个体化人工颞下颌关节置换术远期疗效报告

目的：随访2例3侧采用人工颞下颌关节置换的患者,随访时间分别为4年和4年半,以评价人工关节置换的远期临床疗效。方法：2例3侧采用人工颞下颌关节置换术进行骨关节病治疗的患者,分别进行了为期4年和4年半的临床随访。记录患者术后在关节疼痛、开口度等指标的变化及患者对治疗结果的主观评价。结果：2例患者术后受累关节疼痛、开口受限及咀嚼能力等方面均获得了满意的改善,开口度在术后4年均增加至35mm以上,未再出现明显颞下颌关节区疼痛．VAS疼痛评估为0-1。开口受限无复发,开口度维持良好。患者自觉咀嚼能力明显增强,生活质量明显提高。结论：人工关节置换术是重建颞下颌关节的一种良好术式,对恢复因骨关节病等导致的关节功能丧失是一种较理想的选择。     

2例个体化人工关节用于颞下颌关节置换的初步效果评价

目的：采用CAD／CAM技术设计个体化人工全颞下颌关节，通过全关节置换，治疗严重颞下颌关节病，对其疗效进行初步评价。方法：2例女性颞下颌关节疾病患者，年龄分刖为53岁和60岁。术前经MRI等检查发现严重的关节盘及髁突病变，开口度分别为2．0cm和1．8cm，均表现有明显的关节疼痛。2例患者均采用TMJ Concepts公司的个体化人工颞下颌关节全关节置换术。结果：成功完成了2例3侧颞下颌关节的置换手术。未出现术后并发症。关节疼痛在术后2周后逐渐缓解。6个月后开口度分别为2．7cm和2．9cm。术后口颌功能改善良好。结论：人工全颞下颌关节置换治疗严重颞下颌关节骨关节病具有良好的效果，个体化设计可为人工关节发挥良好功能提供有效的保证．     

Accuracy of digital templates for guidance of custom-made total temporomandibular joint replacement

This study evaluated the application of digital templates to guide custom-made total temporomandibular joint (TMJ) replacement. Patients treated with a custom-made total TMJ prosthesis for TMJ osteoarthrosis, ankylosis, or tumours were included prospectively. Before surgery, two types of digital template (articular eminence and condyle neck templates) were designed to guide the bone osteotomy and prosthesis positioning. The reconstructive outcomes were assessed through clinical examinations and accuracy analysis by superimposing the postoperative three-dimensional craniomaxillofacial model onto the preoperative virtual plan. Thirty-seven patients (45 joints) underwent successful TMJ reconstruction with the custom-made TMJ prosthesis guided by the digital templates, without intermaxillary fixation. For all patients, the occlusal relationship was stable in reference to the preoperative state. There were significant improvements in pain and maximum inter-incisal opening. Through merging of the pre- and postoperative craniomaxillofacial models, the maximum implanted error was 1.17 ± 0.23 mm in linear measurement and 1.19 ± 0.14 mm in surface deviation. There was more deviation in the anteromedial part of the fossa and inferior part of the mandibular handle. The digital templates were able to assist in the accurate placement of the TMJ prosthesis without the need for intermaxillary fixation.     

One stage management of ankylosis of the temporomandibular joint with a custom-made total joint replacement system

Alloplastic joint prostheses have been used in the treatment of severe diseases of the temporomandibular joint (TMJ) for many years. Treatment of ankylosis of the TMJ has been difficult, with many surgical approaches being used that traditionally involved multistage procedures, long treatment times, and increasing expense. We report a single stage technique for replacement of an ankylosed joint using a custom-made prosthesis, and discuss the technical aspects of the procedure, including our use of a custom-made acrylic glenoid fossa template.     

A prospective,single-centre study on patient outcomes following temporomandibular joint replacement using a custom-made Biomet TMJ prosthesis

This study describes the clinical variables in 61 patients following total alloplastic temporomandibular joint reconstruction (TJR) in which the Biomet Microfixation Patient-Patient-Matched TMJ Implant was used. All patients were classified using the Wilkes classification. The visual analogue scale score for jaw pain intensity, the maximum inter-incisal opening (MIO), and the frequency of adverse events were recorded during follow-up; the mean follow-up was 14.2 ± 8.6 months. Significant improvements were found in the MIO (P < 0.0005), except at the 3-year follow-up. Additionally, a significant reduction in pain was observed both short and long term (P < 0.0005). The incidence of adverse events was low (seven of the 81 alloplastic joints); two joints needed revision. TJR appears to be a relevant treatment option in patients with a broad range of temporomandibular joint disorders in whom none of the joint components are salvageable because of significant disease. Our patients gained an almost normal range of mouth opening and experienced a significant reduction in pain. Our results are promising, however TJR is associated with some side effects. TJR should be considered when less invasive procedures fail and a comprehensive presurgical work-up has been performed. Ongoing prospective studies are needed to consolidate the possible significant treatment outcomes.     

