Total Mandibular Joint Replacement as a Treatment Modality for Temporomandibular Joint Disorders: A Case Report
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Abstract
Temporomandibular Joints (TMJ) is a bilateral fibrocartilage joint. This joint is unique in that it is a bilateral joint that functions as one unit. As with the other joints, many conditions affect TMJ causing It not to do its tasks. These conditions are ankylosis, arthritis, trauma, congenital abnormalities, pathologic diseases, and chronic dislocation. Although as a rule less is often best in treating Temporomandibular disorder (TMD) sometimes it is necessary to use invasive modalities. Total mandibular joint replacement (TMJR) is one of them that has been in use since 1963 and has been developed since. It is used in End-stage TMJ diseases resulting in anatomical architectural form distortion and physiological dysfunction dictates the need for reconstruction. Although nowadays the use of TMJ prosthesis is popular, sometimes it has catastrophic results due to its complications. If there is no indication, this method may cause legal issues. This article provides an overview of the clinical indications and contraindications associated with the TMJR and outcomes for our custom TMJ prosthesis cases are presented. Keywords: Temporomandibular joint replacement; Indication; Contraindication; Total joint, ankylosis; Degenerative joint disease.
1. Bordoni, Bruno; Varacallo, Matthew (2021-02-07). "Anatomy, Head and Neck, Temporomandibular Joint". National Center for Biotechnology Information, U.S. National Library of Medicine. StatPearls Publishing LLC. PMID 30860721. Retrieved June 23, 2021
2. https://www.nidcr.nih.gov/health-info/tmj/
3. Christensen RW. The correction of mandibular ankylosis by arthroplasty and the insertion of a cast vitallium glenoid fossa: a new technique. A preliminary report of three cases. Am Journal Orthop 1963; 5:16–24.
4. Mercuri LG. The use of alloplastic prostheses for temporomandibular joint reconstruction. J Oral Maxillofac Surg. 2000; 58:70–5.
5. Kazanjian V H. Ankylosis of the temporomandibular Joint. American Journal of Orthodontics and Oral Surgery 1938; 24(12):118-20.
6. Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg. 1990; 48:1145–51.
7. Elgazzar R.F., Abdelhady A.I., Saad K.A. Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt. Int. J Oral Maxillofac. Surg. 2010; 39:333–342.
8. Obeid G, Gutterman SA, Connole PW. Costochondral grafting in condylar replacement and Management of TMJ Ankylosis and mandibular reconstruction. J Oral Maxillofac Surg 1988; 48:177.
9. Balon P., Vesnaver A., Kansky A., Kočar M., Prodnik L. Treatment of end-stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: the Slovenian experience. J Cranio-Maxillo-Fac Surg. 2019;47(1):60–65.
10. Wolford L., Movahed R., Teschke M., Fimmers R., Havard D., Schneiderman E. Temporomandibular joint ankylosis can Be successfully treated with TMJ concepts patient-fitted total joint prosthesis and autogenous fat grafts. J Oral Maxillofac Surg. 2016;74(6):1215–1227.
11. Gerbino G., Zavattero E., Berrone S., Ramieri G. One stage treatment of temporomandibular joint complete bony ankylosis using total joint replacement. J Cranio-Maxillo-Fac Surg. 2016;44(4):487–492.
12. Sahdev R., Wu B.W., Anderson N., Khawaja S.N., Kim S., Keith D.A. A retrospective study of patient outcomes after temporomandibular joint replacement with alloplastic total joint prosthesis at Massachusetts General Hospital. J Oral Maxillofac Surg. 2019;77(2):280–288.
13. Wang X.D., Zhang J.N., Gan Y.H., Zhou Y.H. Current Understanding of Pathogenesis and Treatment of TMJ Osteoarthritis. J. Dent. Res. 2015; 94:666–673. doi: 10.1177/0022034515574770.
14. Mejersjo C. Therapeutic and prognostic considerations in TMJ osteoarthrosis: a literature review and a long-term study in 11 subjects. Cranio 1987; 5:69-78.
15. Al-Moraissi, E.A.; Wolford, L.M.; Ellis E 3rd Neff, A. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J. Craniomaxillofac. Surg. 2020, 48, 9–23.
16. Yoda, T.; Ogi, N.; Yoshitake, H.; Kawakami, T.; Takagi, R.; Murakami, K.; Yuasa, H.; Kondoh, T.; Tei, K.; Kurita, K. Clinical guidelines for total temporomandibular joint replacement. Jpn. Dent. Sci. Rev. 2020, 56, 77–83.
