Modified Total Alloplastic Temporomandibular Joint Reconstruction: Technical Notes

Modified Total Alloplastic Temporomandibular Joint Reconstruction: Technical  Notes.  Purpose: In this research, we focus on the modified surgical techniques of total alloplastic temporomandibular joint reconstruction. METHODS: In 2007, we introduced, and performed, alloplastic total temporomandibular joint replacement, using the TMJ Biomet stock system. The modifications regarding surgical techniques are as follows: 1) Autogenous bone was filled into the fossa bottom to achieve a flat surface and ensure the tripod stability of the fossa prostheses 2) Discs were filled into the condylar prostheses to prevent heterotopic bone formation 3) Free fat from the submandibular approach was filled into the periprosthetic spaces to avoid abdominal incision. Postoperative follow-up mainly proceeds from the imaging examination, including: panoramic radiographs, or computer tomography to observe the position of the prostheses and the periprosthetic bone structure. RESULTS：12 patients (14 joints) attended follow-up appointments. The average follow-up period was 26.08 months (4~48 months). 13 fossa prostheses were fitted, with the assistance of autogenous bone: 8 cases (9 joints) from the eminence, 2 cases (2 joints) from the condyle, 1 case (2 joints) from the ramus stump. Discs in 5 cases (5 joints) were filled into the condylar prostheses. Free fat in 10 cases (10 joints) from the submandibular approach were grafted. Postoperative imaging examination instantly, in 6 months, and in 1 year, showed the position of the prostheses was proper in all patients and the periprosthetic bone structure showed no abnormalities. All patients showed postoperative occlusal stability, and no phenomenon of prostheses loosening, heterotopic bone or facial asymmetry. CONCLUSIONS: Modified total alloplastic TMJ reconstruction can help improve the stability of prostheses, reduce postoperative heterotopic bone, and avoid additional surgical incisions, which is worth spreading and applying.

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