A Retrospective Study of Patient Outcomes Following Temporomandibular Joint Replacement with Alloplastic Total Joint Prosthesis at Massachusetts General Hospital

Publication date: Available online 18 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Rohit Sahdev, Brendan W. Wu, Nina Anderson, Shehryar N. Khawaja, Somi Kim, David A. Keith

Abstract

Background

Disorders of the temporomandibular joint (TMJ) occur frequently, with a prevalence of 15-18%. Total joint replacement (TJR) surgery is indicated for severe joint damage associated with impaired function, pain, or occlusal change where other treatments have been unsuccessful.

Purpose

The aim of this study was to assess changes in pain and range of motion (ROM), as well as post-operative complications and comorbidities, in subjects receiving TJR surgery at the Massachusetts General Hospital (MGH).

Methods

This study is a retrospective review that describes the clinical variables in patients following alloplastic TMJ reconstruction at MGH from 2000-2015. Clinical variables included primary diagnosis, number of previous surgeries, comorbidities, pre- and post-operative pain, pre-, intra-, and post-operative ROM, and complications.

Results

Data was obtained from 95 patients undergoing a total of 108 surgeries, with an average follow-up of 4.48±3.38 years. The most common primary indications for TJR were ankylosis (44%) and inflammatory disease (23%). Maximum inter-incisal opening improved by a mean of 7.7±10.27 mm and pain decreased by a mean of 1.5±3.29 points on the visual analogue scale. Transient facial nerve palsy (25%) was the most common post-operative complication; however, long-term complications were rare. The most frequent comorbidities were psychiatric disorders (56%) and gastrointestinal disease (46%). Psychiatric patients had similar pre-operative pain (6.0±2.90), but significantly higher post-operative pain (4.7±2.58), than non-psychiatric patients. Twenty-eight percent of the patients had prior failed TMJ implant materials, specifically Proplast-Teflon (Vitek, Houston, TX). These patients were significantly older (50.4±8.26 years) and had smaller pre-operative ROM (21.7±8.85 mm) and smaller post-operative ROM (28.3±9.59 mm).

Conclusion

Patients gained a statistically significant (p<0.01) increase in ROM and reduction in pain. TJR is an effective treatment option in patients with limited mouth opening or severe pain.

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