Extended temporomandibular joint prostheses: a retrospective analysis of feasibility, outcomes, and complications.

G Gerbino, F Sobrero, R Poelaert, C Borbon, G Ramieri, M Mommaerts
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Abstract

Prostheses for extended total temporomandibular joint replacement (eTJR) include modifications to the traditional alloplastic fossa-condyle joint that extend to adjacent bone defects. The aim of this retrospective study was to assess the feasibility, postoperative complications, and functional and aesthetic outcomes after eTJR. Patients aged ≥18 years undergoing eTJR between 2013 and 2022 were included. Data recorded were age, sex, comorbidities, indication for eTJR, prosthesis brand, classification, concomitant surgical procedures, postoperative complications, maximum inter-incisal opening (MIO), pain, quality of life (QoL), and aesthetic outcome. Twenty-five patients (mean age 40 years), with a total of 30 joint prostheses, were included. Over a median follow-up of 42 months, there was a significant improvement in MIO in patients with reduced mouth opening at baseline (P = 0.003), as well as in pain (P = 0.007) and QoL (P = 0.004). Both patients and surgeons judged facial appearance as improved or unchanged in 88% of cases. Postoperative complications included permanent trigeminal nerve hypoesthesia (44%), permanent facial nerve dysfunction (35%), infection (8%), salivary leak (4%), and lingual nerve impairment (4%). The findings suggest that eTJR is a safe and effective treatment for temporomandibular joint deficits extending to adjacent structures, yielding satisfactory functional and aesthetic outcomes.

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加长型颞下颌关节假体:对可行性、效果和并发症的回顾性分析。
扩展全颞下颌关节置换术(eTJR)的假体包括对传统的异体窝-髁状关节的改良,扩展到邻近的骨缺损。这项回顾性研究旨在评估eTJR的可行性、术后并发症以及功能和美学效果。研究纳入了2013年至2022年间接受eTJR手术的年龄≥18岁的患者。记录的数据包括年龄、性别、合并症、eTJR的适应症、假体品牌、分类、伴随的外科手术、术后并发症、最大椎间隙(MIO)、疼痛、生活质量(QoL)和美学效果。研究共纳入了 25 名患者(平均年龄 40 岁),共使用了 30 个关节假体。在中位 42 个月的随访中,基线张口度降低的患者的 MIO(P = 0.003)、疼痛(P = 0.007)和 QoL(P = 0.004)均有显著改善。在 88% 的病例中,患者和外科医生都认为面部外观得到了改善或保持不变。术后并发症包括永久性三叉神经麻痹(44%)、永久性面神经功能障碍(35%)、感染(8%)、唾液渗漏(4%)和舌神经损伤(4%)。研究结果表明,eTJR 是一种安全有效的治疗方法,可用于治疗颞下颌关节功能障碍扩展到邻近结构的情况,并能产生令人满意的功能和美观效果。
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