical interventions and the response to each, and most importantly on the evidence from refereed literature that supports the choice of alloplast verses Maxillofac Surg Clinics North Am 18:399-410, 2006 autogenous reconstruction based on scientific data. This article provides an evidence-based review of the autogenous and alloplastic TMJ reconstruction literature. The reader can then more accurately determine which of these two modalities provides the most appropriate option for the management of the above conditions so as to achieve the functional goals. Purpose: The purpose of this study was to continue the assessment of the safety and effectiveness of the Patient-Fitted Total Temporomandibular Joint Reconstruction System (now, TMJ Concepts Patient- Fitted Total Temporomandibular Joint Reconstruction System, Ventura, CA; previously referred to as Techmedica, Camarillo, CA, the CAD/CAM Patient-Fitted Total Temporomandibular Joint Reconstruction System). Patients and Methods: Questionnaires were mailed to the available addresses of 193 patients who had been implanted with Techmedica/TMJ Concepts devices between 1990 and 2004. Of 193 recorded addresses, 149 (77.2%) were valid, and 44 (22.7%) were returned by the US Postal Service as undeliverable. Two (1%) surveys were remailed; both were returned completed. A total of 61 (31.6%) surveys were returned properly completed. This represented 102 devices (41 bilateral, Mercuri LG, Edibam NR, Giobbie-Hurder A: Fourteen-year follow-up of a 20 unilateral), with a mean follow-up of 11.4 years (standard deviation [SD] 3.0; range, 0 to 14). Subjective data related to pain, perception of mandibular function, diet consistency, and 22 patient-fitted total temporomandibular joint reconstruction system. J Oral current quality of life were collected with the use of visual analog scales. Objective measures of maximum interincisal opening (MIO) were obtained from direct measurements with the Maxillofac Surg 65:1140-1148, 2007 Therabite Measuring Scale (Atos Medical, Milwaukee, WI), which was provided in the survey along with instructions on its use. Results: Analysis of subjective data showed a significant reduction in pain scores and an increase in mandibular function and diet consistency scores (P .001). Analysis of objective data showed an improvement in mandibular range of motion after 14 years (P .02). Among all respondents, 85% reported quality of life (QOL) scores that showed improvement since baseline. Long-term quality of life improvement scores also were found to be statistically related to the number of previous temporomandibular joint operations the patient had undergone. Conclusions: Outcome data presented show that the Patient- Fitted Total Temporomandibular Joint Reconstruction System continues to be a safe, effective, and reliable long-term management modality for the specific patient population surveyed in this study. Herrera AF, Mercuri LG, Petruzzelli G, Rajan P: Simultaneous occurrence The incidence of 2 histologically distinct concurrent malignant tumors in adjacent anatomical regions of the head and neck is uncommon. When the presenting symptoms overlap, it can 23 of 2 different low-grade malignancies mimicking TMJ dysfunction. J Oral make their diagnosis very difficult. This article presents a case of a 72-year-old female patient with a left parotid low-grade mucoepidermoid carcinoma and a myxoid fibrosarcoma of the left Maxillofac Surg 65:1353-1358, 2007 temporomandibular joint (TMJ) condylar head in which the presenting symptoms were similar to those found on temporomandibular joint disorders (TMD).

Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Xy WH, Ma XC, Guo CB, Yi B, Bao SD: Synovial chondromatosis of the Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with 24 temporomandibular joint with middle cranial fossa extension. Int J Oral excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the Maxillofac Surg 36:652-655, 2007 infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented. Idiopathic condylar resorption (ICR), also known as progressive condylar resorption (PCR), is described by Arnett et al as a dysfunctional remodeling of the temporomandibular joint (TMJ) manifested by morphologic change (decrease condylar head volume), decreased ramal height, and progressive mandibular retrusion in the adult or decreased mandibular growth in the juvenile. Patients undergoing orthodontic treatment and/or orthognathic surgery can also be affected by ICR/ PCR, resulting in occlusal instability, maxillomandibular skeletal mal- Mercuri LG: A rationale for total alloplastic temporomandibular joint relationships, TMJ dysfunction, and pain. Management options have included orthotics to minimize excessive physical stress by decreasing the loading on the joint; “non-loading” 25 reconstruction in the management of idiopathic/progressive condylar orthodontic and orthognathic surgical procedures after 6 to 12 months of “remission”; deferment of any treatment until complete “remission”; arthroscopic lysis and lavage; total TMJ resorption. J Oral Maxillofac Surg 65:1600-1609, 2007 reconstruction with autogenous costochondral graft; maxillary orthognathic surgery only for correction of occlusal discrepancies only and to avoid involvement of the mandible; distraction osteogenesis; and combined bimaxillary orthognathic/TMJ disc repositioning surgery. Based on the ICR/PCR pathophysiology model proposed by Arnett, accepted bone biology remodeling/resorption paradigms, review of the oral and maxillofacial surgery ICR/PCR management outcomes literature, and the author’s experience with 8 cases, a rationale for the use of total alloplastic TMJ reconstruction in ICR/PCR will be presented.

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Item Bibliography Entry Abstract / Summary The first 25 consecutive patients with high occlusal plane angulation, dysfunction, and pain who were treated with temporomandibular joint (TMJ) total joint prostheses and simultaneous maxillomandibular counterclockwise rotation were evaluated before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3) for surgical movements and long-term stability. Subjective ratings were used for patients’ facial pain/headache, TMJ pain, jaw function, diet, and disability, and objective functional changes were determined by measuring Wolford LM, Pinto LP, Cardenas LE, Molina OR: Outcomes of treatment maximum incisal opening and lateral excursive movements. Results showed that the areas of greatest surgical change included an average decrease in the occlusal plane of 13.3 degrees with custom-made temporomandibular joint total joint prostheses and with advancement at point B of 13.4 mm and at the genial tubercles of 16.3 mm. At longest follow-up, relapse was 0.7 degrees, 0.8 mm, and 1.2 mm, respectively, with no statistically 26 maxillomandibular counter-clockwise rotation. Bayl Univ Med Cent Proc significant changes. Significant subjective pain and dysfunction improvements were observed (P ≤ 0.001). Maximum incisal opening increased, but lateral excursion decreased. Those who 21:18-24, 2008 had two or more previous TMJ surgeries showed greater levels of dysfunction at T1 and T3 than those who had one or no previous surgeries, but otherwise patients presented similar amounts of absolute changes. In conclusion, end-stage TMJ patients can achieve significant improvement in their pain, dysfunction, dentofacial deformity, and airway problems in one operation with TMJ reconstruction and mandibular advancement using TMJ custom-made total joint prostheses and simultaneous maxillary osteotomies for maxillomandibular counter- clockwise rotation. This paper provides a review of the current knowledge of temporomandibular joint total replacement systems. An electronic Medline search was performed to identify all the relevant English- language, peer-reviewed articles published during 1990–2006. Twenty-eight references were considered for review, seven of which were reviews, 17 clinical trials or case series, and four Guarda-Nardini L, Manfredini D, Ferronato G: Temporomandibular joint single-patient case reports. Therapeutic outcomes were encouraging for all three total prosthetic systems for which follow-up data from a consistent sample of patients exist. A lack of 27 total replacement prosthesis: Current knowledge and considerations for the homogeneity between studies in patient selection and indications for the intervention was noted. A better integration between clinical and research settings is needed to achieve a future. Int J Oral Maxillofac Surg 37:103-110, 2008 standardized definition of the rationale and indications for total temporomandibular joint replacement. Findings from the available studies are promising, and need to be confirmed by multicenter trials taking into account interoperator variability. The term "osteoarthritis" has classically been defined as a low-inflammatory arthritic condition. The term "osteoarthrosis," a synonym for osteoarthritis in the medical orthopedic literature, has recently come to be identified in the dental/temporomandibular joint (TMJ) disorders literature with any noninflammatory arthritic condition that results in similar degenerative changes as Mercuri LG: Osteoarthritis, osteoarthrosis, and idiopathic condylar 28 in osteoarthritis. The term "idiopathic condylar resorption," also known as "progressive condylar resorption," is described as a dysfunctional remodeling of the TMJ manifested by resorption. Oral Maxillofac Surg Clinics North Am 20:169-183, 2008 morphologic change, decreased ramal height, progressive mandibular retrusion in the adult, or decreased mandibular growth in the juvenile. This article discusses the diagnosis and management of osteoarthritic TMJ disorders and idiopathic condylar resorption. This study evaluated 1) the efficacy of packing autologous fat grafts around temporomandibular joint (TMJ) total joint prosthetic reconstructions to prevent fibrosis and heterotopic bone formation and 2) the effects on postsurgical joint mobility and jaw function. One hundred fifteen patients (5 males and 110 females) underwent TMJ reconstruction with total joint prostheses and simultaneous fat grafts (88 bilateral and 27 unilateral) for a total of 203 joints. The abdominal fat grafts were packed around the articulating portion of the joint prostheses after the fossa and mandibular components were stabilized. Patients were divided into two groups: group 1 (n = 76 joints) received Christensen total joint prostheses, and group 2 (n = 127 joints) received TMJ Concepts total joint prostheses. Clinical and radiographic assessments were performed before surgery, immediately after surgery, and at long-term follow-up. In group 1, maximal Wolford LM, Morales-Ryan CA, Morales PG, Cassano DS: Autologous fat incisal opening (MIO) increased 3.5 mm, lateral excursions (LE) decreased 0.2 mm, and jaw function improved 1.9 levels. In group 2, MIO increased 6.8 mm, LE decreased 1.4 mm, and grafts placed around temporomandibular joint total joint prostheses to 29 jaw function improved 2.4 levels. The improvement for MIO and patient perception of jaw function in both groups was statistically significant; no significant difference was found for LE. prevent heterotopic bone formation. Bayl Univ Med Cent Proc 21:248-254, There was no radiographic or clinical evidence of heterotopic calcifications or limitation of mobility secondary to fibrosis in either group. Twenty-five Christensen prostheses (33%) were 2008 removed because of device failure and/or metal hypersensitivity; no fibrosis or heterotopic bone formation was seen at surgical removal. Four TMJ Concepts prostheses (3%) were removed because of metal hypersensitivity. In all instances, removal of the prostheses was unrelated to the autologous fat grafting. Ten patients (8.7%) developed complications involving the fat donor site: two patients (1.8%) developed abdominal cysts requiring surgery, and eight patients (6.9%) developed seroma formation requiring aspiration. Autologous fat transplantation is a useful adjunct to prosthetic TMJ reconstruction to minimize the occurrence of excessive joint fibrosis and heterotopic calcification, consequently providing improved range of motion and jaw function. Temporomandibular joint (TMJ) problems are a common cause of morbidity in general and ENT practice. Around 30% of the population will complain of problems related to the joint at some Sidebottom AJ: Assessment and initial management of temporomandibular stage during their life, with around 10% of the population having one ormore TMJ symptomor sign at any one time. Differential diagnosis can be confusing and patients are often considered 30 joint disorders. ENT News 17:71-74, 2008 to have ‘earache’ and referred for ENT advice. The following article will aim to aid the general practitioner and ENT surgeon in diagnosing TMJ disorders and in primary management, with advice when onward referral for maxillofacial surgery advice is appropriate. Multiple reports document that a foreign-body giant cell reaction forms around Proplast-Teflon temporomandibular joint (TMJ) implants. This results in destruction of surrounding bone and Abramowicz S, Dolwick MF, Lewis SB, Dolce C: Temporomandibular joint instability of the implants. This case presents a patient whose Proplast-Teflon TMJ implants became displaced into her middle cranial fossa. The staged reconstruction of this patient is 31 reconstruction after failed teflon-proplast implant: Case report and literature described, including removal of the TMJ implants, reconstruction of the defect, concomitant orthodontic treatment and final reconstruction with TMJ Concepts1. This process involved a review. Int J Oral Maxillofac Surg 37:763-767, 2008 multidisciplinary approach between several medical and dental specialties. At her 3-year follow up, the patient had a stable postoperative result.

Purpose: The purpose of this investigation was to review the subjective, objective, and quality of life outcomes in a group of temporomandibular joint (TMJ) reankylosis patients managed by total alloplastic replacement surgery with a patient fitted system augmented with periarticular autogenous fat grafts to prevent the reformation of heterotopic bone. A review of the literature regarding the use of autogenous fat as evidence for its efficacy in such cases is also presented. Patients and Methods: All 20 TMJ reankylosis patients (4 males, 16 females) who had undergone total TMJ replacement with the TMJ Concepts (Ventura, CA) Patient-Fitted Total TMJ Prosthesis System were studied. Thirteen patients had bilateral, 7 unilateral for a Mercuri LG, Ali FA, Woolson R: Outcomes of total alloplastic replacement total of 33 joint replacements. All patients had autogenous fat harvested from the abdomen and grafted around the articulating portion of the prostheses at implantation. The patients’ 32 with periarticular autogenous fat grafting for management of reankylosis of subjective variable outcomes of TMJ pain, mandibular function, diet consistency, quality of life since the reconstruction, and objective variable of maximal interincisal opening were obtained the temporomandibular joint. J Oral Maxillofac Surg 66:1794-1803, 2008 in a detailed questionnaire and follow-up phone calls. Results: Analysis of the subjective outcomes data showed improvement in reported pain, increased jaw function, and diet consistency. Further, a significant number of these patients reported improvement in their quality of life after surgery. Analysis of the objective outcomes data showed a significant increase in the maximum interincisal opening postreplacement that was maintained. Conclusions: In the patients followed over the course of this study, total alloplastic replacement with a patient- fitted prosthesis seemed to provide a safe and effective management for reankylosis of the TMJ. Autogenous fat transplantation seems to be a useful adjunct as its use seems to minimize the recurrence of joint heterotopic calcification, consequently providing improved and consistent range of mandibular motion

Total replacement of the temporomandibular joint (TMJ) has been done in the UK since 1987. The three currently available systems are the Christensen system, the TMJ Concepts system Speculand B: Current status of replacement of the temporomandibular joint and the Lorenz (BMF) system. Data from surgeons who replace TMJ were collated up to May 2007. There were nine units (eight NHS, one private) offering replacement. The TMJ 33 in the United Kingdom. Br J Oral Maxillofac Surg 47:37-41, 2009 Concepts system is the most popular of the three systems. Units are treating between five and 12 patients each year with an estimated total annual workload of 60-65 patients. The current total costs range from £15 000 to £19 000 for bilateral replacement. The most worrying complication is infection, which may affect up to 2.6% of patients.

