Comparison of Functional Recovery Rates Following TMJ Total Joint Reconstruction in Patients with Painful Degenerative Joint Disease versus Non-Painful Hypomobility or Trauma-induced Malocclusion: A Multi-Center Study.
The aim of this study was to determine functional recovery rates in patients who underwent temporomandibular joint (TMJ) total joint reconstruction with patient-fitted TMJ alloplastic prostheses (TMJ concepts, Venture, CA) for painful degenerative joint disease versus non-painful malocclusion due to trauma or pathology at two separate institutions from 2000-2010.
A retrospective chart review of 65 patients was undertaken after formal IRB approval at 2 different institutions. Inclusion criteria included: 1) clinical follow up to at least one year post-TMJ reconstruction and 2) diagnosis of either painful degenerative joint disease (DJD) or non-painful hypomobility or malocclusion due to trauma or pathology by an oral and maxillofacial surgeon or TMJ specialist. Ordinal variables obtained included maximal incisal opening (MIO) at preoperative, 1 month, 3-6 months and 1+ year follow up visits. Secondary variables obtained included prior history of TMJ surgery and incidence of surgical complications. Other variables recorded included age at time of surgery and gender. SPSS statistical software, version 21 was used. One- way analysis of variance (ANOVA) and non-parametric tests were utilized and statistical significance was set at a p-value of <0.05.
A total of 65 patients' charts were reviewed. Females comprised 91% of the patient population and 77% had a prior history of open joint surgery. The mean age was 47 years old. Forty-seven patients (74% of study population) were diagnosed with painful DJD while 17 (26%) were diagnosed with non-painful malocclusion due to trauma or pathology. Mean preoperative MIO (± sem) for DJD group was 25.1 ± 7.7mm versus 31.8 ± 12.3mm in the latter group. While preoperative MIO between the groups were statistically different (p=0.02), the distribution of mean MIO values for groups at 1 month, 3-6 months and >1year intervals were equivalent (p>0.05). Average improvement in range of motion after 1 year when compared to preoperative values was greater in the DJD group (mean = 8mm increase in MIO) than painless hypomobility/trauma/malocclusion group (mean = 3mm increase in MIO). Interestingly, a prior history of open joint surgery affects mandibular range of motion at all time intervals except 1-month post TJR surgery (p<0.05). The rate of postoperative complications was 58%, although the vast majority were neurologic deficits that recovered by 1 year postoperative.
TMJ total joint reconstruction surgery was beneficial in both patients diagnosed with both painful degenerative joint disease and those who developed malocclusions secondary to trauma or pathology. The temporal rate of functional recovery (MIO) was equivalent in both groups, however, the average improvement after 1 year was greater in those who suffer from painful degenerative joint disease. A prior history of TMJ surgery may affect both short (<6months) and long term (>1year) functional outcomes independent of a diagnosis of painful DJD or painless hypomobility or trauma-induced malocclusion.
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