TMJ Reconstruction in Patients with Autoimmune/Connective Tissue Disease

Publication date: Available online 22 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Pushkar Mehra, Charles Henry, Mohammed Nadershah
PurposeTo evaluate clinical outcomes in patients with autoimmune/connective tissue (CT) disease undergoing temporomandibular joint (TMJ) reconstructionMaterials and MethodsPatients were divided into two groups based on the type of TMJ reconstruction. Group I patients (n=9) underwent autogenous reconstruction and had a diagnosis of rheumatoid arthritis (5), lupus arthritis (1), and psoriatic arthritis (3). Group 2 patients (n= 2l) had alloplastic reconstruction with a patient-fitted total joint prosthesis (TMJ Concepts, Ventura, CA) and had a diagnosis of rheumatoid arthritis (15), lupus (3), and psoriatic arthritis (3). Standardized clinical and radiographic examinations were performed pre-surgically (T1), immediately postsurgery (T2), and at longest follow-up (T3) after surgery.ResultsGroup l patients experienced no significant improvement in maximal opening without pain, a decrease in lateral excursions, minimal decrease in TMJ pain, and a 32% relapse of chin projection at Point B at T3. Average post-surgery follow-up time was 58 months. Postsurgical ankylosis was seen in 22% of patients. Contrastingly, group 2 patients showed a statistically significant decrease in subjective TMJ pain and lateral excursive movements, and improvement in jaw function, diet, maximal incisal opening without pain, and only 5% relapse at Point B at T3. Average postsurgical follow-up in this group was 78 months.ConclusionsImproved treatment outcomes were obtained with alloplastic TMJ total joint reconstruction as compared to autogenous TMJ reconstruction in patients with autoimmune/CT disease.



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