17. Sansare K, Raghav M, Mallya SM, Karjodkar F. Management-related outcomes and radiographic findings of idiopathic condylar resorption: A systematic review. Int J Oral Maxillofac Surg. 2015; 44:209–16.
18. J.C. Posnick et al. Idiopathic condylar resorption: current clinical perspectives J Oral Maxillofac Surg (2007)
19. Riechmann, Merle, et al. "Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence-and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project." Journal of Clinical Medicine 12.15 (2023): 4946.
20. Mercuri, L.G. A rationale for total alloplastic temporomandibular joint reconstruction in the management of idiopathic/progressive condylar resorption. J. Oral. Maxillofac. Surg. 2007, 65, 1600–1609.
21. Neff AM, McLeod NM, Jung JP, Reichert CS, Schmidt C. Indications for alloplastic temporomandibular joint replacement in maxillofacial trauma—An analysis of condylar trauma patients with scoping review of the literature. Frontiers of Oral and Maxillofacial Medicine. 2023 Jun 10;5.
22. Sidebottom AJ. UK TMJ replacement surgeons; British Association of Oral and Maxillofacial Surgeons. Guidelines for the replacement of temporomandibular joints in the United Kingdom. Br J Oral Maxillofac Surg 2008;46:146-7.
23. Poveda-Roda, R.; Bagan, J.V.; Sanchis, J.M.; Margaix, M. Pseudotumors and tumors of the temporomandibular joint. A review. Med. Oral Patol. Oral Cir. Bucal 2013, 18, 392–402.
24. Fallahi Motlagh M, Janbaz Y, Abaszade A. Huge peripheral osteoma of the mandibular condyle: a case report. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2015 Nov 1;27(6):808-11.
25. Poveda-Roda R, Bagán JV, Sanchis JM, et al. Pseudotumors and tumors of the temporomandibular joint. A review. Med Oral Patol Oral Cir Bucal 2013;18:e392-402.
26. Fallahi Motlagh M, Bayat M, Naji S. Bone allograft: an option for total mandibular reconstruction. Craniomaxillofacial Trauma & Reconstruction. 2017 Dec;10(4):306-13.
27. Teschke M, Naujokat H. Indications for alloplastic temporomandibular joint replacement in maxillofacial surgery for benign lesions: a review of the literature and clinical cases. Frontiers of Oral and Maxillofacial Medicine. 2023 Dec 30;5.
28. Mommaerts MY, Nicolescu I, Dorobantu M, De Meurechy N. Extended total temporomandibular joint replacement with occlusal adjustments: pitfalls, patient-reported outcomes, subclassification, and a new paradigm. Annals of Maxillofacial Surgery. 2020 Jan;10(1):73.
29. Wolford LM, Kesterke MJ, Harrison II CE. The efficacy of patient-fitted total joint prostheses and orthognathic surgery to reconstruct patients with congenital craniofacial deformities and temporomandibular joint malformation: a systematic review. Frontiers of Oral and Maxillofacial Medicine. 2023 Sep 10;5.
30. A. R. Vento, R. A. LaBrie, and J. B. Mulliken, “The O.M.E.N.S. classification of hemifacial microsomia,” Cleft Palate-Craniofacial Journal, vol. 28, no. 1, pp. 68–77, 1991.
31. L. M. Wolford and D. E. Perez, “Surgical management of congenital deformities with temporomandibular joint malformation,” Oral and Maxillofacial Surgery Clinics of North America, vol. 27, no. 1, pp. 137–154, 2015.
32.L. M. Wolford, T. C. Bourland, D. Rodrigues, D. E. Perez, and E. Limoeiro, “Successful reconstruction of nongrowing hemifacial microsomia patients with unilateral temporomandibular joint total joint prosthesis and orthognathic surgery,” Journal of Oral and Maxillofacial Surgery, vol. 70, no. 12, pp. 2835–2853, 2012.
33. L. B. Kaban, B. L. Padwa, and J. B. Mulliken, “Surgical correction of mandibular hypoplasia in hemifacial microsomia: the case for treatment in early childhood,” Journal of Oral and Maxillofacial Surgery, vol. 56, pp. 628–638, 1998.
34. Posnick, Jeffrey C. "Treacher Collins syndrome: perspectives in evaluation and treatment." Journal of oral and maxillofacial surgery 55.10 (1997): 1120-1133.
