title: Does Unilateral Temporomandibular Total Joint Reconstruction Result in Contralateral Joint Pain and Dysfunction?
abstract: OBJECTIVE
  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.
  
  
  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 prosthesis. Secondary outcome variables for all patients included TMJ pain, facial pain, headaches, diet, disability, quality of life, maximum incisal opening (MIO), and lateral excursion movements after unilateral TMJ reconstruction with the patient-fitted total joint prosthesis. Student t test and Wilcoxon test were used for statistical analyses, with a P value less than .01 for 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.
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas, Health Science Center San Antonio, San Antonio, TX.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Perez
authors.affiliation: Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University Baylor College of Dentistry; Private Practice, Baylor University Medical Center, Dallas, TX. Electronic address: lwolford@swbell.net.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Wolford
authors.affiliation: Professor, Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX.
authors.forename: Emet
authors.initials: E
authors.lastname: Schneiderman
authors.affiliation: Clinical Assistant Professor, Department of Orthodontics, St Louis University, Center for Advanced Dental Education, St Louis, MO.
authors.forename: Reza
authors.initials: R
authors.lastname: Movahed
authors.affiliation: Former Resident, Department of Oral and Maxillofacial Surgery, Texas A&M University Baylor College of Dentistry; Private Practice, Dallas, TX.
authors.forename: Campbell
authors.initials: C
authors.lastname: Bourland
authors.affiliation: Senior Adviser, Food Borne Diseases and Zoonosis, World Health Organization, New York, NY.
authors.forename: Enrique Perez
authors.initials: EP
authors.lastname: Gutierrez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000209:etiology*; D019643:Arthroplasty, Replacement; D002648:Child; D005157:Facial Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011475:Prosthesis Failure / Q000209:etiology*; D011788:Quality of Life; D012086:Reoperation; D012307:Risk Factors; D013704:Temporomandibular Joint / Q000601:surgery*; D013997:Time Factors