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Item Bibliography Entry Abstract / Summary

The purpose of this study was to evaluate skeletal and dental stability in patients who had temporomandibular joint (TMJ) reconstruction and mandibular counterclockwise advancement using TMJ Concepts total joint prostheses (TMJ Concepts Inc. Ventura, CA) with maxillary osteotomies being performed at the same operation. All patients were operated at Baylor Dela Coleta KE, Wolford LM, Gonçalves JR, dos Santos Pinto A, Pinto LP, University Medical Center, Dallas TX, USA, by one surgeon (Wolford). Forty-seven females were studied; the average post-surgical follow-up was 40.6 months. Lateral cephalograms were Cassano DS: Maxillo-mandibular counter-clockwise rotation and analyzed to estimate surgical and post-surgical changes. During surgery, the occlusal plane angle decreased 14.9 ± 8.0. The maxilla moved forward and upward. The posterior nasal spine 34 mandibular advancement with TMJ Concepts® total joint prostheses: Part moved downward and forward. The mandible advanced 7.9 ± 3.5 mm at the lower incisor tips, 12.4 ± 5.4 mm at Point B, 17.3 ± 7.0 mm at menton, 18.4 ± 8.5 mm at pogonion, and 11.0 ± 1 – Skeletal and dental stability. Int J Oral Maxillofac Surg 38:126-138, 5.3 mm at gonion. Vertically, the lower incisors moved upward -2.9 ± 4.0 mm. At the longest follow-up post surgery, the maxilla showed minor horizontal changes while all mandibular 2009 measurements remained stable. TMJ reconstruction and mandibular advancement with TMJ Concepts total joint prosthesis in conjunction with maxillary osteotomies for counter-clockwise rotation of the maxillomandibular complex was a stable procedure for these patients at the longest follow-up.

The management of temporomandibular joint (TMJ) disorders in secondary care has progressed through the 1990s from a condition dealt with by generalists to one with an increasing number of surgeons with a subspecialist interest. Within this latter group there is a subgroup of those with a specific training towards joint replacement surgery. Increasingly patients who previously had surgery for pain are being managed with non-surgical options. Alternative pain management regimens with the introduction of botulinum toxin as well as tricyclic medication Sidebottom AJ: Current thinking in temporomandibular joint management. have reduced the need for any invasive management. The surgical management of the TMJ has been revolutionised by the introduction of arthroscopy in the late 1970s. The use of 35 Br J Oral Maxillofac Surg 47:91-94, 2009 arthroscopy and arthrocentesis has lead to a reduction in indications for open joint surgery. There is no longer a perceived need to correct internal derangement with disc repositioning surgery. The primary management of acute restriction of opening and joint pain is now with arthrocentesis and arthroscopy. Degenerative and ankylotic conditions of the joint can be safely treated by the use of alloplastic joint replacement, which has less morbidity and more predictable outcomes than costochondral grafting, with the latter still the method of choice in children. The revolution continues with the introduction of national guidelines and databases supported by BAOMS. Manemi RV, Fasanmade A, Revington PJ: Bilateral ankylosis of the jaw Minimal documentation exists regarding bilateral temporomandibular joint (TMJ) involvement in ankylosing spondylitis (AS) and surgical management of this specific manifestation. Use of treated with total alloplastic replacement using the TMJ concepts system in 36 TMJ concepts prostheses in AS patients has not been previously described. This case demonstrates that TMJ replacement with prosthetic joints in AS is technically possible and a patient with ankylosing spondylitis. Br J Oral Maxillofac Surg 47:159-161, appropriate. 2009 The purpose of this study was to evaluate the anatomical changes and stability of the oropharyngeal airway and head posture following TMJ reconstruction and mandibular advancement with TMJ Concepts custom-made total joint prostheses and maxillary osteotomies with counter-clockwise rotation of the maxillo-mandibular complex. All patients were operated at Baylor Coleta KED, Wolford LM, Gonçalves JR, dos Santo Pinto A, Cassano DS, University Medical Center, Dallas TX, USA, by one surgeon (Wolford). The lateral cephalograms of 47 patients were analyzed to determine surgical and post-surgical changes of the Gonçalves DAG: Maxillo-mandibular counter-clockwise rotation and oropharyngeal airway, hyoid bone and head posture. Surgery increased the narrowest retroglossal airway space 4.9 mm. Head posture showed flexure immediately after surgery ( 5.6 ± 37 mandibular advancement with TMJ Concepts® total joint prostheses: Part 6.7) and extension long-term post surgery (1.8 ± 6.7); cervical curvature showed no significant change. Surgery increased the distances between the third cervical vertebrae and the II – Airway changes and stability. Int J Oral Maxillofac Surg 38:228-235, menton 11.7 ± 9.1 mm and the third cervical vertebrae and hyoid 3.2 ± 3.9mm, and remained stable. The distance from the hyoid to the mandibular plane decreased during surgery (-3.8 ± 2009 5.8 mm) and after surgery (-2.5 ± 5.2 mm). Maxillo-mandibular advancement with counter-clockwise rotation and TMJ reconstruction with total joint prostheses produced immediate increase in oropharyngeal airway dimension, which was influenced by long-term changes in head posture but remained stable over the follow-up period.

47 end-stage TMJ patients with high occlusal plane angulation, treated with TMJ custom-fitted total joint prostheses and simultaneous maxillo-mandibular counter-clockwise rotation were evaluated for pain and dysfunction presurgery (T1) and at the longest follow-up (T2). Patients subjectively rated their facial pain/headache, TMJ pain, jaw function, diet and disability. Pinto LP, Wolford LM, Buschang PH, Bernardi FH, Gonçalves JR, Objective functional changes were determined by measuring maximum interincisal opening (MIO) and laterotrusive movements. Patients were divided according to the number of previous Cassano DS : Maxillo-mandibular counter-clockwise rotation and failed TMJ surgeries: Group 1 (0–1), Group 2 (2 or more). Significant subjective pain and dysfunction improvements (37–52%) were observed ( 0.001). MIO increased 14% but lateral 38 mandibular advancement with TMJ Concepts® total joint prostheses: Part excursion decreased 60%. The groups presented similar absolute changes, but Group 2 showed more dysfunction at T1 and T2. For patients who did not receive fat grafts around the III – Pain and dysfunction outcomes. Int J Oral Maxillofac Surg 38:326-331, prostheses and had previous failure of proplast/teflon and or silastic TMJ implants, more than half required surgery for TMJ debridement and removal of foreign body giant cell reaction and 2009 heterotopic bone formation. Endstage TMJ patients can be treated in one operation with TMJ custom-made total joint prostheses and maxillo-mandibular counter-clockwise rotation, for orrection of dentofacial deformity and improvement in pain and TMJ dysfunction; Group 1 patients had better results than Group 2 patients.

Temporomandibular joint (TMJ) is a complex, sensitive, and highly mobile joint. Millions of people suffer from temporomandibular disorders (TMD) in USA alone. The TMD treatment options need to be looked at more fully to assess possible improvement of the available options and introduction of novel techniques. As reconstruction with either partial or total joint prosthesis is the potential treatment option in certain TMD conditions, it is essential to study outcomes of the FDA approved TMJ implants in a controlled comparative manner. Evaluating the kinetics and Ingawale S, Goswami T: Temporomandibular joint: Disorders, treatments, 39 kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of and biomechanics. Ann Biomed Eng 37:976-996, 2009 treatment. Although many researchers have conducted biomechanical analysis of the TMJ, many of the methods have certain limitations. herefore, a more comprehensive nalysis is necessary for better understanding of different movements and resulting forces and stresses in the joint components. This article provides the results of a state-of-the-art investigation of the TMJ anatomy, TMD, treatment options, a review of the FDA approved TMJ prosthetic devices, and the TMJ biomechanics. The purpose of this study was to evaluate soft tissue response to maxillomandibular counter-clockwise rotation, with TMJ reconstruction and mandibular advancement using TMJ Concepts1 total joint prostheses, and maxillary osteotomies in 44 females. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one surgeon (Wolford). Eighteen patients had genioplasties with either porous block hydroxyapatite or hard tissue replacement implants (Group 2) 26 had no genioplasty (Group 1). Surgically, the maxilla moved Coleta KED, Wolford LM, Gonçalves JR, dos Santos Pinto A, Cassano forward and upward by counter-clockwise maxillo-mandibular rotation with greater horizontal movement in Group 2. Vertically, both groups showed diversity of maxillo-mandibular mean DS, Gonçalves DAG: Maxillo-mandibular counter-clockwise rotation and 40 movement. Group 1 showed a consistent 1: 0.97 ratio of hard to soft tissue advancement at pogonion; Group 2 results were less consistent, with ratios between 1: 0.84 and 1: 1.02. mandibular advancement with TMJ Concepts® total joint prostheses: Part Horizontal changes in upper lip morphology after maxillary advancement/impaction, VY closure, and alar base cinch sutures showed greater movement in both groups, than observed in IV – Soft tissue response. Int J Oral Maxillofac Surg 38:637-646, 2009 hard tissue. Counterclockwise rotation of the maxillo-mandibular complex using TMJ Concepts total joint prostheses resulted in similar soft tissue response as previously reported for traditional maxillo-mandibular advancement without counter-clockwise rotation of the occlusal plane. The association of chin implants, in the present sample, showed higher variability of soft tissue response. The variety of temporomandibular joint (TMJ) prostheses and condylar reconstruction plates available is in contradiction to their rare application. This emphasizes that alloplastic TMJ reconstruction is still evolving. This article reviews the history of TMJ reconstruction. Medline as well as public and private libraries have been searched. Current systems are reviewed. Driemel O, Braun S, Müller-Richter UDA, Behr M, Reichert TE, Kunkel M, Prosthetic devices can be differentiated into fossa-eminence prostheses, ramus prostheses and condylar reconstruction plates, and total joint prostheses. Fossa and total joint prostheses Reich R: Historical development of alloplastic temporomandibular joint are recommended when the glenoid fossa is exposed due to excessive stress (degenerative disorders, arthritis, ankylosis, multiply operated pain patients). Singular replacement of the 41 replacement after 1945 and state of the art. Int J Oral Maxillofac Surg condyle is preferred as a temporary solution in ablative surgery. The use of prosthetic devices for long-term replacement should be restricted to selected cases, taking care to retain the 38:909-920, 2009 disk, in order to prevent penetration into the middle cranial fossa. The term ‘condylar reconstruction plate’ reflects this more clearly than ‘ramus prosthesis’ which suggests permanent reconstruction. Long-term studies comparing the functional and aesthetic results of the various prostheses and condylar reconstruction plates are not available, which leaves the choice to personal experience.

