Extended Total Temporomandibular Joint Replacement – A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint

Abstract

Introduction Alloplastic temporomandibular joint replacement has been established as a standard technique for end-stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Methods and patients In this retrospective case series, the authors report the results, surgical techniques, pitfalls and outcome of more than 2 years follow-up with reference to thirteen extended TMJ-replacements (TMJe) including twelve patients. The most common diagnosis was ameloblastoma of the mandibular ramus. Discussion The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Conclusion Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.