Influence of preoperative anatomy and functional status on outcomes after total temporomandibular joint replacement with patient-specific endoprostheses: A retrospective cohort study.

IF 2.7 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Dental and Medical Problems Pub Date : 2024-04-24 DOI:10.17219/dmp/174598
Rostyslav Terletskyi, Krzysztof Dowgierd, Y. Chepurnyi, A. Kopchak, Andreas Neff
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Abstract

BACKGROUND Temporomandibular joint (TMJ) replacement may be indicated for various pathological conditions, and the type of condition can affect the surgical procedure and outcomes. The causes of limited range of motion after alloplastic TMJ replacement have not been extensively studied. OBJECTIVES The present study aimed to evaluate the impact of preoperative jaw anatomy and functional status on the immediate and long-term outcomes of total TMJ replacement using a two-component patient-specific TMJ endoprosthesis. MATERIAL AND METHODS This retrospective study included 31 patients who underwent total TMJ replacement surgery between 2016 and 2020. The main outcome variable was the maximal incisal opening (MIO) after treatment. Secondary outcome variables included MIO improvement and the presence and type of postoperative complications. The primary predictive variable was the preoperative initial MIO. Secondary predictive variables included sex, age, indications for TMJ replacement, preoperative occlusion, condition of the glenoid fossa and/or condyle, shortening of the mandibular ramus, sagittal mandible position, lateral chin deviation, shape of the coronoid process, and type of surgery. RESULTS The mean preoperative MIO was 13.0 ±8.0 mm, while the mean MIO 1 month after surgery was 20.6 ±5.5 mm, which was not statistically significant. However, at a later follow-up, functional parameters showed a significant improvement (p = 0.003), with a mean MIO of 32.5 ±5.0 mm 3 years after surgery. Statistical analysis indicated that the initial mouth opening is the strongest predictor of long-term functional recovery after TMJ replacement. Postoperative complications occurred in 4 cases (12.9%) following patient-specific endoprosthesis (PSE) placement. CONCLUSIONS The use of PSEs for TMJ replacement has enabled the restoration of anatomical relationships in complex clinical cases and an improvement in mouth opening. The preoperative MIO was the only factor that significantly influenced long-term functional outcomes.
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使用患者特异性内固定器进行全颞下颌关节置换术后,术前解剖结构和功能状态对术后效果的影响:一项回顾性队列研究。
背景颞下颌关节(TMJ)置换术可能适用于各种病症,病症类型会影响手术过程和结果。本研究旨在评估术前颌骨解剖和功能状态对使用双组分患者特异性颞下颌关节内假体进行全颞下颌关节置换术的近期和远期疗效的影响。材料和方法这项回顾性研究纳入了 31 名在 2016 年至 2020 年期间接受全颞下颌关节置换手术的患者。主要结果变量是治疗后的最大切口开度(MIO)。次要结果变量包括 MIO 的改善以及术后并发症的存在和类型。主要预测变量是术前初始 MIO。次要预测变量包括性别、年龄、颞下颌关节置换术的适应症、术前咬合、盂窝和/或髁状突的状况、下颌横突缩短、下颌骨矢状位、颏侧偏斜、冠突的形状以及手术类型。然而,在随后的随访中,功能参数有了明显改善(p = 0.003),术后 3 年的平均 MIO 为 32.5 ± 5.0 毫米。统计分析表明,初始张口度是颞下颌关节置换术后长期功能恢复的最有力预测指标。结论颞下颌关节置换术中使用特异性颞下颌关节内假体(PSE)可恢复复杂临床病例的解剖关系,并改善张口情况。术前MIO是唯一对长期功能结果有显著影响的因素。
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来源期刊
CiteScore
4.00
自引率
3.80%
发文量
58
审稿时长
53 weeks
期刊最新文献
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