Patient-Centered Quality of Life (QOL) Measures after Temporomandibular Total Joint Replacement Surgery
Purpose: To evaluate patient-reported outcome measures assessing the quality of life (QOL) for patients with End Stage Temporomandibular Joint (ESTMJ) disease who have undergone unilateral or bilateral TMJ prosthetic replacement.
Patients & Methods: After obtaining approval from the Institutional Review Board, the records of 28 patients who had undergone either unilateral or bilateral alloplastic total joint replacement procedures were retrospectively analyzed. All patients were treated using either TMJ Concepts or Biomet/Lorenz prosthetics at the Case Medical Center between the years 2007-2012. The indications to perform TMJ replacement were due to intolerable chronic TMJ pain, and joint dysfunction which failed to respond to medical or previous surgical therapies. The patients were asked to complete an 18-item TMJ-S-QOL survey, which encompassed questions pertaining to pain, speech, chewing function, and various aspects of social life and mental health. The questions were answered on a 5-point scale as they pertained to both pre and post-surgery. The data was collected during post-surgery clinic appointments, by mail, and via phone calls. Paired pre/post-surgery data were then statistically analyzed using the Wilcoxon Signed Ranks Test.
Results: Among 28 patients (4 males and 24 females), 18 patients responded to our QOL survey. The markers of QOL after surgery were compared to the preoperative period. Pain, chewing, speech, anxiety, activity, recreation and mood were significantly improved (see table). The table below demonstrates the number and percent of improved patients, as well as the pvalue for each marker.
Conclusion: TMJ prosthetic replacement significantly enhances the QOL among patients suffering from chronic pain, limited range of motion, anxiety, impaired speech, and chewing due to ESTMJ disease in this small sample of surgical patients.
Outcome measure |
Patients Reporting Improvement (number, percent) |
Z – score |
P – value |
Pain |
(17) 94.4% |
-3.671 |
0.0001 |
Diet & chewing |
(15) 83.3% |
-3.106 |
0.002 |
Speech |
(10) 55.6% |
-2.583 |
0.010 |
Activity |
(12) 66.7% |
-3.067 |
0.002 |
Recreation |
(11) 61.1% |
-2.915 |
0.004 |
Mood |
(12) 66.7% |
-3.165 |
0.002 |
Anxiety |
(13) 72.2% |
-3.228 |
0.001 |
1. Pinto LP, Wolford LM, Buschang PH, Bernardi FH, Gonçalves JR, Cassano DS. Maxillo-mandibular counter-
clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part III--pain and
dysfunction outcomes. Int J Oral Maxillofac Surg 2009; 38:326-31.
2. Wolford LM, Pitta MC, Reiche-Fischel O, Franco PF. TMJ Concepts/Techmedica custom-made TMJ total
jint prosthesis:5-year follow-up study. Int J Oral Maxillofac Surg 2003; 32: 268-74.