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Item Bibliography Entry Abstract / Summary Zanakis NS, Gavakos K, Faippea M, Faippea M, Karamanos A, Zotalis N: A case of hemifacial microsomia in an adult female is presented. The ascending ramus and condyle was primarily reconstructed using an iliac crest free bone graft. Following resorption of 42 Application of custom-made TMJ prosthesis in hemifacial microsomia. Int J the bone graft, a custom-made total TMJ device (TMJ Concepts, USA) was used to correct the deformity. The alternative available reconstructive techniques are discussed and the Oral Maxillofac Surg 38:988-992, 2009 advantages and disadvantages of the method selected. Purpose: To prospectively evaluate the outcomes of single-stage reconstruction of patients with rheumatoid arthritis (RA) with temporomandibular joint (TMJ) pathologic features and an associated dentofacial deformity. Patients and Methods: Fifteen patients (12 females, 3 males) with RA underwent TMJ reconstruction, with or without a Le Fort I osteotomy in a single operation. Clinical and radiographic examinations were performed before surgery, immediately after surgery, and at the longest follow-up intervals. Numeric analog scales were used for subjective evaluation of TMJ pain, jaw function, diet, and disability. The maximal interincisal opening, lateral excursions, and TMJ crepitus were recorded at each visit. Standardized cephalometric acetate tracings were superimposed to assess for surgical (immediately after surgery compared with before surgery) and postoperative (longest follow-up interval compared with immediately after surgery) changes. Results: The average patient age was 27.4 years (range 15 to 61), and the follow-up was 34.3 months (range 10 to 77). At the longest follow-up interval, all 15 patients had had a statistically significant reduction in the incidence and severity of TMJ pain and headaches. The average maximal interincisal opening increased after Mehra P, Wolford LM, Baran S, Cassano DS: Single-stage comprehensive surgery, but the difference was not statistically significant. Lateral excursions decreased significantly after surgery. Dietary restrictions and disability were significantly improved, and TMJ 43 surgical treatment of the rheumatoid arthritis temporomandibular joint crepitus had reduced significantly. The average advancement at point B was 21.7 mm (range 14 to 28), and the postoperative change at the longest follow-up interval was 0.1 mm (range 0 patient. J Oral Maxillofac Surg 67:1859-1872, 2009 to 1). The average pogonion advancement was 29.2 mm (range 19.5 to 38), with a postoperative change of 0.2 mm (range 0 to 1). The average gonion vertical lengthening was 20.7 mm (range 10.5 to 29) with a postoperative change of 1.4 mm (range 0 to 4.5). The average occlusal plane angle change was a decrease of 20.7° (range 16° to 26°), with a postoperative change of 0.4° (range 0° to 2°). Of the 15 patients, 10 had undergone maxillary orthognathic surgery performed at the same operation. The average advancement of these 10 patients at point A was 3 mm (range 2 to 7), and the postoperative change was 0.5 mm (range 0 to 1). Conclusions: Surgical correction of rheumatoid-associated TMJ disease and the resulting dentofacial deformity can successfully be performed in a single operation using custom-made TMJ total joint prostheses to reconstruct the TMJs and advance the mandible, with maxillary orthognathic surgery and genioplasty performed at the same operation when indicated. The significant reduction in TMJ dysfunction symptoms and the long-term stability of the orthognathic surgery movements show the benefits and predictability of treating these complex patients with this treatment protocol. Mercuri LG, Swift JQ: Considerations for the use of alloplastic The purpose of this article is to raise the following question: Is there any evidence in the literature for considering alloplastic TMJ TJR in the growing patient? A case will be presented where 44 temporomandibular joint replacement in the growing patient. J Oral alloplastic TMJ TJR provided a successful functional, esthetic, and occlusal result in a growing patient in whom autogenous reconstruction had failed in the past. Maxillofac Surg 67:1979-1990, 2009 Pearce CS, Cooper C, Speculand B: One stage management of ankylosis Alloplastic joint prostheses have been used in the treatment of severe diseases of the temporomandibular joint (TMJ) for many years. Treatment of ankylosis of the TMJ has been difficult, 45 of the temporomandibular joint with a custom-made total joint replacement with many surgical approaches being used that traditionally involved multistage procedures, long treatment times, and increasing expense. We report a single stage technique for system. Br J Oral Maxillofac Surg 47:530-534, 2009 replacement of an ankylosed joint using a custom-made prosthesis, and discuss the technical aspects of the procedure, including our use of a custom-made acrylic glenoid fossa template.

Surgery for tumors extending into the infratemporal fossa requires adequate exposure to identify and protect vital structures. We present a patient who had, at some time in the past, been treated by condylar resection of the right temporomandibular joint (TMJ) because of a pigmented villonodular synovitis. The condyle had been replaced with a standard reconstruction plate that had eroded deep into the skull base. Prosthetic reconstruction of the TMJ was performed 1.5 years later after renewed bone tumor excision from the infratemporal space. The standard preauricular and submandibular approaches for implantation of a total TMJ prosthesis did not offer adequate access for tumor removal from the infratemporal fossa. The tumor was excised Leiggener C, Jaquiéry C, Kunz C, Westermark A: Transparotid approach successfully through an additional transparotid approach. Bone tumors originating from the mandibular condylar process can extend into the infratemporal fossa, an area which is for tumor excision from the infratemporal space in temporomandibular joint challenging to access surgically. Few primary tumors arise in this area and, in fact, metastases to the infratemporal space from tumors elsewhere are a rare occurrence. The infratemporal 46 reconstruction: A 3-year follow-up. Oral Surg Oral Med Oral Pathol Oral fossa is the irregular retromaxillary space under the floor of the middle cranial fossa, and it is circumscribed by the ascending ramus of the mandible laterally and by the lateral pterygoid Radiol Endod 109:e1-e4, 2010 plate of the sphenoid medially. The anterior boundary of the fossa is formed by the posterior wall of the maxilla. The standard approach for installation of a total alloplastic temporomandibular joint (TMJ) prosthesis is a combination of preauricular and submandibular incisions.3 These approaches provide adequate exposure for placement of the fossa and mandibular components, and are followed by a good cosmetic outcome. However, the combined preauricular and submandibular exposure may not offer an adequate surgical approach to tumors extending into the infratemporal fossa. Owing to the oblique course of the facial nerve, access is limited, especially to the medial part of the infratemporal fossa. The case reported here illustrates the addition of a transparotid approach to the standard procedure for tumor exicision from the infratemporal fossa and insertion of a TMJ prosthesis.

Purpose: The purpose of the present study was to answer the following clinical question: of the patients with temporomandibular joint ankylosis, do those treated with ankylosis resection and ramuscondyle unit reconstruction with a prosthetic total joint (total joint replacement [TJR]) have improved jaw function and decreased pain compared with those treated with ankylosis resection and interpositional arthroplasty (IA)? Materials and Methods: Using a retrospective study design, the investigators enrolled a sample derived from the population of patients presenting to the Massachusetts General Hospital (Boston, MA) and the University of Oslo Faculty of Dentistry from 1998 to 2008 for the evaluation and management of Loveless TP, Bjornland T, Dodson TB, Keith DA: Efficacy of temporomandibular joint ankylosis. The primary predictor variable was treatment (ie, TJR or IA). The outcome variables were the maximal interincisal opening and pain. Data analyses were 47 temporomandibular joint ankylosis surgical treatment. J Oral Maxillofac performed using bivariate and multiple regression methods. Results: The final study sample included 36 subjects with a mean age of 40 ± 13.1 years, and 25 were women (69%). Of the 36 Surg 68:1276-1282, 2010 patients, 14 (39%) and 22 (61%) were in the TJR and IA groups, respectively. The changes in the maximal interincisal opening in the TJR and IA groups were 9.4 ± 6.7 and 18 ± 9.7 mm (P = .02). After adjusting for institutional location, number of previous operations, laterality (unilateral versus bilateral operation), age, and etiology, the difference in the maximal interincisal opening between the 2 treatment groups was not significant (P = .06). The changes between preoperative and postoperative pain scores were insignificant between the groups (P =.16). Conclusion: Ankylosis resection and ramus-condyle unit reconstruction with a prosthetic total joint and IA produced comparable outcomes in terms of mandibular range of motion and pain.

Zizelmann C, Bucher P, Rohner D, Gellrich, Kokemueller H, Hammer B: Temporomandibular joint (TMJ) reconstruction with a TMJ Concepts total joint prosthesis (TMJ Concepts, Ventura, USA) requires a precise 3D model of the jaws in centric occlusion. The Virtual restoration of anatomic jaw relationship to obtain a precise 3D 48 authors present a virtual procedure for repositioning the lower jaw in centric occlusion to obtain a precise stereolithographic model for TMJ reconstruction using a custom-made total joint model for total joint prosthesis construction for treatment of TMJ ankylosis prosthesis in a case of TMJ ankylosis and anterior open bite. with open bite. Int J Oral Maxillofac Surg 39:1012-1015, 2010

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Item Bibliography Entry Abstract / Summary

Purpose: Patients with specific temporomandibular joint (TMJ) conditions and pathology may benefit from TMJ reconstruction by use of total joint prostheses. A potential risk to patients receiving TMJ total joint prostheses is infection. The purpose of this study was to present our experience in treating infected TMJ total joint prostheses over a 12-year period, as well as the protocol we have developed to manage acute infections and the protocol we follow for chronic infections of TMJ total joint prostheses. Patients and Methods: This retrospective study evaluated the records of 316 consecutive patients (290 female and 26 male patients) who had TMJ reconstruction from 1997 to 2009 by 1 surgeon, using patient-fitted TMJ Concepts total joint prostheses (TMJ Concepts, Ventura, CA), with a total of 579 prostheses placed, to determine the occurrence and management methods of postoperative infections. Postoperative infections involving the TMJ prostheses developed in 8 of 316 patients (2.5%) and 9 of 579 prostheses (1.6%): 7 patients unilaterally and 1 patient bilaterally. Patients were divided into 2 Wolford LM, Rodrigues DB, McPhillips A: Management of the infected groups: group 1 (n = 5) had acute infections in 6 joints and group 2 (n = 3) had chronic infections in 3 joints. Patient 5 began in group 1 but was transferred to group 2. One patient with 49 temporomandibular joint total joint prosthesis. J Oral Maxillofac Surg Munchausen syndrome and self-induced infections was eliminated from the study. Patients were treated by our protocol for management of acute or chronic infections. Results: In group 1 68:2810-2823, 2010 (n = 5) the onset of infection symptoms averaged 12 days after surgery (range, 5-24 days). The time from onset of symptoms to surgical intervention was 3.4 days (range, 2-5 days). We found that 4 of 5 patients (80%) and 5 of 6 joints (83%) were successfully treated with retention of the prostheses. Patient 5 varied from the protocol and maintained a chronic infection of her right TMJ prosthesis that transferred her to group 2. In group 2 (n = 3) all 3 patients (including patient 5) had chronic infections with draining fistulas that were successfully treated by the chronic infection protocol including prosthesis removal and replacement. Conclusions: TMJ total joint prostheses can become infected. The earlier the diagnosis is made and the acute infection protocol initiated (within 2-5 days), the greater the chance of salvage of the prosthesis. For chronic infections, the treatment protocol has likewise been very successful, but it does require 2 surgical stages for removal and replacement of the prosthesis. Management of infected total joint prosthesis can be challenging, but with aggressive treatment following the appropriate protocol, infected prostheses can be successfully managed.

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare group of sterile, inflammatory osteoarticular disorders classically associated with skin manifestations. The etiology is unknown but probably involves genetic, infectious, and immunological components. The characteristic feature of the disease is found in the bone lesions, which typically involve MCPhillips A, Wolford LM, Rodrigues DB: SAPHO syndrome with TMJ the anterior chest wall and axial skeleton. In the literature review, six case reports discussed involvement of the TMJ. Treatment of SAPHO is geared toward symptom management as 50 involvement: Review of the literature and case presentation. Int J Oral there is no cure. Surgery for mandibular lesions is usually a last resort as results are reported to be temporary with symptoms recurring within a year. Surgery appears to be performed early Maxillofac Surg 39:1160-1167, 2010 after diagnosis of TMJ related pathology; probably because lesions affecting the TMJ involve some limitation in mouth opening with varying degrees of ankylosis. The authors provide a literature review and describe a case of SAPHO syndrome with ankylosis of the left TMJ. The patient was treated with joint reconstruction using a patient-fitted total joint prosthesis (TMJ Concepts Inc., Ventura CA) in single stage surgery. This paper is the first to report maxillary involvement in SAPHO syndrome. Sidebottom AJ: Encapsuloma: A case report (letter to editor) . Br J Oral 51 Maxillofac Surg 49:328, 2011 Mandibular fractures are one the most common maxillofacial injuries. Their management has been traditionally regarded as one of the cornerstones of oral and maxillofacial surgery. Despite many technological and technical advances, to consistently return patients to their preinjury state remains one of the main challenges in the management of these injuries. As a Vega LG: Reoperative mandibular trauma: Management of posttraumatic result, an unavoidable number of patients develop unsatisfactory results. Diagnostic errors, poor surgical technique, healing disorders, or complications may lead to the establishment of 52 mandibular deformities. Oral Maxillofac Surg Clinics North Am 23:47-61, posttraumatic mandibular deformities. Nonunion, malunion/malocclusion, or facial asymmetry can be found early during the healing process or as long-term sequelae after the initial 2011 mandibular fracture repair. Although occasionally these problems can be solved in a nonsurgical manner, reoperations play an important role in the management of these untoward outcomes. Temporomandibular joint (TMJ) surgery is perhaps one of the most controversial and challenging topics in oral and maxillofacial surgery. Although clear indications for TMJ surgery exist (Boxes 1 and 2), in numerous circumstances, multiple surgical procedures are suggested for the same TMJ condition. Clinicians are faced not only with the critical task of recognizing when or when not to operate but they also have to establish what is the most effective surgery to treat a particular patient. Unfortunately, TMJ surgeries are not always successful, and the Vega LG, Gutta R, Louis P: Reoperative temporomandibular joint surgery. 53 patient’s preoperative symptoms persist or may even increase after surgery. There are many potential pitfalls that can occur during any phase of the treatment that can lead to Oral Maxillofac Surg Clinics North Am 23:119-132, 2011 complications, less than desirable results, and short- or longterm failures. Unsatisfactory results can occur for multiple reasons, including misdiagnosis of the original pathologic condition, incorrect selection of surgical technique, technical failures, complications, systemic disease, and unrealistic expectations. This article focuses on the reoperation of the TMJ primarily in cases of internal derangement and specifically discusses TMJ arthrocentesis, arthroscopy, modified condylotomy, and open joint procedures.

