Temporomandibular joint reconstruction of the complex patient with the Techmedica custom-made total joint prosthesis.
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 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 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 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.
Wolford
L M
LM
Baylor College of Dentistry, Dallas, TX.
Cottrell
D A
DA
Henry
C H
CH
D000293:Adolescent; D000328:Adult; D001171:Arthritis, Juvenile / Q000150:complications; D002508:Cephalometry; D002858:Chromium Alloys; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000209:etiology; D011095:Polyethylenes; D019736:Prostheses and Implants / Q000009:adverse effects; D012086:Reoperation; D013705:Temporomandibular Joint Disorders / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D014025:Titanium; D016896:Treatment Outcome
D002858:Chromium Alloys; D011095:Polyethylenes; D014025:Titanium