35. Arvystas M. Shprintzen R.J.Craniofacial morphology in Treacher Collins syndrome.Cleft Palate Craniofac J. 1991; 28: 226
36. Mercuri L.G textbook: Temporomandibular Joint Total Joint Replacement – TMJ TJR.2016. DOI 0.1007/978-3-319-21389-7
37. Huang IY, Chen CM, Kao YH, Chen CM, Wu CW. Management of long-standing mandibular dislocation. Int J Oral Maxillofac Surg. 2011; 40:810–4.
38. Debnath SC, Kotrashetti SM, Halli R, Baliga S. Bilateral vertical-oblique osteotomy of the ramus (external approach) for treatment of a long-standing dislocation of the temporomandibular joint: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. 2006;101: e79–82.
39. Sarlabous M, Psutka DJ. Total joint replacement after condylar destruction secondary to long-standing dislocation of the temporomandibular joint. Journal of Craniofacial Surgery. 2020 Jun 1;31(4):989-95.
40. Elledge RO, Speculand B. Indications for replacement after alloplastic temporomandibular joint device failure: a narrative review. Frontiers of Oral and Maxillofacial Medicine. 2023 Dec 30;5.
41. Amarista FJ, Mercuri LG, Perez D. Temporomandibular Joint Prosthesis Revision and/or Replacement Survey and Review of the Literature. J Oral Maxillofac Surg 2020; 78:1692-703.
42. Pittenger DE. Heterotopic ossification. Orthop Rev. 1991; 20:33–9.
43. Reid R, Cooke H. Postoperative ionizing radiation in the management of heterotopic bone formation in the temporomandibular joint. J Oral Maxillofac Surg. 1999; 57:900–5.
44. Mercuri LG, Alcheikh Ali F, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of re-ankylosis of the temporomandibular joint. J Oral Maxillofac Surg. 2008; 66:1794–803.
45. Sidebottom AJ. Alloplastic or autogenous reconstruction of the TMJ. J Oral Biol Craniofac Res 2013; 3:135-9.
46. Hussain OT, Sah S, Sidebottom AJ. Prospective comparison study of one-year outcomes for all titanium total temporomandibular joint replacements in patients allergic to metal and cobalt-chromium replacement joints in patients not allergic to metal. Br J Oral Maxillofac Surg 2014;52:34–37.
47. Mercuri, LG. Avoiding and managing temporomandibular joint total joint replacement surgical site infections. J Oral Maxillofac Surg 2012;70:2280–2289
48. Mercuri LG. Microbial biofilms: a potential source for alloplastic device failure. J Oral Maxillofac Surg 2006;64:1303–1309.
2. https://www.nidcr.nih.gov/health-info/tmj/
3. Christensen RW. The correction of mandibular ankylosis by arthroplasty and the insertion of a cast vitallium glenoid fossa: a new technique. A preliminary report of three cases. Am Journal Orthop 1963; 5:16–24.
4. Mercuri LG. The use of alloplastic prostheses for temporomandibular joint reconstruction. J Oral Maxillofac Surg. 2000; 58:70–5.
5. Kazanjian V H. Ankylosis of the temporomandibular Joint. American Journal of Orthodontics and Oral Surgery 1938; 24(12):118-20.
6. Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg. 1990; 48:1145–51.
7. Elgazzar R.F., Abdelhady A.I., Saad K.A. Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt. Int. J Oral Maxillofac. Surg. 2010; 39:333–342.
8. Obeid G, Gutterman SA, Connole PW. Costochondral grafting in condylar replacement and Management of TMJ Ankylosis and mandibular reconstruction. J Oral Maxillofac Surg 1988; 48:177.
9. Balon P., Vesnaver A., Kansky A., Kočar M., Prodnik L. Treatment of end-stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: the Slovenian experience. J Cranio-Maxillo-Fac Surg. 2019;47(1):60–65.
10. Wolford L., Movahed R., Teschke M., Fimmers R., Havard D., Schneiderman E. Temporomandibular joint ankylosis can Be successfully treated with TMJ concepts patient-fitted total joint prosthesis and autogenous fat grafts. J Oral Maxillofac Surg. 2016;74(6):1215–1227.
11. Gerbino G., Zavattero E., Berrone S., Ramieri G. One stage treatment of temporomandibular joint complete bony ankylosis using total joint replacement. J Cranio-Maxillo-Fac Surg. 2016;44(4):487–492.
