Alloplastic reconstruction of the temporomandibular joint in treatment of craniofacial developmental or congenital anomalies: a surgical case report.
OBJECTIVE
To describe the surgical planning and treatment approach in addressing the oral and maxillofacial needs for one particular patient suffering congenital anomalies of the craniofacial anatomy. A secondary objective is to restore mandibular and maxillary function and esthetics to the young, adult patient. The tertiary objective is to educate the surgeon as to alloplastic implant options that may be available to restore function and relieve pain for the patient missing certain anatomical structures from birth.


METHODS
Through the use of advanced medical imaging tools, a thorough understanding of the patient's prior failed medical treatments, and a meticulous understanding of the benefits of alloplastic reconstruction, the surgeon can mitigate patient symptoms and at the same time increase the probability of a successful outcome. The surgeon can then collaborate with the surgical and implant design team to not only prescribe the surgical correction necessary, but also design and construct the actual temporomandibular joint (TMJ) and mandibular implants used for the case, as well as perform mock surgery on a stereolithography anatomical (SLA) model needed to restore function and esthetics for the patient. The end result is that a Patient-Specific (custom) (TMJ Implants, Inc., Golden, CO, USA) prosthesis can then be manufactured and adapted surgically to the patient's unique anatomy.


RESULTS
The early results from this alloplastic reconstructive surgery have brought forth the anticipated results of replacement of the congenitally absent TMJ, improvement of jaw function, reduction of joint pain, as well as improvement of the esthetics. Without this breakthrough surgical development, many of these congenital anatomically deficient patients would not be able to enjoy normal breathing, mastication, jaw function, esthetics, oral and dental health, and the emotional relief that these corrections allow.


CONCLUSIONS
Many patients who suffer birth-related anatomical deficiencies (such as cleft lip and branchial arch syndrome) never receive the surgical correction necessary. Many have had autogenous reconstruction of missing mandibular and TMJ structures only to relapse, at times, into a more disfiguring and lasting condition. By simply placing a Christensen Fossa-Eminence Prosthesis (FEP) and Condylar Prosthesis (CP) in a total joint-replacement solution, one is more likely to achieve satisfactory TMJ mobility and reduction in pain, as well as the mechanical replacement of missing anatomical structures and predictable and lasting improvement. As an additional benefit, the patient also would enjoy enhanced esthetics.
Worrall
Stephen F
SF
The British Association of Oral and Maxillofacial Surgeons, Bradford, England, UK.
Christensen
Robert W
RW
D000328:Adult; D018771:Arthralgia / Q000209:etiology / Q000517:prevention & control*; D019465:Craniofacial Abnormalities / Q000601:surgery; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D013704:Temporomandibular Joint / Q000002:abnormalities* / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome