Evaluation of fit feasibility of stock total joint replacement in temporomandibular joint ankylosis patients |
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| Affiliation: | 1. Department of Oral & Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India;2. Department of Radiology, All India Institute of Medical Sciences, New Delhi, India;1. Resident, Department of Oral Surgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China;2. Resident, Department of Oral Surgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China;3. Professor, Department of Oral Surgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China;4. Professor, Department of Oral Surgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, and National Clinical Research Center of Stomatology, Shanghai, China;6. Resident, Department of Oral Surgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China;5. Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX;1. University Hospitals Birmingham NHS Foundation Trust, United Kingdom;2. Imperial College London, United Kingdom;3. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, United States;4. TMJ Concepts, Ventura, CA, United States;5. Spire Little Aston Hospital, Sutton Coldfield, United Kingdom;1. Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India;2. Department of Oral and Maxillofacial Surgery, People''s College of Dental Sciences and Research Center, People''s University, Bhanpur, Bhopal 462 037, Madhya Pradesh, India;3. Center for Technology Assisted Reconstructive Surgery, Santhome, Chennai, India;4. Department of Oral and Maxillofacial Surgery, People''s Dental Academy, People''s University, Bhanpur, Bhopal 462 037, Madhya Pradesh, India;5. TMJ Consultancy Services, Bhopal 462 001, Madhya Pradesh, India;1. Maxillofacial Department, Royal Brisbane and Women''s Hospital, Brisbane, Queensland, Australia;2. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia;3. Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia;4. Research School of Population Health, The Australian National University, Canberra, Australia;5. College of Medicine, Qatar University, Doha, Qatar;1. Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA;2. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA;3. TMJ Concepts, Ventura, CA, USA;4. Department of Oral and Maxillofacial Surgery, The University of Oklahoma, Oklahoma City, OK, USA;1. Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, and Harvard School of Dental Medicine, Harvard University, Boston, MA;2. DMD Candidate, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, and Harvard School of Dental Medicine, Harvard University, Boston, MA;3. Instructor of Developmental Biology, Harvard School of Dental Medicine, Harvard University, Boston, MA;4. Resident, Division of Oral and Maxillofacial Pain, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA;6. Instructor of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA;5. Professor of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, and Harvard School Dental Medicine, Harvard University, Boston, MA |
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| Abstract: | Long standing adult temporomandibular joint ankylosis (TMJA) results in smaller ramal height, and warped and undulated ramus. Despite the efforts made to standardise the sizes available in stock joint (Zimmer Biomet®), the system causes fit challenges in TMJA patients. The aim of the study was to evaluate the virtual feasibility of stock prostheses in TMJA patients. The data included amount of bone contouring for fossa placement, available ramal length, length discrepancy if placed straight, angulation of mandibular component required to adapt to the bone, and mediolateral fit discrepancy. CT data of 50 TMJA patients (71 joints; unilateral, n = 29; bilateral, n = 21; male, n = 33; female, n = 17) with mean age of 24.26 ± 8.88 years were included. 53 joints required more than 3 mm lateral bone reduction for fossa placement. The ramal length were categorised into ranges 35–40 mm (n = 15), 41–45 mm (n = 14), 46–50 mm (n = 28) and >50 mm (n = 14). Correlation between the age of occurrence of ankylosis and ramal length using the Pearson correlation coefficient revealed a positive correlation (r = 0.38, p = 0.001). Length discrepancy, angulation of mandibular component, and mediolateral fit discrepancy decreases as the ramal length increases. Only 14 joints had appropriate fit of stock prostheses while the remaining 57 joints warranted compromised placement. Even the smallest available stock mandibular component (45 mm) had a compromised fit in terms of length and adaptability on the lateral aspect of ramus. The study concludes that a short ramus is mostly limiting factor in using stock prosthesis in TMJA patients. There is a need for still smaller size stock prostheses. |
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| Keywords: | Stock alloplastic prosthesis TMJ replacement TMJ TJR Fit feasibility Temporomandibular joint ankylosis Biomet prosthesis |
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