Review of emerging temporomandibular joint total joint replacement systems

Total temporomandibular joint (TMJ) replacement has been documented as a viable option for the management of end-stage TMJ disease, but data on long-term outcomes have been reported for only two established systems: TMJ Concepts, and Zimmer Biomet. Other devices are now emerging globally, but reports of preclinical laboratory and clinical outcomes are limited. We retrieved information on the design, material composition, preclinical laboratory tests, regulatory status, and clinical outcomes of new TMJ replacement systems from PubMed and Google, and from personal correspondence with surgeons worldwide. Fifteen countries have developed, or are developing, 27 TMJ replacement systems, of which 21 are custom-designed, but to date, only four have been given regulatory approval. All the devices are designed to have both a skull-based glenoid fossa component and a mandibular ramus or condyle, and 22/27 are similar to the designs of the two established systems. Twenty-one devices use an ultra-high-molecular-weight polyethylene (UHMWPE) fossa-bearing surface, and 10 have a titanium alloy condyle. Nineteen manufacturers report that a titanium alloy is used for the ramus portion of the condyle/ramus component. Preclinical laboratory tests on 12 of the systems have been reported but, to our knowledge, no outcomes have yet been reported on nine of the 27 reviewed. Not all systems are equal in terms of design, material composition, preclinical laboratory testing, manufacturing methods, regulatory status, and reports of clinical outcomes.     

Synovial entrapment in alloplastic temporomandibular joint replacement

Complications of alloplastic temporomandibular joint (TMJ) prostheses can lead to stress and anxiety for the patient and the surgical team, and prosthesis substitution is sometimes required. The aim of this case report is to describe the surgical finding of synovial entrapment with interposed fibrosis in a postoperative alloplastic TMJ revision, managed effectively with adequate surgical debridement. The authors believe that synovial entrapment needs to be considered as a possible postoperative complication of total joint replacement when no clear symptoms of infection, metal hypersensitivity, osteolysis, or heterotopic bone formation are present. The implications of synovial entrapment in TMJ alloplastic replacement remains relatively unpredictable and poorly understood.     

Electrosonographic characteristics of sounds from temporomandibular joint disc replacement

The purpose of this study was to investigate the waveform and electrosonographic characteristics of sounds emanating from internal derangement of the temporomandibular joint (TMJ). TMJ sounds were recorded from 10 joints of normal people (NP), 10 joints from patients with anterior disc displacement with reduction (DDR) and 20 joints from patients with anterior disc displacement without reduction (DDNR). The sounds were analyzed through fast Fourier transfer methods to observe their waveforms and electrosonographic characteristics. The observations were then used in differentially diagnosing internal derangement. Wave pattern and electrosonography (ESG) differed among the NP, DDR and DDNR groups. There was very little difference in frequency between the sounds from DDR and DDNR, but the amplitude of the DDR sounds was higher than those of DDNR and NP. The sensitivity and specificity of ESG diagnosis for DDR were 77.2% and 93.3%, respectively, while for DDNR they were 81.6% and 64.7%, respectively.     

Stability study of total temporomandibular joint replacement on sheep

ObjectiveTo evaluate the stability of our custom-made prosthesis by establishing the model of sheep total temporomandibular joint (TMJ) replacement.MethodsSix sheep were included in our study. Spiral computed tomography (CT) data of all sheep was obtained and transformed into 3-dimensional model by surgicase5.0 software preoperatively. Total TMJ prostheses were made based on the skull model. Ultra-high molecular weight polyethylene was used to make glenoid fossa lining, while titanium alloy to prefabricate mandibular retention handle and titanium plate over glenoid fossa. Cobalt-chromium-molybdenum alloy was also used to prefabricate the condyle. The right sides of all sheep, as the experimental group, were carried out total TMJ replacement, while the left sides were as the control group. The bone in both experimental and control side were excised after 3 and 6 months. Scanning electron microscope (SEM) was used to observe the interface between bone and prosthesis. Van Gieson staining and immunohistochemical staining (IHC) were used respectively to observe the interface of titanium screw and bone and the expression of alkaline phosphatase (ALP).ResultsSEM and Van Gieson staining showed that there was immature bone and osteoid formed in the interface of prosthesis and bone after 3 months. While after 6 months, there was osseointegration between them. IHC showed that the expression of ALP in the experimental side was much higher than in the control side after 3 months and its expression decreased after 6 months with no difference from the control side.ConclusionThe custom-made TMJ prosthesis which was designed and manufactured by ourselves has good stability after total TMJ replacement.     