12. Sahdev R., Wu B.W., Anderson N., Khawaja S.N., Kim S., Keith D.A. A retrospective study of patient outcomes after temporomandibular joint replacement with alloplastic total joint prosthesis at Massachusetts General Hospital. J Oral Maxillofac Surg. 2019;77(2):280–288.
13. Wang X.D., Zhang J.N., Gan Y.H., Zhou Y.H. Current Understanding of Pathogenesis and Treatment of TMJ Osteoarthritis. J. Dent. Res. 2015; 94:666–673. doi: 10.1177/0022034515574770.
14. Mejersjo C. Therapeutic and prognostic considerations in TMJ osteoarthrosis: a literature review and a long-term study in 11 subjects. Cranio 1987; 5:69-78.
15. Al-Moraissi, E.A.; Wolford, L.M.; Ellis E 3rd Neff, A. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J. Craniomaxillofac. Surg. 2020, 48, 9–23.
16. Yoda, T.; Ogi, N.; Yoshitake, H.; Kawakami, T.; Takagi, R.; Murakami, K.; Yuasa, H.; Kondoh, T.; Tei, K.; Kurita, K. Clinical guidelines for total temporomandibular joint replacement. Jpn. Dent. Sci. Rev. 2020, 56, 77–83.
17. Sansare K, Raghav M, Mallya SM, Karjodkar F. Management-related outcomes and radiographic findings of idiopathic condylar resorption: A systematic review. Int J Oral Maxillofac Surg. 2015; 44:209–16.
18. J.C. Posnick et al. Idiopathic condylar resorption: current clinical perspectives J Oral Maxillofac Surg (2007)
19. Riechmann, Merle, et al. "Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence-and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project." Journal of Clinical Medicine 12.15 (2023): 4946.
20. Mercuri, L.G. A rationale for total alloplastic temporomandibular joint reconstruction in the management of idiopathic/progressive condylar resorption. J. Oral. Maxillofac. Surg. 2007, 65, 1600–1609.
21. Neff AM, McLeod NM, Jung JP, Reichert CS, Schmidt C. Indications for alloplastic temporomandibular joint replacement in maxillofacial trauma—An analysis of condylar trauma patients with scoping review of the literature. Frontiers of Oral and Maxillofacial Medicine. 2023 Jun 10;5.
22. Sidebottom AJ. UK TMJ replacement surgeons; British Association of Oral and Maxillofacial Surgeons. Guidelines for the replacement of temporomandibular joints in the United Kingdom. Br J Oral Maxillofac Surg 2008;46:146-7.
23. Poveda-Roda, R.; Bagan, J.V.; Sanchis, J.M.; Margaix, M. Pseudotumors and tumors of the temporomandibular joint. A review. Med. Oral Patol. Oral Cir. Bucal 2013, 18, 392–402.
24. Fallahi Motlagh M, Janbaz Y, Abaszade A. Huge peripheral osteoma of the mandibular condyle: a case report. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2015 Nov 1;27(6):808-11.
25. Poveda-Roda R, Bagán JV, Sanchis JM, et al. Pseudotumors and tumors of the temporomandibular joint. A review. Med Oral Patol Oral Cir Bucal 2013;18:e392-402.
26. Fallahi Motlagh M, Bayat M, Naji S. Bone allograft: an option for total mandibular reconstruction. Craniomaxillofacial Trauma & Reconstruction. 2017 Dec;10(4):306-13.
27. Teschke M, Naujokat H. Indications for alloplastic temporomandibular joint replacement in maxillofacial surgery for benign lesions: a review of the literature and clinical cases. Frontiers of Oral and Maxillofacial Medicine. 2023 Dec 30;5.
28. Mommaerts MY, Nicolescu I, Dorobantu M, De Meurechy N. Extended total temporomandibular joint replacement with occlusal adjustments: pitfalls, patient-reported outcomes, subclassification, and a new paradigm. Annals of Maxillofacial Surgery. 2020 Jan;10(1):73.
29. Wolford LM, Kesterke MJ, Harrison II CE. The efficacy of patient-fitted total joint prostheses and orthognathic surgery to reconstruct patients with congenital craniofacial deformities and temporomandibular joint malformation: a systematic review. Frontiers of Oral and Maxillofacial Medicine. 2023 Sep 10;5.