This paper is a preliminary paper which presents the early findings of an ongoing prospective trial on the use of the TMJ Concepts and Biomet Lorenz total joint replacement systems for the reconstruction of the temporomandibular joint (TMJ). Total alloplastic replacement of the TMJ has become a viable option for many people who suffer from TMJ disease where surgical reconstruction is indicated. Degenerative joint diseases such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, TMJ ankylosis, malunited condylar fractures and tumours can be successfully treated using this technique. There are a number of TMJ prostheses available. Two of the joint replacement products, which have been found to be most reliable and have FDA Jones RHB: Temporomandibular joint reconstruction with total alloplastic 54 approval in the United States, are the TMJ Concepts system and the Biomet Lorenz system, and for this reason they are being investigated in this study. This study presents the findings of joint replacement. Aust Dent J 56:85-91, 2011 seven patients with a total of 12 joint replacements using either the TMJ Concepts system or the Biomet Lorenz joint system. Two patients (3 joints) had the TMJ Concepts system and five patients (9 joints) had the Biomet Lorenz system. Although still early, the results were generally pleasing, with the longest replacement having been in position for three years and the most recent six months. The average postoperative mouth opening was 29.7 mm (range 25–35 mm) with an average pain score of 1.7 (range 0–3, minimum score of 0 and maximum 10). Complications were minimal and related to sensory disturbance to the lip in one patient and joint dislocation in two patients. Relatively few patients develop such severe degenerative temporomandibular joint (TMJ) disease that they require total joint replacement. Current indications include those conditions Felstead AM, Revington PG: Surgical management of temporomandibular involving condylar bone loss such as degenerative (osteoarthritis) or inflammatory joint disease (ankylosing spondylitis, rheumatoid, and psoriatic). Ankylosis of the temporomandibular joint 55 joint ankylosis in ankylosing spondylitis. Int J Rheumatol Volume 2011, (TMJ) secondary to ankylosing spondylitis remains an under investigated entity. We aim to provide an overview of treatment objectives, surgical procedures, and our experience with total 2011 TMJ replacement for this condition. Temporomandibular joint (TMJ) reconstruction may be required in complex cases in which there are additional mandibular or zygomatic arch defects. The reconstructive options include autogenous tissue, alloplastic material, or combinations of these. The authors describe 4 cases in which TMJ reconstruction was performed with TMJ Concepts customized joint prostheses. Westermark A, Hedén P, Aagaard E, Cornelius CP: The use of TMJ The prosthetic components were designed to restore major defects in the zygomatic arch and the mandibular ramus and body, including one case in which the mandibular component was 56 Concepts prostheses to reconstruct patients with major temporomandibular used to restore total mandibular continuity. The prosthetic components used in these cases provided excellent anatomical reconstruction, and were a viable treatment option in cases in joint and mandibular defects. Int J Oral Maxillofac Surg 40:487-496, 2011 which the pathological process made autogenous grafts unsuitable. The prostheses have been functioning for up to 6 years. In one case a revision operation was required because the lack of a pterygomasseteric sling resulted in the condyle dropping out of the fossa. The authors’ clinical experience with these cases suggests that a customized prosthesis combined with TMJ reconstruction can be a reliable treatment alternative for ridging complex, major maxillo-mandibular defects.

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Item Bibliography Entry Abstract / Summary Introduction: New virtual surgery planning techniques like CAD/CAM and advances in biomaterials have made it possible to undertake increasingly complex cases of temporomandibular joint reconstruction. The planning and preparation of custom alloplastic devices makes it possible to accurately accommodate anatomic structures. Dental and facial deformities often García Sánchez A, Morey Mas Á, Ramos Murguialday M, Janeiro Barrera coexist with articular pathology. Using computerized planning methods, orthognathic surgery procedures can be combined with temporomandibular joint reconstruction in a single procedure. S, Molina Barraguer I, Iriarte Ortabe JI: Post-traumatic reconstruction with 57 Material and methods: The authors’ experience with computerized planning and surgical execution of three cases of bilateral articular ankylosis (6 joints) is presented with simulation of custom prosthesis of the temporomandibular joint: Computerized surgical osteotomies, maxillomandibular movements and custom total alloplastic prosthesis design for the temporomandibular joint. Conclusions: A comprehensive approach to articular planning. Rev Esp Cirug Oral y Maxilofac 33:53-60, 2011 biomechanics, intermaxillary relations and dental occlusion is necessary to obtain predictable and satisfactory results. Computer modeling and the use of custom alloplastic devices allows exact, safe total articular reconstruction. Chung CJ, Choi YJ, Kim IS, Huh JK, Kim HG, Kim KH: Total alloplastic This case report describes the successful treatment of an adult patient with skeletal Class II open-bite malocclusion secondary to idiopathic condylar resorption. Total alloplastic joint temporomandibular joint reconstruction combined with orthodontic 58 reconstruction and counterclockwise rotation of the maxillomandibular complex combined with orthodontic treatment provided a satisfying outcome with maximum functional and esthetic treatment in a patient with idiopathic condylar resorption. Am J Orthod improvement. Dentofacial Orthop 140:404-417, 2011 Mercuri LG: Patient-fitted ("custom") alloplastic temporomandibular joint 59 replacement technique. Atlas Oral Maxillofac Surg Clinics North Am 19:233-This article provides the reader with an illustrated technique for placement of “custom” alloplastic TMJ replacement device components. 242, 2011 Dhanda J, Cooper C, Ellis D, Speculand B: Technique of The dental occlusion sets the intermaxillary relation during planning, construction of a prosthesis, and surgery for total replacement of the temporomandibular joint (TMJ), and enables temporomandibular joint replacement using a patient-specific 60 accurate placement of the prosthesis. However, in edentulous patients this no longer exists. We describe techniques to overcome the problems encountered in such patients having TMJ reconstruction system in the edentulous patient. Br J Oral Maxillofac Surg replacement using the patient-specific TMJ Concepts® system (Ventura, California, USA). 49:618-622, 2011 Nager acrofacial dysostosis is a mandibulofacial abnormality characterized by downward slanting of the palpebral fissures, malar hypoplasia, bilateral conductive hearing loss, cleft palate, Schlieve T, Almusa M, Miloro M, Kolokythas A: Temporomandibular joint micrognathia, absent or hypoplastic thumbs, and radial limb hypoplasia. The syndrome shares many phenotypic features with Treacher-Collins syndrome; however, it is recognized as a 61 replacement for ankylosis correction in Nager syndrome: Case report and separate clinical entity. A comprehensive review of the published data regarding Nager syndrome was completed to better understand the syndrome itself and the multiple treatment review of the literature. J Oral Maxillofac Surg 70:616-625, 2012 modalities historically used for correction of the variety of clinical manifestations, including mandibular retrognathism. In addition, we present the 94th reported case of Nager syndrome and the correction of bilateral temporomandibular joint (TMJ) ankylosis, resulting from multiple failed previous mandibular surgeries, with bilateral custom total TMJ prosthetic replacement.

The essential life functions of mastication, speech, airway support and deglutition are supported by temporomandibular joint (TMJ) function and form. Over a lifetime, this puts the TMJ complex under more cyclical loading and unloading than any other joint. Therefore, to provide long-term effective outcomes, the TMJ total joint replacement (TJR) device selected must be Mercuri LG: Alloplastic temporomandibular joint replacement: Rationale for capable of managing the anatomical, functional and aesthetic discrepancies that dictated its use. The primary goal of TMJ TJR is the restoration of mandibular function and form. Outcomes 62 the use of custom devices. Int J Oral Maxillofac Surg 41:1033-1040, 2012 data confirm that any pain relief attained must be considered of only secondary benefit. Despite persistent but reduced chronic pain, increased mandibular function and form improvement have been reported, resulting in quality of life improvement for 85% of custom TMJ TJR patients studied long-term. Based on the literature and the accepted orthopaedic criteria for the development and utilisation of successful TJR devices, this paper presents a rationale for the use of custom TMJ TJR devices as a ‘fitting’ management option for end-stage TMJ disorders. Total alloplastic temporomandibular joint (TMJ) reconstruction is a reliable treatment modality in patients with severely diseased TMJ with good clinical behaviour. TMJ mandibular function after alloplastic reconstruction has scarcely been analysed as a biomechanical parameter and investigation has generally been limited to interincisal measurements without deeper insight Leiggener CS, Erni S, Gallo LM: Novel approach to the study of jaw into joint kinematics. Dynamic stereometry to assess condylar movements relative to the fossa was performed at the 5 year follow-up of a patient who underwent condylar resection of the 63 kinematics in an alloplastic TMJ reconstruction. Int J Oral Maxillofac Surg right TMJ followed by total alloplastic joint reconstruction to treat pigmented villonodular synovitis. The patient could achieve wide mouth opening, but overall mandibular kinematics showed 41:1041-1045, 2012 a strong deviation towards the prosthetic side due to the lack of mandibular translation caused by the absence of the lateral pterygoid attachment. Possible overloading of the joint contralateral to the TMJ prosthesis might be prevented by optimizing replacement joint design. Purpose: The purpose was to analyze the mandibular patterns (condylar range of motion during opening; incisal range of motion during opening, lateral excursion, and protrusion; velocity during opening and closing; mandibular rotation angle during opening and closing) in patients with alloplastic total joint replacement (TJR). Materials and Methods: Seventeen patients with different diagnoses resulting in condylar hypomobility (8 patients, 15 joints) and condylar instability (9 patients, 12 joints) had undergone alloplastic TJR. Data were recorded preoperatively Linsen S, Reich RH, Teschke M: Mandibular kinematics in patients with and 2, 6, and at least 12 months postoperatively. For ordinal data comparison at different time points, the Wilcoxon signed-ranks test was used. Results: Analysis of the kinematic data at 64 alloplastic total temporomandibular joint replacement—A prospective least 12 months postoperatively showed in patients with condylar hypomobility a statistically significant increase in all measured data except the incisal range of motion lateral excursion. In study. J Oral Maxillofac Surg 70:2057-2064, 2012 patients with condylar instability, the results showed a statistically significant decrease for incisal range of motion protrusion and laterotrusion. A slight increase in condylar range of motion, incisal range of motion linear distance, and velocity during opening and closing was found. Conclusions: Even after successful alloplastic TJR, a complete restoration of normal joint function is not achievable. Nevertheless, the kinematic data indicate that alloplastic TJR results in an improved function in patients with joint hypomobility and in a decrease of abnormal hypermobility in patients with condylar instability. Synovial metaplasia has been reported to occur in tissue surrounding silicone breast implants and in tissue adjacent to joint prostheses. It has also been described in skin and soft tissues, Monje F, Mercuri L, Villanueva-Alcojol L, Fernandez de Mera JJ: Synovial most frequently in healing or healed traumatic or surgical wounds. Heterotopic bone formation (HBF) is defined as the formation of bone within the temporomandibular joint (TMJ) that may metaplasia found in tissue encapsulating a silicone spacer during 2-staged cause partial or complete ankylosis of the joint, causing pain and limited range of motion. Multiple previous surgeries, a history of trauma, and ineffective postsurgical physical therapy 65 temporomandibular joint replacement for ankylosis. J Oral Maxillofac Surg regimens have been postulated as possible contributing factors to its development. Different therapeutic options have been proposed, each showing variable success in preventing 70:2290-2298, 2012 reankylosis. We report the first case in which papillary synovial metaplasia occurred due to placement of a temporary silicone implant in a patient in whom HBF developed after total alloplastic TMJ replacement with a stock prosthesis and present a review of the literature. Purpose: Alloplastic total temporomandibular joint replacement (TJR) for end-stage disease, congenital disorders, and after ablative surgery has been shown improve function and to decrease pain. The purpose of this study was to evaluate the pain pressure threshold (PPT) and oral health-related quality of life (OHRQoL) in patients undergoing alloplastic TJR. Linsen SS, Reich RH, Teschke M: Pressure pain threshold and oral health- Materials and Methods: Subjects requiring TJR from May 2007 through February 2011 were enrolled in the study. The PPT and OHRQoL were measured preoperatively and 2, 6, and 12 related quality of life implications of patients with alloplastic TMJ 66 months postoperatively. The primary predictor variable was postoperative time (preoperatively and 2, 6, and 12 months postoperatively). The primary outcome variables were the PPT and replacement--A prospective study. J Oral Maxillofac Surg 70:2531-2542, OHRQoL. Results: Seventeen subjects requiring TJR were enrolled in and completed the required 12-month follow-up. There was no difference in the PPT at any time point. There was a 2012 significant improvement in the OHRQoL domain of psychological discomfort (P = .04) at 12 months. Facial pain intensity, temporomandibular joint pain, mandibular function, and diet were also significantly improved at 12 months (P=.001). Conclusion: Alloplastic TJR appears to decrease pain, improve function and diet, and decrease psychological discomfort.

