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Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm
CONTEXT: Alloplastic temporomandibular joint (TMJ) replacement is a treatment strategy for segmental mandibular defects with occlusal abnormalities. AIMS: To describe our experience with extended total TMJ replacement (eTMJR) by reporting operative obstacles, complications, and patient-reported outc...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433953/ https://www.ncbi.nlm.nih.gov/pubmed/32855919 http://dx.doi.org/10.4103/ams.ams_245_19 |
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author | Mommaerts, Maurice Yves Nicolescu, Ion Dorobantu, Mihai De Meurechy, Nikolas |
author_facet | Mommaerts, Maurice Yves Nicolescu, Ion Dorobantu, Mihai De Meurechy, Nikolas |
author_sort | Mommaerts, Maurice Yves |
collection | PubMed |
description | CONTEXT: Alloplastic temporomandibular joint (TMJ) replacement is a treatment strategy for segmental mandibular defects with occlusal abnormalities. AIMS: To describe our experience with extended total TMJ replacement (eTMJR) by reporting operative obstacles, complications, and patient-reported outcomes, as well as to suggest a subclassification system and paradigm shift. SETTING AND DESIGN: University hospital and private clinic; case series with retrospective follow-up. METHODS AND MATERIALS: Five patients (6 eTMJRs) were followed for more than 1 year after surgery. Patient-reported outcomes were assessed using FACE-Q™ “Satisfaction with Outcome” questionnaires (sum and corresponding transformed Rasch scores). STATISTICAL ANALYSIS: Descriptive analyses were performed. RESULTS: Problems were related to contralateral mandibular osteotomy healing (if performed), keying the prosthetic condyle into the fossa component, intra- and postoperative prosthetic lag, and intraoperative proper establishment of the occlusion when unilateral replacement was performed. Patients reported high satisfaction with the outcome, with a mean Rasch score of 89.2/100. CONCLUSIONS: Unilateral eTMJR obstacles related to three-dimensional rotational repositioning of the remaining mandible. We suggest a paradigm shift, considering primary alloplastic replacement instead of microvascular osseous transplantation for reconstruction when radiotherapy is not required. This can avoid donor site morbidity and long reconstructive surgery. An autologous osseous transplant is still available in case of implant failure. A subclassification system is proposed for eTMJR, which accounts for contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy. |
format | Online Article Text |
id | pubmed-7433953 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-74339532020-08-26 Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm Mommaerts, Maurice Yves Nicolescu, Ion Dorobantu, Mihai De Meurechy, Nikolas Ann Maxillofac Surg Original Article – Evaluative Study CONTEXT: Alloplastic temporomandibular joint (TMJ) replacement is a treatment strategy for segmental mandibular defects with occlusal abnormalities. AIMS: To describe our experience with extended total TMJ replacement (eTMJR) by reporting operative obstacles, complications, and patient-reported outcomes, as well as to suggest a subclassification system and paradigm shift. SETTING AND DESIGN: University hospital and private clinic; case series with retrospective follow-up. METHODS AND MATERIALS: Five patients (6 eTMJRs) were followed for more than 1 year after surgery. Patient-reported outcomes were assessed using FACE-Q™ “Satisfaction with Outcome” questionnaires (sum and corresponding transformed Rasch scores). STATISTICAL ANALYSIS: Descriptive analyses were performed. RESULTS: Problems were related to contralateral mandibular osteotomy healing (if performed), keying the prosthetic condyle into the fossa component, intra- and postoperative prosthetic lag, and intraoperative proper establishment of the occlusion when unilateral replacement was performed. Patients reported high satisfaction with the outcome, with a mean Rasch score of 89.2/100. CONCLUSIONS: Unilateral eTMJR obstacles related to three-dimensional rotational repositioning of the remaining mandible. We suggest a paradigm shift, considering primary alloplastic replacement instead of microvascular osseous transplantation for reconstruction when radiotherapy is not required. This can avoid donor site morbidity and long reconstructive surgery. An autologous osseous transplant is still available in case of implant failure. A subclassification system is proposed for eTMJR, which accounts for contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy. Wolters Kluwer - Medknow 2020 2020-06-08 /pmc/articles/PMC7433953/ /pubmed/32855919 http://dx.doi.org/10.4103/ams.ams_245_19 Text en Copyright: © 2020 Annals of Maxillofacial Surgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article – Evaluative Study Mommaerts, Maurice Yves Nicolescu, Ion Dorobantu, Mihai De Meurechy, Nikolas Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm |
title | Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm |
title_full | Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm |
title_fullStr | Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm |
title_full_unstemmed | Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm |
title_short | Extended Total Temporomandibular Joint Replacement with Occlusal Adjustments: Pitfalls, Patient-reported Outcomes, Subclassification, and a New Paradigm |
title_sort | extended total temporomandibular joint replacement with occlusal adjustments: pitfalls, patient-reported outcomes, subclassification, and a new paradigm |
topic | Original Article – Evaluative Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433953/ https://www.ncbi.nlm.nih.gov/pubmed/32855919 http://dx.doi.org/10.4103/ams.ams_245_19 |
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