Kinematic study of the temporomandibular joint in normal subjects and patients following unilateral temporomandibular joint arthrotomy with metal fossa-eminence partial joint replacement.

PURPOSE: The primary purpose of this study is to quantify the kinematics of the temporomandibular joint (TMJ) in patients following unilateral TMJ arthrotomy with metal fossa-eminence partial joint replacement and compare them with TMJ kinematics of healthy individuals. MATERIALS AND METHODS: Fourteen healthy volunteers and 13 female surgical patients (minimum 4 years postoperative) participated in this study. An electromagnetic tracking device was used to record the kinematics of the mandible relative to temporal bone during opening-closing, protrusive, and lateral movements. The mean linear distance (LD) traveled by condyles was compared between operated and normal subjects. RESULTS: Patients responded with statistically significant improvement in pain and jaw function questions. Mean satisfaction with the surgical result was 25.7 on a scale of 1 to 30. The LD measured for condyles during all 4 movements showed similar measurements. However, operated and unoperated condyles showed statistically significant motion values during opening and protrusive motion from each other and from normal subjects. In addition, contralateral condyles during lateral motion showed statistically significant values in operated, unoperated, and normal condyles. CONCLUSION: The results of this study suggest that the surgical reconstruction of the TMJ with partial joint replacement provided highly significant clinical improvement. Moreover, condyle and incisor kinematics were preserved to a significant amount as compared with the normal group. The difference in kinematic measurements between the operated and unoperated condyle was significant and secondary to previous joint disease and previous surgical intervention. These results should be evaluated by prospective studies in pre- and postsurgical patients.     

Total alloplastic temporomandibular joint replacement: the Czech-Slovak initial experience

In 2004, total alloplastic temporomandibular joint (TMJ) replacement began in the Czech Republic and Slovakia. This paper presents initial subjective and objective data compiled between 2005 and 2009 from those cases. Data were collected from 27 patients (38 joints) reconstructed with the Biomet-Lorenz stock and custom TMJ prostheses during a mean follow-up period of 24 months. The variables of pain and mouth opening were evaluated pre- and postoperatively. Patients classified pain on a scale of 0-5 (none - unbearable). The extent of opening was investigated by a physician (the distance between the points of the incisors on the upper and lower jaw was measured). The most common indication for replacement was ankylosis. There was an improvement in pain score in 15 patients. 4 patients reported worsening of pain and 8 patients did not complain of pre- or postoperative pain. Mandibular opening increased from a mean of 17.7 mm preoperatively to a mean of 29.1mm postoperatively. There were complications related to the surgery, but no significant complications related to the devices. Total alloplastic TMJ replacement appears to be a safe and effective method of reconstruction in the patients in this initial study.     

Historical development of alloplastic temporomandibular joint replacement before 1945

Resections of the temporomandibular joint (TMJ) have been carried out for about 150 years. This article reviews the beginning of TMJ surgery technique before 1945 by carrying out extensive inquiries in public and private libraries and collections. Before 1945 the technique of alloplastic reconstruction of the TMJ was mainly influenced by German and French surgeons. Reconstruction was limited to replacement of the condyle. The role of the TMJ within the orofacial system was not considered. Interposition of alloplastic implants, resection dressings and prostheses were the dominant technique. The main concerns were sterilisation, biocompatibility and implant fixation. No evidence-based data on outcomes are available from that time. By 1945 reconstruction of the TMJ involved the close cooperation of surgeons and dentists.     

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颞下颌人工关节经过近50年的发展已较为成熟,主要用于关节强直、髁突骨关节炎晚期、髁突肿瘤以及髁突特发性吸收等疾病的关节置换治疗。然而国内目前尚无相关产品。本文就国际主流人工关节置换系统的设计、类型和临床应用情况做一综述。