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Item Bibliography Entry Abstract / Summary

Purpose: Traditionally, patients with hemifacial microsomia (HFM) and significant ipsilateral hypoplasia or absence of the condyle and ramus undergo reconstruction on the ipsilateral side with autogenous tissues such as rib grafts, often with compromised results. This study analyzed the surgical treatment outcomes of nongrowing patients with HFM and reconstruction of the ipsilateral temporomandibular joint (TMJ) and advancement of the mandible with a patient-fitted TMJ total joint prosthesis (TMJ Concepts, Inc, Ventura, CA), a contralateral mandibular ramus sagittal split osteotomy, and maxillary osteotomies performed in 1 operation. Patients and Methods: All nongrowing patients with HFM treated with this surgical protocol from 1997 to 2010 in a single private practice were included in this study and subjectively evaluated before surgery and at the longest postsurgical follow-up for pain, diet, jaw function, and disability Wolford, LM, Bourland TC, Rodrigues D, Perez DE, Limoeiro E: using a visual numerical scale (0 to 10). Surgical changes and postsurgical stability were analyzed using lateral cephalograms before surgery, immediately after surgery, and at the longest Successful reconstruction of nongrowing hemifacial microsomia patients follow-up. Results: Six patients (4 female and 2 male) were included in this study, with an average age at surgery of 23.5 years (range, 14 to 39 yrs) and an average follow-up of 6 years 3 67 with unilateral temporomandibular joint total joint prosthesis and months (range, 1 yr to 11 yrs 4 mo). For all subjective parameters, all patients improved or remained the same. Incisal opening improved or remained the same in 4 of the 6 patients, with 2 orthognathic surgery. J Oral Maxillofac Surg 70:2835-2853, 2012 patients having decreased opening. Excursive movements decreased. The maxillomandibular complex was surgically rotated counterclockwise, advanced, and transversely leveled, with the anterior maxillary reference points (anterior nasal spine, point A) undergoing relative small movements. The mandibular incisor tips (lower incisor tips) advanced a mean of 8.9 mm, point B 14.8 mm, pogonion 18.6 mm, menton 17.5 mm and the occlusal plane angle decreased -12.3°. Postsurgical long-term stability indicated that the anterior maxillary references changed a significant amount, whereas all horizontal and vertical anterior mandibular measurements (lower incisor tip, point B, pogonion, menton) and the occlusal plane showed no significant changes. Conclusions: The TMJ Concepts total joint prosthesis in conjunction with orthognathic surgery for TMJ and jaw reconstruction in nongrowing patients with HFM is highly predictable for skeletal and occlusal stability, comfort, TMJ function, and improved facial balance.

Alloplastic temporomandibular joint replacement (TMJ TJR) presents unique problems due to the integral and multifaceted roles this joint plays within the stomatognathic system to establish and maintain appropriate mandibular function and form. The TMJ not only acts as a secondary mandibular growth center pre-puberty, but is also crucial in maintaining proper mastication, speech, airway support and deglutition. Further, these essential life functions place the TMJ under more cyclical loading and unloading than any other body joint over a lifetime. Therefore, when TMJ TJR is indicated the device chosen must be able to provide long-term mandibular function and form outcomes. End-stage TMJ pathology accompanied by physiological function Mercuri LG: The role of custom-made prosthesis for temporomandibular and anatomical form distortions dictates the need for replacement. Due to the complex nature of joint related masticatory muscle functional and anatomical associations, it is unreasonable 68 joint replacement. Rev Esp Cirug Oral y Maxilofac 35:1-10, 2013 to expect an autogenous reconstructed TMJ or an alloplastic replaced TMJ can be returned to “normal” pre-morbid function. Therefore, as is understood with any orthopaedic joint replacement, patient and surgeon must agree and accept that there will always be some functional disability involved with any reconstructed or replaced TMJ. Further, in the multiply operated, anatomically distorted patients, chronic neuropathic centrally mediated pain will always be a major component of their disability. Therefore, it is imperative that surgeon and patient understand that the primary goal of any TMJ TJR is the restoration mandibular function and form and that any pain relief must be considered of only secondary benefit. This paper will discuss the role of custom TMJ TJR devices have in the management of severe and debilitating TMJ disorders.

This article summarises the rheumatoid diseases that particularly affect the temporomandibular joint (TMJ): psoriatic arthropathy, ankylosing spondylitis, and rheumatoid arthritis. Management is by a joint approach between rheumatologists and maxillofacial surgeons with a specific interest in diseases of the TMJ who give early surgical advice. Steroid injections, Sidebotoom AJ, Salha R: Management of the temporomandibular joint in 69 whilst useful in the short term, are not useful for long term or repeated treatment, and may lead to collapse of the joint and development of a deformed anterior open bite. These disorders rheumatoid disorders. Br J Oral Maxillofac Surg 51:191-198, 2013 should be managed primarily using standard conservative regimens, and failure to respond should lead to diagnostic or therapeutic arthroscopy and appropriate surgical treatment. When ankylosis develops or the joint collapses, a replacement joint should be considered and patients should be referred to an appropriately trained surgeon. Arthrogryposis is a rare condition that comprises contracture of the joints, muscular weakness, and fibrosis. Restricted mouth opening caused by coronoid hyperplasia has been reported but to our knowledge, ankylosis of the temporomandibular joint (TMJ) has not. Standard management of ankylosis includes creation of a gap arthroplasty and possible reconstruction with Sidebottm AJ: Management of recurrent ankylosis in arthrogryposis: new 70 autogenous or alloplastic materials. We describe management of a patient with arthrogryposis who developed ankylosis for a second time after satisfactory gap arthroplasty and total solutions to a rare problem. Br J Oral Maxillofac Surg 51:256-258, 2013 replacement of the TMJ with a custom-made prosthesis. The original prosthesis was removed, the ankylosis resected, and the prosthesis replaced. This has given an excellent outcome at 12 months. Reconstruction of acquired temporomandibular joint (TMJ) defects represents a unique challenge because of the important role of the TMJ in daily activities such as mastication, deglutition, Vega LG, González-Garcia R, Louis P: Reconstruction of acquired and phonation. Autogenous reconstructions such as costochondral or sternoclavicular joint graft continue to be the best option in children, owing to their ability to transfer a growth center. In 71 temporomandibular joint defects. Oral Maxillofac Surg Clinics North Am adults, alloplastic reconstructions are a safe and predictable option. In regions of the world where prosthetic reconstruction is not available, is cost prohibitive, or is contraindicated because 25:251-269, 2013 of patient-related factors such as allergy to materials or multiple previous infections associated with the prosthesis, autogenous reconstruction should be considered. Vascularized tissue transfers have also become a popular and reliable way to restore these defects, especially when larger amounts of tissue are missing or in the presence of an irradiated bed. A variety of options have been proposed for the surgical management of temporomandibular joint (TMJ) idiopathic/progressive condylar resorption (ICR/PCR) cases in the past. Various Mercuri LG: Alloplastic total joint replacement: A management option in developments in understanding the molecular biology of the TMJ and the postulated role of estrogen in bone biology have led to a proposed pathophysiology model for ICR/PCR of the 72 temporomandibular joint condylar resorption. Semin Orthod 19:116-126, TMJ, which is also based on the established orthopedic bone biology remodeling/resorption paradigm. Therefore, a critical review of the ICR/PCR and TMJ total alloplastic joint replacement 2013 surgery literature, as well as the author's experience, suggests that TMJ total alloplastic joint replacement can provide enhanced long-term surgical outcomes in the management of end- stage ICR/PCR pathology. Bueno JM, Fernández-Barriales M, Morey-Mas, MA, Hernández-Alfaro, F: We report condylar resorption of the temporomandibular joint after difficult intubation, leading to progressive midline mandibular deviation, subsequently treated by prosthetic joint 73 Progressive mandibular midline deviation after difficult tracheal intubation. replacement. Anaesthesia 68:770-772, 2013 Alloplastic temporomandibular total joint replacement (TJR) for end-stage disease, congenital disorders and following ablative oncological surgery has been shown to reduce pain and improve function. The purpose was to assess the maximum voluntary bite force and maximum interincisal opening (MIO) in patients undergoing alloplastic total temporomandibular joint Linsen SS, Reich RH, Teschke M: Maximum voluntary bite force in patients replacement (TJR). Seventeen patients with different diagnoses resulting in condylar hypomobility (8 patients; 15 joints) and condylar instability (9 patients; 12 joints) had undergone 74 with alloplastic total TMJ replacement—A prospective study. J alloplastic TMJ reconstruction. Maximum voluntary bite force and MIO were measured at pre-operatively (T0), 2 (T1), 6 (T2) and 12 (T3) months. For ordinal data comparison at different Craniomaxillofac Surg 41:423-428, 2013 time-points, the Wilcoxon signed-ranks test was used. There was a significant improvement in maximum voluntary bite force for both, patients with condylar hypomobility (P = 0.003) and condylar instability (P = 0.007). Analysis of MIO revealed a significant improvement at T3 (P = 0.002). Alloplastic TJR would appear to increase maximum voluntary bite force and MIO. Biomechanical integrity of the stomatognathic system and the ability of the patient to triturate food could be improved by alloplastic temporomandibular joint (TMJ) replacement.

A 23-year-old man presented with a history of fibrous ankylosis of the left temporomandibular joint (TMJ), scarring and shortening of the left temporalis muscle secondary to transection, and Kirchheimer S, Sainuddin S, Bojanic S, Saeed NR: Simultaneous custom- surgically-induced neuropathic pain after previous decompression of the temporal bone. There was evident hollowing of the left temporal fossa, and mouth opening was limited to 5 mm. 75 made replacement of the temporomandibular joint and cranioplasty (short The aims of the operation were to treat the ankylosis, improve cosmesis, and reduce his medication. His left TMJ was reconstructed with a custom made alloplastic joint, and a communication). Br J Oral Maxillofac Surg 51:e70-e71, 2013 simultaneous custom-made cranioplasty. At follow-up after 2 years he was free of pain and taking no drugs. He had no obvious cranial deformity, and his mouth opening had increased to 35 mm. To our knowledge this is the first reported case of simultaneous custom-made cranioplasty and reconstruction of the TMJ.

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Item Bibliography Entry Abstract / Summary This study focused on three-dimensional (3D) airway space changes and stability following simultaneous maxillomandibular counterclockwise rotation, mandibular advancement, and temporomandibular joint (TMJ) reconstruction with custom-made total joint prostheses (TMJ Concepts). Cone beam computed tomography (CBCT) scans of 30 consecutive female patients Gonçalves JR, Gomes LCR, Vianna AP, Rodrigues DB, Gonçalves DAG, with irreversibly compromised TMJs were obtained at the following intervals: T1, presurgery; T2, immediately after surgery; and T3, at least 6 months after surgery. The CBCT volumetric Wolford LM: Airway space changes after maxillomandibular rotation and datasets were analysed with Dolphin Imaging software to evaluate surgical and postsurgical changes to oropharyngeal airway parameters. The average changes in airway surface area 76 mandibular advancement with TMJ Concepts® total joint prostheses: three- (SA), volume (VOL), and minimum axial area (MAA) were, 179.50 mm, 6302.60 mm, and 92.23 mm, respectively, at the longest follow-up (T3-T1) (P ≤ 0.001). Significant correlations dimensional assessment. Int J Oral Maxillofac Surg 42:1014-1022, 2013 between the amount of mandibular advancement and counterclockwise rotation of the occlusal plane and 3D airway changes were also found (P ≤ 0.01). The results of this investigation showed a significant immediate 3D airway space increase after maxillomandibular counterclockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses, which remained stable over the follow-up period. Background: Temporomandibular joint (TMJ) total replacement with alloplastic prostheses has been performed since 1960s. Research in these last two decades has achieved important improvement in the development of biomaterials, design, adaptation, and fixation of the prosthesis components. Objective To evaluate total TMJ replacement with alloplastic prostheses. Methods We studied 27 patients, between 19 and 73 years old, who had total TMJ uni or bilateral replacement surgery with custom-made alloplastic prostheses manufactured by TMJ Briceño F, Ayala R, Delgado K, Piñango S: Evaluation of TMJ total Concepts, Inc. (Ventura, CA) between 1996 and 2011. The general data and preoperative measurements were taken from medical records. Subjective data related to pain, diet 77 replacement with alloplastic prosthesis: Observational study of 27 patients. consistency, and current quality of life were collected with a questionnaire answered by the patients;measures ofmaximum interincisal opening and lateral mandibular movements were Craniomaxillofac Trauma Reconstr 6:171-178, 2013 obtained from direct examination. Results We found significant difference (p < 0.05) comparing pre- to postoperative results about improvement in mouth opening, pain relief, and satisfaction with the surgery and diet consistency. Conclusion The results of this study show that total alloplastic TMJ prostheses are an efficient, safe, and stable long-term solution for patients who need TMJ total replacement. Total replacement of the temporomandibular joint (TMJ) is increasingly accepted as the gold standard for reconstruction of irreparably damaged or ankylosed joints. The TMJ Concepts system (TMJ Concepts, Ventura, USA) has the longest follow-up of the 2 systems used in the UK. A total of 74 patients had placement of TMJ Concepts prostheses. The primary diagnoses were degenerative disease, multiple previous operations, injury, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ankylosis. Of these, 12 were revisions of previous Sidebottom AJ, Gruber E: One-year prospective outcome analysis and replacements (3 after multiple operations). Over the year there was a significant mean (SD) reduction in pain score (10 cm visual analogue scale) from 72 (2.5) to 8 (1.7) (p < 0.0001), and complications following total replacement of the temporomandibular joint mean (SD) improvements in mouth opening from 22.4 mm (9.4) to 33.7 mm (6.2) (p < 0.0001), and dietary consistency (10 cm analogue liquid 0 to solid 100) from 38 (23) to 93 (16) (p < 78 with the TMJ Concepts system. Br J Oral Maxillofac Surg 51:620-624, 0.0001). No patient had worse symptoms postoperatively. Joints in 2 patients failed because of biofilm infections. Two patients required blood transfusion and one required ligation of the 2013 external carotid artery. Five had perioperative dislocation, which responded to elastic intermaxillary fixation for one week. A total of 31 patients had partial, and 2 had total weakness of the facial nerve. All resolved fully except weakness of the temporal branch in one patient, which required brow lift. Total TMJ replacement gives good early improvements in function and pain with few complications. Of the 74 patients, 71 were very pleased to have had the procedure. One was dissatisfied despite complete pain relief and improvement in mouth opening from 3 to 30 mm, and 2 were ambivalent (one had infection, revision, and permanent weakness of the temporal branch of the facial nerve). Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can performthe surgery in 1 stage or 2 separate stages. The 2-stage approach Movahed R, Teschke M, Wolford LM: Protocol for concomitant requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery temporomandibular joint custom-fitted total joint reconstruction and 79 (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer- orthognathic surgery utilizing computer-assisted surgical simulation. J Oral assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new Maxillofac Surg 71:21233-2129, 2013 CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery. We prospectively analysed the incidence of metal allergies in patients listed for total replacement of the temporomandibular joint (TMJ) and the efficacy of patch testing to prevent rejection Sidebottom AJ, Mistry K: Prospective analysis of the incidence of metal phenomena. All patients (n = 101) that required a prosthetic TMJ between March 2004 and August 2012 were tested preoperatively. A total of 39% had anallergy to one or more metals and 80 allergy in patients listed for total replacement of the temporomandibular they were given all-titanium prostheses. Following the introduction of this protocol no patients have shown signs of an allergic rejection within 6 months of operation. We suggest that all joint (short communication). Br J Oral Maxillofac Surg 52:85-86, 2014 patients listed for total TMJ replacement should have patch tests for metal allergies and that all-titanium prostheses are used when allergy is detected.

