Single-stage Patient-specific Total Temporomandibular Joint Replacement with Simultaneous Correction of Dentofacial Deformity

Abstract

End stage TMJ diseases severely affect the architecture as well as physiology of TMJ resulting in impairment in mastication, speech, airway support and esthetics requiring joint reconstruction to improve mandibular form and function. In cases of multiple prior operations and severe anatomical discrepancies from pathology, autogenous bone grafts often fail. Alloplastic total joint replacement has been evolving as a salvage procedure in such end stage TMJ diseases. Although stock prosthesis are available, patient specific prosthesis are preferred due to variability in mandibular anatomy and angulation of fit of condylar head to fossa. Advances like virtual surgical planning and 3D printing allowing patient- specific implants have increased the precision of preoperative planning with evolution of single step surgery.

We present 2 cases; a case of left TMJ ankylosis in a 28 years old female with resultant dentofacial deformity and a case of left condylar prosthesis failure in a 45 years old female where patient specific temporomandibular joint  prosthesis were used for joint reconstruction with concomitant Orthognathic surgery to correct facial deformity .Easy adaptation of prosthesis without need of alteration of bony surfaces, reduction in operating time with avoidance of second surgical site with added advantage of starting physical therapy on the following day of operation , uneventful postoperative recovery and replication of virtually planned treatment objectives were experienced in both cases.

The aim of this report is to highlight “ patient specific TJR with simultaneous orthognathic surgery “ as an effective surgical option for the management of end stage TMJ diseases.