30. A. R. Vento, R. A. LaBrie, and J. B. Mulliken, “The O.M.E.N.S. classification of hemifacial microsomia,” Cleft Palate-Craniofacial Journal, vol. 28, no. 1, pp. 68–77, 1991.
31. L. M. Wolford and D. E. Perez, “Surgical management of congenital deformities with temporomandibular joint malformation,” Oral and Maxillofacial Surgery Clinics of North America, vol. 27, no. 1, pp. 137–154, 2015.
32.L. M. Wolford, T. C. Bourland, D. Rodrigues, D. E. Perez, and E. Limoeiro, “Successful reconstruction of nongrowing hemifacial microsomia patients with unilateral temporomandibular joint total joint prosthesis and orthognathic surgery,” Journal of Oral and Maxillofacial Surgery, vol. 70, no. 12, pp. 2835–2853, 2012.
33. L. B. Kaban, B. L. Padwa, and J. B. Mulliken, “Surgical correction of mandibular hypoplasia in hemifacial microsomia: the case for treatment in early childhood,” Journal of Oral and Maxillofacial Surgery, vol. 56, pp. 628–638, 1998.
34. Posnick, Jeffrey C. "Treacher Collins syndrome: perspectives in evaluation and treatment." Journal of oral and maxillofacial surgery 55.10 (1997): 1120-1133.
35. Arvystas M. Shprintzen R.J.Craniofacial morphology in Treacher Collins syndrome.Cleft Palate Craniofac J. 1991; 28: 226
36. Mercuri L.G textbook: Temporomandibular Joint Total Joint Replacement – TMJ TJR.2016. DOI 0.1007/978-3-319-21389-7
37. Huang IY, Chen CM, Kao YH, Chen CM, Wu CW. Management of long-standing mandibular dislocation. Int J Oral Maxillofac Surg. 2011; 40:810–4.
38. Debnath SC, Kotrashetti SM, Halli R, Baliga S. Bilateral vertical-oblique osteotomy of the ramus (external approach) for treatment of a long-standing dislocation of the temporomandibular joint: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. 2006;101: e79–82.
39. Sarlabous M, Psutka DJ. Total joint replacement after condylar destruction secondary to long-standing dislocation of the temporomandibular joint. Journal of Craniofacial Surgery. 2020 Jun 1;31(4):989-95.
40. Elledge RO, Speculand B. Indications for replacement after alloplastic temporomandibular joint device failure: a narrative review. Frontiers of Oral and Maxillofacial Medicine. 2023 Dec 30;5.
41. Amarista FJ, Mercuri LG, Perez D. Temporomandibular Joint Prosthesis Revision and/or Replacement Survey and Review of the Literature. J Oral Maxillofac Surg 2020; 78:1692-703.
42. Pittenger DE. Heterotopic ossification. Orthop Rev. 1991; 20:33–9.
43. Reid R, Cooke H. Postoperative ionizing radiation in the management of heterotopic bone formation in the temporomandibular joint. J Oral Maxillofac Surg. 1999; 57:900–5.
44. Mercuri LG, Alcheikh Ali F, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of re-ankylosis of the temporomandibular joint. J Oral Maxillofac Surg. 2008; 66:1794–803.
45. Sidebottom AJ. Alloplastic or autogenous reconstruction of the TMJ. J Oral Biol Craniofac Res 2013; 3:135-9.
46. Hussain OT, Sah S, Sidebottom AJ. Prospective comparison study of one-year outcomes for all titanium total temporomandibular joint replacements in patients allergic to metal and cobalt-chromium replacement joints in patients not allergic to metal. Br J Oral Maxillofac Surg 2014;52:34–37.
47. Mercuri, LG. Avoiding and managing temporomandibular joint total joint replacement surgical site infections. J Oral Maxillofac Surg 2012;70:2280–2289
48. Mercuri LG. Microbial biofilms: a potential source for alloplastic device failure. J Oral Maxillofac Surg 2006;64:1303–1309.
| Files | ||
| Issue | Vol 11, No 4 (Autumn 2024) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/jcr.v11i4.18713 | |
| Keywords | ||
| Temporomandibular joint replacemen Indication Contraindication Total joint ankylosis Degenerative joint disease. | ||
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How to Cite
1.
Fallahi Motlagh M, Taghi Kiani M, Seyad Ashrafi MM, Fallahi Motlagh F. Total Mandibular Joint Replacement as a Treatment Modality for Temporomandibular Joint Disorders: A Case Report. J Craniomaxillofac Res. 2025;11(4):249-257.