Total replacement of the temporomandibular joint (TMJ) is an effective treatment for intractable pain and impaired function that is a consequence of end-stage joint disease. Prospective Mustafa EM, Sidebottom A: Risk factors for intraoperative dislocation of assessment of 138 joint replacements identified an 8% risk of intraoperative dislocation of the joint, which was associated primarily with coronoidectomy (30%) and inflammatory arthropathy 81 the total temporomandibular joint replacement and its management. Br J (24%). Management included the use of intermaxillary elastic traction and treatment of masticatory dystonia when present. Of the 11 patients who had light elastic traction for one week, Oral Maxillofac Surg 52:190-192, 2014 only one required further treatment for dislocation. Patients with no intraoperative dislocation did not require elastics, and joints remained stable postoperatively.

Purpose: To evaluate the use of preoperative computed tomographic angiography (CTA) and selective embolization as an ancillary tool for the treatment of patients with temporomandibular joint (TMJ) ankylosis. Materials and Methods: The present study was a case series of subjects with bilateral TMJ ankylosis who had undergone preoperative CTA and surgical release with immediate reconstruction. The indications for CTA were either an intimate association between the vessels and the ankylotic mass on the facial computed tomography Susarla SS, Peacock ZS, Williams WB, Rabinow JD, Keith DA, Kaban LB: (CT) scan or a history of multiple previous TMJ operations. In cases in which intimate anatomic association was present between the branches of the maxillary artery and the ankylotic Role of computed tomographic angiography in treatments of patients with masses, preoperative selective embolization was performed. All subjects underwent a standard approach to ankylosis release with immediate reconstruction and were followed up for up to 82 temporomandibular joint ankyloses. J Oral Maxillofac Surg 72:267-276, 6 months postoperatively. The demographic and operative variables were recorded for each subject. Results: Five subjects (mean age, 36.4 years; 3 females) with bilateral TMJ ankylosis 2014 underwent release and had undergone preoperative CTA for vascular assessment. Three subjects underwent preoperative embolization. The total operating time ranged from 5.9 to 10.3 hours. The intraoperative blood loss ranged from 150 to 3,750 mL. One patient who had undergone unilateral embolization required an intraoperative transfusion because of bleeding on the nonembolized side. No adverse cardiac, renal, or neurologic events developed secondary to the blood loss. In all 5 subjects, the preoperative maximal incisor opening was less than 15 mm, increased to more than 35 mm intraoperatively, and was 30 mm or more at 6 months or longer of follow-up. Ameloblastoma is a common epithelial odontogenic tumor, representing 1 to 3% of all cysts and tumors of the oral and maxillomandibular region. It has been more commonly found in the Ruiz Valero CA, Duran-Rodriguez G, Solano-Parra N, Castro-Núñez, J: mandible than in the maxilla. Treatment of ameloblastoma is essentially surgical, ranging from conservative therapy such as enucleation, marsupialization, and curettage, to more radical Immediate total temporomandibular joint replacement with TMJ Concepts approaches, including marginal, segmental, or composite resection. It has a high tendency to recur and, in some instances, has shown malignant development when treated inadequately. 83 prosthesis as an alternative for ameloblastoma cases. J Oral Maxillofac When resection is indicated, reconstructive measures must be considered. The aim of the present study is to report on 2 cases of large ameloblastomas of the solid/multicystic type that Surg 72:646.e1-646.e.12, 2014 were treated by hemimandibulectomy and reconstructed with a novel technique consisting of a custom-made TMJ Concepts prosthesis (TMJ Concepts, Ventura, CA). The role and outcomes of custom-made temporomandibular joint prostheses in these circumstances are discussed.

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Item Bibliography Entry Abstract / Summary

Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually. We report on 402 patients (332 (83%) female and 70 (17%) male) who had 577 joints inserted between 1994 and 2012. The main diagnoses that resulted in total joint replacement were osteoarthritis, failed operation, ankylosis, Idle MR, Lowe D, Rogers SN, Sidebottom AJ, Speculand B, Worrall SF: and seronegative arthritis. Preoperatively, the median (IQR) maximal incisal opening was 20 (15–26) mm (mean 20) and the median pain scores on the visual analogue scale (VAS 0–10) 84 UK temporomandibular joint replacement database: report on baseline were 8 for both joints. The median (IQR) baseline dietary score (liquid 0 – solid 10) was 4 (3–6). A total of 173 (43%) patients had had one or more open procedure(s) before total data. Br J Oral Maxillofac Surg 52:203-207, 2014 replacement, 177 (44%) had not had open operation, and 52 (13%) had no data entered. The 3 primary systems used were the TMJ Concepts System (Ventura, USA), the Biomet System (Biomet/Lorenz Microfixation, Jacksonville, USA), and the Christensen System (TMJ Implants, Golden, USA). The median (IQR) duration of inpatient stay was 3 (2–4) days (mean 3). Follow-up data will be collected to assess patient recorded outcome measures (PROM) and objective measurements of total joint replacements in the UK from 1994 onwards.

Alloplastic total temporomandibular joint replacement (TMJ TJR) has been performed in New Zealand utilizing the TMJ Concepts patient-fitted system since 2000. The data analysed in this study were collected retrospectively from questionnaires sent to all maxillofacial surgeons in New Zealand who had implanted TMJ Concepts devices between 2000 and 2011. A total of 63 Murdoch B, Buchanan J, Cliff J: Temporomandibular joint replacemen: a devices were implanted in 42 patients (13 males, 29 females) during this 12-year period. The primary indication for TMJ TJR was end-stage joint disease resulting from ankylosis and 85 New Zealand perspective. Int J Oral Maxillofac Surg 43:595-599, 2014 arthritis. The mean age of the patients was 47 years (range 7–80 years). The most common complication reported was transient facial nerve impairment in 4.8% of the patients. Objective results, measured as the maximal incisional opening, improved by a mean of 17.3 mm (P < 0.01); 90% of patients reported improved quality of life. New Zealand oral and maxillofacial surgeons have concluded that TMJ TJR using the TMJ Concepts prosthesis is a reliable treatment option for the management of end-stage TMJ disease. Purpose: The aim of the present studywas to assess pain, function, diet, and quality of life (QOL) in subjects undergoing alloplastic temporomandibular joint (TMJ) reconstruction. Materials and Methods: A total of 72 subjects were sent a questionnaire an average of 4 years after undergoing either unilateral or bilateral total joint replacement with a custom TMJ Concepts or Burgess M, Bowler M, Jones R, Hase M, Murdoch B: Improved outcomes stock Biomet total joint replacement device. The changes in pain, function, diet, and quality of life were assessed. Results: Of the 72 subjects, 52 returned the questionnaire. Pain, function, 86 after alloplastic TMJ replacement: Analysis of a multicenter study from diet, and QOL were all significantly improved at a mean follow-up of 46.3 months. The complications reported included an altered facial sensation and facial weakness. No implant failures Australia and New Zealand. J Oral Maxillofac Surg 72:1251-1257, 2014 were reported. Conclusions: The placement of an alloplastic TMJ total joint replacement can provide benefits for patients in the areas of pain, function, diet, and QOL. Additional research is required in this area. Temporomandibular joint (TMJ) disorder (TMD) is a collection of medical and dental conditions affecting the joint and muscles of mastication, as well as contiguous tissue components. This leads to pain and altered oral function and can lead to a poor quality of life. The majority of the population can be affected to some degree. Management of TMD is often simple in the first instance, but may involve complex decision making. This article summarizes the current investigative and treatment options available. Magnetic Resonance Imaging is the recommended Sidebottom AJ, Shahme F, Cascarini L: Current management of 87 radiological investigation of choice for soft tissue assessment whilst TMJ arthroscopy supersedes most other invasive treatments available in relation management of symptoms and more temporomandibular joint (TMJ) disease. J Arthritis 3(3):138, 2014 accurate diagnosis. Should arthroscopy fail to achieve satisfactory resolution of symptoms a standardised treatment pathway based on arthroscopic findings involves appropriate assessment, possible open surgery or even TMJ replacement. This latter procedure is governed by NICE guidelines and delivers an excellent short and medium term outcome up to 20 years. Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease that can create clinical problems in the masticatory musculature, jaws, occlusion, and other associated structures Rodrigues DB, Wolford LM, Malaquias P, Campos PSF: Concomitant and is commonly accompanied by inflammatory changes and pain. Many cases of TMJ dysfunction can be managed with nonsurgical therapies, but patients with irreversible TMJ damage treatment of mandibular ameloblastoma and bilateral temporomandibular may require surgical intervention for repair or reconstruction. Despite various methods of TMJ reconstruction, the patient-fitted total joint prostheses may be the best option to achieve good 88 joint osteoarthritis with bone graft and total joint. J Oral Maxillofac Surg outcomes. Multicystic ameloblastoma is a benign odontogenic neoplasm of the jaws that is found most often in the mandible, in the region of the molars, and the ramus. Ameloblastomas 73:63-74, 2015 usually progress slowly, but are locally invasive and may cause significant morbidity and sometimes death. This report describes a case of concomitant treatment of recurrent mandibular ameloblastoma and severe bilateral TMJ osteoarthritis treated by resection of the tumor, reconstruction with bone grafting, and bilateral TMJ reconstruction in a 63-year-old woman. Temporomandibular joint (TMJ) ankylosis is a pathologic condition where the mandible is fused to the fossa by bony or fibrotic tissues. This interferes with mastication, speech, oral hygiene, Movahed R, Mercuri LG: Management of temporomandibular joint and normal life activities, and can be potentially life threatening when struggling to acquire an airway in an emergency. Trauma is the most common cause of TMJ ankylosis, followed by 89 ankylosis. Oral Maxillofac Surg Clinics North Am 27:27-35, 2015 infection. Diagnosis of TMJ ankylosis is usually made by clinical examination and imaging studies. The management goal in TMJ ankylosis is to increase the patient's mandibular function, correct associated facial deformity, decrease pain, and prevent reankylosis. Clinicians who address temporomandibular joint (TMJ) disorders and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach Movahed R, Wolford LM: Protocol for concomitant temporomandibular joint requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery custom-fitted total joint reconstruction and orthognathic surgery using 90 (CTOS) in these cases requires careful treatment planning and surgical proficiency in the two surgical areas. This article presents a new treatment protocol for the application of computer- computer-assisted surgical simulation. Oral Maxillofac Surg Clinics North assisted surgical simulation (CASS) in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. Am 27:37-45, 2015 The new CTOS protocol helps decrease the preoperative work-up time and increase the accuracy of model surgery. During the past 3 decades, major advancements have been made in TMJ diagnostics and the development of surgical protocols to treat and rehabilitate the pathologic, dysfunctional, and Wolford LM, Goncalves JR: Condylar resorption of the temporomandibular painful TMJ as well as the associated dentofacial deformity. Research has clearly demonstrated that TMJ and orthognathic surgery can be safely and predictably performed at the same 91 joint: How do we treat it?. Oral Maxillofac Surg Clinics North Am 27:47-67, operation, but it does necessitate the correct diagnosis and treatment protocol as well as requires the surgeon to have expertise in both TMJ and orthognathic surgery. The surgical 2015 procedures can be separated into 2 or more surgical stages, but the TMJ surgery should be done first. With the correct diagnosis and treatment protocol, simultaneous TMJ and orthognathic surgical approaches provide complete and comprehensive management of patients with coexisting TMJ pathologic abnormality and dentofacial deformities.

