Revision temporomandibular joint arthroplasty for the treatment of acquired metal allergy and review of the literature

The purpose of this study was to examine the outcomes of patients who received revision temporomandibular joint (TMJ) arthroplasty for the treatment of acquired metal allergy. It was hypothesized that subjects would have significant improvements in pain, swelling, and function. Patients who underwent TMJ revision due to nickel allergy were identified retrospectively. Outcomes documented included the presence or absence of facial erythema and facial swelling. Maximum incisal opening was also measured. Additional outcomes collected included age at initial surgery, initial TMJ device type, presenting symptoms, and TMJ device used for surgical revision. Four patients were identified with a nickel allergy to their TMJ prosthesis (containing nickel). All subjects experienced pain and swelling as their primary symptoms prior to the revision, with two subjects showing dermatological symptoms of overlying erythema. The four female subjects underwent exchange of their previously implanted prosthesis with a titanium alloy prosthesis. Postoperatively, all subjects showed improvements in pain score, resolution of swelling and erythema, and improvements in maximum incisal opening. This small case series suggests that revision TMJ arthroplasty with a titanium alloy prosthesis is a potential treatment for acquired metal allergy from traditional TMJ prosthesis implantation.