Dislocation of the temporomandibular joint is one of many pathophysiologic joint conditions that the oral and maxillofacial surgeon is challenged with managing. Although not particularly Liddell A, Perez DE: Temporomandibular joint dislocation. Oral Maxillofac 92 common, managing a dislocated joint will inevitably be the challenge of most surgeons or physicians, whether in private or academic practice. Accordingly, this article will address the Surg Clinics North Am 27:125-136, 2015 pathophysiology associated with dislocation, in addition to treatment strategies (both historical and current practice techniques) aimed at managing acute, chronic, and recurrent dislocation. This article discusses hemifacial microsomia and Treacher Collins syndrome relative to the nature of these congenital deformities as well as the clinical, radiographic, and diagnostic Wolford LM, Perez DE: Surgical management of congenital deformities characteristics. These patients often have severe facial deformities with hypoplasia or aplasia of the temporomandibular joints (TMJs) and mandible. The surgical treatment options are 93 with temporomandibular joint malformation. Oral Maxillofac Surg Clinics presented, including the advantages and disadvantages of autogenous tissues versus patient-fitted total joint prostheses to reconstruct the TMJs and mandible as well as counterclockwise North Am 27:137-154, 2015 rotation of the maxillomandibular complex.

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Item Bibliography Entry Abstract / Summary

The general requirements for joint replacement devices emphasizes the importance of device material biocompatibility, with no inflammatory or toxic response to wear beyond a tolerable level, the appropriate mechanical properties for the desired application, and lastly economically viable manufacturing and processing methods. Implicit in these requirements is the Mercuri LG, Mathew MT, Kerwell S, et al: Temporomandibular joint importance of understanding wear and failure mechanisms of implanted devices. However, compared to orthopedic total joint replacement (TJR) devices, functional wear failure replacement device research wear and corrosion technology transfer from 94 mechanisms for temporomandibular joint (TMJ) TJR implants have not been clearly defined. Our research group has started initial translational investigations involving the analysis of failed orthopedics (short communication). J Bio Tribo Corros , Vol 1, Issue 3, retrieved TMJ TJR devices alloy microstructure compared to control, never implanted,TMJ TJR devices utilizing established orthopedic TJR device retrieval tribocorrosion evaluation 2015 protocols. This and future studies will guide future material choices and functional design improvements for TMJ TJR devices. Orthopedic TJR implant schemes may also be improved by understanding the degradation mechanism of TMJ TJR implants, as the materials employed in both TJR devices are similar.

Idiopathic condylysis (IC), also known as condylar atrophy, progressive condylar resorption, or idiopathic condylar resorption, is a progressive degeneration of the condylar anatomy due to abnormal morphological remodeling or resorption. This rare condition is nine times more likely to occur in females than in males; because it has been linked to trauma in teenage females, it is sometimes called “cheerleader’s syndrome”. Etiological factors are commonly classified as local or systemic. IC can be a manifestation of medical conditions such as juvenile idiopathic Abela S, Tewson D, Prince S, Sidebottom A, Bister D: Total TMJ arthritis or hormonal imbalance, or can occur as a complication of orthodontic treatment or orthognathic surgery. A patient with IC usually presents with a severe Class II skeletal base 95 reconstruction in cases of advanced idiopathic condylysis. J of Clinical accompanied by a retrognathic mandible, an excessive vertical dimension, and a reduced chin-to-throat distance. Intraoral evaluation will confirm a shortening of the mandibular ramus- Orthodontics 49:263-269, 2015 condylar unit and deficient lower posterior facial height.10 Typical features include a Class II, division 1 incisor relationship with an inadequate overbite or anterior open bite and excessive overjet. Treatment invariably requires orthodontics in combination with orthognathic surgery, articular-disc repositioning, distraction osteogenesis, and/or TMJ reconstruction with autogenous or alloplastic grafts. This article describes an unusual case of a young adult treated with bilateral alloplastic reconstruction of the TMJs.

In this prospective analysis, we assess the medium-term benefits, efficacy, and safety of the TMJ Concepts joint replacement system in theUnited Kingdom. Outcome measures of pain, maximum mouth opening, and diet were recorded preoperatively and at intervals up to 3 and 5 years. All patients who had replacement temporomandibular joints (TMJ) within a 6-year Gruber EA, McCullough J, Sidebottom AJ: Medium-term outcomes and period were included. A total of 58 patients (84 joints) were followed up for 3 years (mean age 47, range 19–72) and 26 (42 joints) for 5 years (mean age 46, range 27–70). The female complications after total replacement of the temporomandibular joint. tomale ratio was 52:6 at 3 years and 23:3 at 5 years. The most common diagnosis was degenerative disease, and the mean number of previousTMJ procedures was 2.4 (range 0–14). 96 Prospective outcome analysis after 3 and 5 years. Br J Oral Maxillofac There were significant improvements in pain scores (7.4 reduced to 0.6 at 3 years and 0.8 at 5 years),maximum mouth opening (21.0–35.5 mm at 3 years and 23.8–33.7 mm at 5 years), Surg 53:412-415, 2015 and dietary scores (4.1–9.7 at 3 years and 3.7–9.6 at 5years). Revision operations were required in 2 patients (not included in the outcome data) for biofilm infection of the prosthesis secondaryto local infection in the head and neck. One patient had weakness of the temporal branch of the facial nerve that needed correction. TMJreplacement is an effective form of management for an irreparably damaged joint, particularly in cases of ankylosis. It lessens pain andimproves function with minimal long-term morbidity. Purpose: To evaluate subjective and objective outcomes of patients receiving Techmedica (currently TMJ Concepts) patient-fitted temporomandibular joint (TMJ) total joint replacement (TJR) devices after 19 to 24 years of service. Patients and Methods: This prospective cohort study evaluated 111 patients operated on by 2 surgeons using Techmedica (Camarillo, CA) patient-fitted TMJ TJR devices from November 1989 to July 1993. Patients were evaluated before surgery and at least 19 years after surgery. Subjective evaluations used standard forms and questions with a Likert scale for 1) TMJ pain (0, no pain; 10, worst pain imaginable), 2) jaw function (0, normal function; 10, no movement), 3) diet (0, no restriction; 10, liquid only), and Wolford LM, Mercuri LG, Schneiderman ED, Movahed R, Allen W: Twenty- 4) quality of life (QoL; improved, the same, or worse). Objective assessment measured maximum incisal opening (MIO). Comparison analysis of presurgical and longest follow-up data used year follow-up study on a patient-fitted temporomandibular joint prosthesis: nonparametric Mann- Whitney and Wilcoxon signed rank tests. Spearman correlations evaluated the number of prior surgeries in relation to objective and subjective variables. Results: Of 97 the Techmedica/TMJ Concepts device. J Oral Maxillofac Surg 73:952-960, the 111 patients, 56 (50.5%) could be contacted and had adequate records for inclusion in the study. Median follow-up was 21 years (interquartile range [IQR], 20 to 22 yr). Mean age at 2015 surgery was 38.6 years (standard deviation, 10 yr). Median number of previous TMJ surgeries was 3 (IQR, 4). Presurgical and longest follow-up data comparison showed statistically significant improvement (P < .001) for MIO, TMJ pain, jaw function, and diet. At longest follow-up, 48 patients reported improved QoL, 6 patients reported the same QoL, and 2 patients reported worse QoL. Spearman correlations showed that an increased number of previous surgeries resulted in lower levels of improvement for TMJ pain and MIO. Conclusions: At a median of 21 years after surgery, the Techmedica/TMJ Concepts TJR continued to function well. More previous TMJ surgeries indicated a lesser degree of improvement. No devices were removed owing to material wear. Changes or disruptions in the process of mandibular development can happen in the early stages of formation, and the malformations may be isolated or part of a syndrome. Hypoplasia or aplasia of the mandibular condyles indicates underdevelopment or non-development and is associated with multiple craniofacial abnormalities. Patients who experience these congenital Castro V: Orthodontic-surgical treatment of a rare case of aplasia of the 98 deformities may benefit from reconstruction using total joint prostheses. In addition, orthognathic surgery may be required to treat severe respiratory syndromes and to correct dentofacial mandibular condyles. iMedPub Journals 1:1-6, 2015 deformities to obtain functional and aesthetic results. Therefore, this paper presents a rare case of aplasia of the mandibular condyles and treatment of dentofacial deformities associated with severe obstructive sleep apnea and the reconstruction of the temporomandibular joint. Tophaceous pseudogout, a variant of calcium pyrophosphate dihydrate deposition, is a relatively rare juxtaarticular disease. It is a metabolic condition, in which patients develop pseudo- tumoral calcifications associated with peri-articular structures secondary to calcium pyrophosphate deposition into joints with fibrocartilage rather than hyaline cartilage. These lesions are reported in the knee, wrist, pubis, shoulder, and temporomandibular joint (TMJ) and induce a histocytic foreign body giant cell reaction.We report a case of tophaceous pseudogout affecting Pellecchia R, Holmes C, Wun E, Wolf J: Treatment of tophaceous the left TMJ with destruction of the condyle and glenoid and middle cranial fossa that was reconstructed with a TMJ Concepts (Ventura, CA) custom-fitted prosthesis in a 2-staged surgical 99 pseudogout with custom-fitted temporomandibular joint: a two-staged approach using a silicone spacer. The surgical management using a patientspecific TMJ is a viable option when the fossa or condylar component has been compromised due to breakdown approach. Oral and Max Surgery 1:53-58, 2015 of bone secondary to a pathologic process. Our case describes and identifies the lesion and its rare occurrence in the region of the temporomandibular region. The successful management of tophaceous pseudogout of the TMJ must include a thorough patient workup including the involvement of other joints as well as the modification of bone of the glenoid fossa and condylar relationship of the TMJ. Patients with temporomandibular joint (TMJ) conditions and coexisting dentofacial deformities can have these conditions corrected with concomitant TMJ and orthognathic surgery (CTOS) in 1 surgical stage or separated into 2 surgical stages. The 2-stage approach requires the patient to undergo 2 separate operations (surgery to correct the TMJ condition and a second Wolford LM: Computer-assisted surgical simulation for concomitant operation to perform the orthognathic surgery) and 2 general anesthetics, significantly lengthening the overall treatment time. Performing CTOS in a single operation significantly decreases temporomandibular joint custom-fitted total joint reconstruction and treatment time and provides better outcomes but requires careful treatment planning and surgical proficiency in the 2 surgical areas. Some TMJ conditions require total joint prostheses for 100 orthognathic surgery. Oral Maxillofac Surg Clinics North Am 24:55-66, best results. The application of computer technology for TMJ and orthognathic surgical planning and implementation has significantly improved the accuracy and predictability of treatment 2016 outcomes. This article presents the treatment planning and surgical protocol for the application of computer-assisted surgical simulation (CASS) for CTOS cases requiring TMJ reconstruction with patient-fitted total joint prostheses and orthognathic surgery. The CASS protocol decreases the preoperative workup time and increases the accuracy of model preparation and subsequent surgery

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Item Bibliography Entry Abstract / Summary Temporomandibular joint (TMJ) ankylosis is a pathological condition characterized by articular bony or fibrous tissue fusion. TMJ ankylosis developing during childhood can lead to growth complications because of the loss of mandibular function. Hard and soft autogenous tissue grafting has been used for TMJ reconstruction in the growing patient. However, in cases where autogenous tissue grafts fail either due to unpredictable growth or ankylosis, total alloplastic temporomandibular joint replacement (TMJ TJR) can provide a viable option. The case of a 7- Cascone P, Basile E, Angeletti D, Vellone V, et al: TMJ replacement year old female suffering from recurrent bilateral TMJ ankylosis resulting from birth trauma, and with concomitant obstructive sleep apnea syndrome (OSAS) is presented. Due to prior 101 utilizing patient-fitted TMJ TJR devices in a re-ankylosis child. J surgical and autogenous graft failures, the decision was made to complete her joint reconstructions utilizing patient-fitted TMJ prostheses. Questions have been raised about the longevity of Craniomaxillofac Surg 44:493-499, 2016 TMJ TJR devices as well as their lack of growth potential, but children with TMJ ankylosis do not have condyle-related growth potential and that replacing failed autogenous tissue graft material with more autogenous tissue will result in the same adverse outcomes. Therefore, in growing patients with recurrent TMJ ankylosis and/or failed autogenous tissue grafts, there may be a role for TMJ TJR. Purpose: Recommended treatment for patients with osteochondromas of the mandibular condyle is to perform complete condylectomy with joint replacement. Low condylectomy with joint preservation has recently been proposed as a treatment option. This study compared the outcomes of these treatment options in patients with condylar osteochondromas. Patients and Methods: Patients were divided into 2 groups: patients who underwent complete condylectomy and joint replacement (group A, n = 13) and patients who underwent low condylectomy and Mehra P, Arya V, Henry C: Temporomandibular joint condylar joint preservation (group B, n = 8). To optimize occlusion, function, and esthetics, maxillary and mandibular orthognathic procedures were performed as necessary to re-establish vertical osteochondroma: Complete condylectomy and joint replacement versus 102 ramus height. Outcomes were measured clinically and radiographically. Results: The 2 groups showed significant clinical improvement (P < .05), with no tumor recurrence. Group A had low condylectomy and joint preservation. J Oral Maxillofac Surg 74:911- increased operating room (OR) time and donor-site complications in those who received autogenous joint reconstruction compared with alloplastic joint replacement. Group B had a shorter 925, 2016 OR duration with quicker postoperative recovery. Orthognathic procedures were stable in all cases. Conclusions: Complete and low condylectomies are viable options for the surgical management of osteochondromas of the mandibular condyle. If temporomandibular joint (TMJ) reconstruction is required, patient-fitted TMJ replacements provide similar clinical outcomes as autogenous reconstruction, but have the advantages of eliminating donor-site morbidity and decreasing operating time.

Purpose: To measure and identify factors associated with treatment outcomes for patients with temporomandibular joint (TMJ) ankylosis treated with TMJ Concepts patient-fitted total joint prostheses and autogenous fat grafts. Patients and Methods: This retrospective cohort study evaluated records of patients with TMJ ankylosis from a single private practice, treated from 1992 to 2011, who met the following inclusion criteria: 1) radiographic evidence of bony ankylosis, 2) limited incisal opening, 3) minimum of 12 months’ follow-up, and 4) treatment with TMJ Concepts (Ventura, CA)/Techmedica (Camarillo, CA) total joint prostheses and fat grafts. For each patient, the number of previous TMJ surgical procedures, as well as the estimated age of ankylosis onset, age at surgery, and length of postoperative follow-up, was recorded. Subjective evaluations were made with Likert-like scales (from 0 to 10) for 1) TMJ pain, 2) headache Wolford L, Movahed R, Teschke M, Fimmers R, et al: Temporomandibular and facial pain, 3) jaw function, 4) diet, and 5) disability. Objective evaluations included maximal incisal opening and excursion movements. Nonparametric statistics were used for analysis. joint ankylosis can be successfully treated with TMJ Concepts patient-fitted Results: There were 32 patients (22 female and 10 male patients) with 48 ankylosed TMJs (16 bilateral and 16 unilateral) in this study, with a mean age of 39 years (range, 11 to 68 years), 103 total joint prosthesis and autogenous fat grafts. J Oral Maxillofac Surg 2 or more previous TMJ surgical procedures in 69%, and a mean follow-up period of 68 months (range, 12 to 168 months). Trauma was the major etiology of TMJ ankylosis, occurring in 17 74:1215-1227, 2016 of 32 patients (53%). The following improvements occurred: The median value for TMJ pain changed from 8.0 preoperatively to 1.5 at longest follow-up; headache, from 8 to 3.5; facial pain, from 8 to 4; jawfunction, from 8 to 2.5; diet, from 7 to 3; and disability, from 7 to 1.5. The median incisal opening was 14.5 mm (interquartile range, 6.3 to 20 mm) preoperatively and 35 mm (interquartile range, 30 to 40 mm) at longest follow-up. The median left lateral excursion improved from 0.5 to 2 mm, and the median right lateral excursion improved from 1 to 1.3 mm. All of these improvements were highly significant (P < .001, Wilcoxon tests). Equally favorable outcomes were found in patients with 12 to 48 months of maximal follow-up and patients with more than 48 months of maximal follow-up. Conclusions: The treatment of TMJ ankylosis with the TMJ Concepts patient-fitted total joint prosthesis in combination with fat grafting around the articulation area of the prosthesis is a viable and predictable method for improving pain levels, function, and quality of life, as well as prevention of reankylosis of the TMJ. We report the outcomes of patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, who had total replacement of thetemporomandibular joint (TMJ) using the TMJ Concepts system between 2005 and 2014. We prospectively measured mouth opening (mm),and pain and dietary function (visual analogue scale (VAS), 1 - 100) before operation, and at 6 O'Connor RC, Saleem S, Sidebottom AJ: Prospective outcome analysis of weeks, 6 months, one year, and beyond.Forty-six joints were replaced in 26 patients (mean age 40, range 16 - 71), 22 of whom were female. Most had rheumatoid (n = 17) or total replacement of the temporomandibular joint with the TMJ Concepts 104 psoriaticarthritis (n = 7). At one year the mean (SD) pain scores had fallen from 55 (36) to 2 (7) on the left, and from 62 (31) to 2 (5) on the right(p < 0.001). Mean (SD) scores for dietary system in patients with inflammatory arthrtic diseases. Br J Oral Maxillofac function had increased from 48(25) to 95(9) (p < 0.001), and mouth opening had increased from amean (SD) of 23(10) mm to 35(5) mm (p < 0.001). The joints dislocated during the Surg 54:604-609, 2016 operation in 5 patients, and 4 had temporary weakness ofthe facial nerve. Outcomes after replacement of the TMJ with the TMJ Concepts system were good in patients with inflammatory arthritis,which further validates the procedure, as damage to the joint is severe in this group. Purpose: The purpose of this study was to evaluate patients requiring unilateral total temporomandibular joint (TMJ) reconstruction and the risk for development of postsurgical contralateral TMJ pain and dysfunction over time requiring subsequent contralateral total joint reconstruction. Long-term subjective and objective outcomes of unilateral TMJ reconstruction also were evaluated. Materials and Methods: Seventy patients underwent unilateral total joint reconstruction using a patient-fitted total joint prosthesis from a single private practice from 1990 through 2012. The inclusion criteria were 1) unilateral TMJ reconstruction with TMJ Concepts or Techmedica patient-fitted total joint prosthesis; 2) operation performed by 1 surgeon (L.M.W.); 3) minimum 12-month follow-up; and 4) adequate records. There were no specific exclusion criteria. The primary outcome variable was to evaluate the effects of unilateral TMJ reconstruction with a total joint prosthesis on the contralateral TMJ relative to development of pain and dysfunction requiring subsequent contralateral reconstruction with a total joint Perez DE, Wolfrd LM, Schneiderman E, Movahed R, et al: Does unilateral prosthesis. Secondary outcome variables for all patients included TMJ pain, facial pain, headaches, diet, disability, quality of life, maximumincisal opening (MIO), and lateral excursion 105 temporomandibular total joint reconstruction result in contralateral joint pain movements after unilateral TMJ reconstruction with the patient-fitted total joint prosthesis. Student t test andWilcoxon test were used for statistical analyses, with a P value less than .01 for and dysfunction?. J Oral Maxillofac Surg 74:1539-1547, 2016 statistical significance. Results: Sixty-one of 70 patients (87%) met the inclusion criteria (47 women [77%] and 14 men [23%]; average age, 38 yr; age range, 11 to 69 yr; average follow-up, 44 months; range, 12 to 215 months). Eight of 61 patients (13%) subsequently required contralateral TMJ reconstruction with a total joint prosthesis related to contralateral pain, dysfunction, and arthritis, but all 8 (8 of 27 [29.6%]) had previous contralateral TMJ disc repositioning surgery. For the secondary outcomes, TMJ pain decreased 63%, jaw function improved 61%, facial pain decreased 59%, headaches decreased 57%, diet improved 52%, disability decreased 58.5%, and MIO increased from 31.4 to 38.8 mm (mean change, 7.4 mm). All subjective factors and MIO showed statistically significant improvements at longest follow-up (P < .01). Conclusions: Patients requiring unilateral TMJ reconstruction with a patient-fitted total joint prosthesis have a strong probability of improving their clinical condition and do not require bilateral reconstruction if the contralateral TMJ is healthy. Patients with previous or concomitant contralateral TMJ surgery (articular disc repositioning) have an approximately 30% chance of requiring a total joint prosthesis in the future.

04/19/2017 TMJ Concepts Related Articles Page 14 of 14

Item Bibliography Entry Abstract / Summary

Purpose: The purpose of this study is to provide a statistical projection of the number of alloplastic temporomandibular joint (TMJ) total joint replacements (TJRs) that will be performed in the United States through the year 2030. Materials and Methods: The program directors of all 101 Commission on Dental Accreditation–accredited oral and maxillofacial surgery training programs in the United States were surveyed online by use of a questionnaire developed using Redcap (Chicago, IL) over a 6-week period (February 2015–March 2015). The questionnaire included 19 questions related to each program’s TMJ disorder and TMJ TJR curricula, as well as clinical experience. In addition, members of the American Society of Temporomandibular Onoriobe U, Miloro M, Sukotjo C, Mercuri LG, et al: How many Joint Surgeons were surveyed online using Redcap and via direct survey forms. Moreover, requests for the total number of TMJ TJR devices produced and implanted during the same 106 temporomandibular joint total joint alloplastic implants will be placed in the period were made to the 3 manufacturers of Food and Drug Administration–approved TMJ TJR devices in the United States. Results: The response rate among program directors was United States in 2030?. J Oral Maxillofac Surg 74:1531-1538, 2016 52.5%, and the total number of TMJ TJR devices implanted in oral and maxillofacial surgery programs in 2005 was 412. This total increased by 38% to 572 in 2014. Statistically, this projects an increase of 58% over the next 16 years to 902 TMJ TJR operations by 2030 (95% prediction limits, 768 and 1,037). The total number of TMJ TJR devices distributed by one manufacturer increased from 430 in the year 2000 to 1,004 in 2014 (133%). By use of these data, statistically over the next 16 years, the number of TMJ TJR devices distributed by this company is projected to be 1,658 (95% prediction limits, 1,380 and 1,935). Conclusions: The data presented in this study show an increasing demand for the use of TMJ TJR devices in the management of end-stage TMJ disorders to the year 2030.

Purpose: To determine whether the number of screws used to fixate a TMJ Concepts total joint prosthesis correlates with loss of hardware fixation or postoperative complications. Materials and Methods: A retrospective cohort study of patients undergoing total temporomandibular joint (TMJ) reconstruction with the TMJ Concepts custom prosthesis at the Mayo Clinic from 2005 to 2015 was undertaken. The primary predictor variable was the percentage of screw fixation used in the condylar component. The primary outcome variable was loss of hardware fixation. Secondary outcome variables included postoperative wound infection, removal of hardware, and return to the operating room. Covariates abstracted included patient demographics, comorbidity indices, preoperative occlusion, contralateral TMJ reconstruction, performing surgeon, duration of procedure and anesthesia, intraoperative fluid administration, Ettinger KS, Arce K, Fillmore WJ, VanEss JM, Yetzer JG, Viozzi CF: Does concomitant surgical procedures, perioperative antibiotics, prior TMJ surgeries, prior Proplast Teflon implantation, prior head and neck radiation, use of heterotopic ossification radiation the amount of screw fixation utilized for the condylar component of the TMJ protocol, and use of the 2 most superior screw holes in the condylar component. Results: The study sample was composed of 45 patients representing 64 TMJ Concepts reconstructions. 107 Concepts Total Temporomandibular joint reconstruction predispose to Mean age was 49.1 years (standard deviation, 13.4 yr; range, 19 to 85 yr). The female distribution was 86%. There were 15 simultaneous bilateral reconstructions, 26 unilateral hardware loss or postoperative complications?. J Oral Maxillofac Surg reconstructions, and 4 staged bilateral reconstructions. Eighteen reconstructions (28%) were placed using 100% of the available screw holes in the condylar component. Forty-six 74:1741-1750, 2016 reconstructions (72%) were placed using fewer than 100% of the available screw holes in the condylar component (range of screw fixation, 56 to 89%). The minimum number of screws used to fixate the condylar component was 5, which was observed in 9 reconstructions (14%). There was no postoperative loss of hardware fixation in any reconstruction under study. Six reconstructions showed a postoperative complication defined by the secondary outcomes. Univariable or multivariable modeling was precluded for the primary and secondary outcomes owing to the low frequency of observed complications. Conclusion: Fixating the condylar component of the TMJ Concepts total joint prosthesis using fewer than 100% of the available screw holes does not predispose the reconstruction to hardware loss, particularly if greater than 50% screw fixation can be achieved or a minimum of 5 screws are used.

Temporomandibular joint (TMJ) replacement is the gold standard for reconstruction of the ankylosed joint, as it provides the facility for early function and a suitably large gap, both aimed at Selbong U, Rashidi R, Sidebottom A: Management of recurrent heterotopic the prevention of recurrence. The recurrence of heterotopic ossification is traditionally managed by resection, a temporary spacer, and remake of the prosthesis, with placement at a second 108 ossification around total alloplastic temporomandibular joint replacement. procedure, which adds to costs and morbidity. Atraumatic removal of the prosthesis, resection of the heterotopic tissue, replacement of the prosthesis into its previous position, and the Int J Oral Maxillofac Surg 45:1234-1236, 2017 packing of fat around the articulation represents a technique that both minimizes morbidity and reduces costs. This technique has been utilized in three cases, with early improvement in mobility, function, and pain. It is still too early to determine whether the outcomes obtained will be maintained in the long-term.

Purpose: Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR. Patients and Methods: A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) Mehra P, Nadershah M, Chigurupati R: Is Alloplastic Temporomandibular mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective Joint Reconstruction a Viable Option in the Surgical Management of Adult evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and 109 Patients With Idiopathic Condylar Resorption?. J Oral Maxillofac Surg relapse. Results: Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years 74:2044-2054, 2016 (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was −10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions. Conclusions: Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.

04/19/2017