Alloplastic reconstruction of the temporomandibular joint in treatment of craniofacial developmental or congenital anomalies: a surgical case report.

OBJECTIVE: To describe the surgical planning and treatment approach in addressing the oral and maxillofacial needs for one particular patient suffering congenital anomalies of the craniofacial anatomy. A secondary objective is to restore mandibular and maxillary function and esthetics to the young, adult patient. The tertiary objective is to educate the surgeon as to alloplastic implant options that may be available to restore function and relieve pain for the patient missing certain anatomical structures from birth. METHODS: Through the use of advanced medical imaging tools, a thorough understanding of the patient's prior failed medical treatments, and a meticulous understanding of the benefits of alloplastic reconstruction, the surgeon can mitigate patient symptoms and at the same time increase the probability of a successful outcome. The surgeon can then collaborate with the surgical and implant design team to not only prescribe the surgical correction necessary, but also design and construct the actual temporomandibular joint (TMJ) and mandibular implants used for the case, as well as perform mock surgery on a stereolithography anatomical (SLA) model needed to restore function and esthetics for the patient. The end result is that a Patient-Specific (custom) (TMJ Implants, Inc., Golden, CO, USA) prosthesis can then be manufactured and adapted surgically to the patient's unique anatomy. RESULTS: The early results from this alloplastic reconstructive surgery have brought forth the anticipated results of replacement of the congenitally absent TMJ, improvement of jaw function, reduction of joint pain, as well as improvement of the esthetics. Without this breakthrough surgical development, many of these congenital anatomically deficient patients would not be able to enjoy normal breathing, mastication, jaw function, esthetics, oral and dental health, and the emotional relief that these corrections allow. CONCLUSIONS: Many patients who suffer birth-related anatomical deficiencies (such as cleft lip and branchial arch syndrome) never receive the surgical correction necessary. Many have had autogenous reconstruction of missing mandibular and TMJ structures only to relapse, at times, into a more disfiguring and lasting condition. By simply placing a Christensen Fossa-Eminence Prosthesis (FEP) and Condylar Prosthesis (CP) in a total joint-replacement solution, one is more likely to achieve satisfactory TMJ mobility and reduction in pain, as well as the mechanical replacement of missing anatomical structures and predictable and lasting improvement. As an additional benefit, the patient also would enjoy enhanced esthetics.

Temporomandibular joint disorders: artificial joint replacements and future research needs.

Temporomandibular disorders (TMD) affect a significant section of the American population. According to the National Institutes of Health (NIH), an estimated 3% to 5% of Americans suffer from temporomandibular disorders. Majority of TMDs can be treated by conservative methods, albeit surgical interventions are indicated for some pathological/clinical conditions (according to the American Association of Temporomandibular Joint Surgeons). A distinction can be made between the TMD and the TMJ disease/dysfunction. In the case of TMD, it most correctly relates to a neuromuscular type of problem in the general area of the Temporomandibular Joint (TMJ), but may not intrinsically be related to the TM joint itself. However, TMJ disease/dysfunction relates to a true joint type of pathology, which ultimately may lead to the use of either a partial or a total joint reconstruction. Degeneration of the meniscus and the actual bony portions of the joint is often seen in cases of true TMJ pathology. The use of custom made or predesigned partial and/or total artificial TMJ replacement remains one of the surgical alternatives for treating various TMJ diseases when other conservative treatments fail. The purpose of this article is to provide an overview of currently existing TMJ implants and to discuss relevant issues, including some of the challenges and current needs facing TMJ research. Additionally, this article describes some of the currently available TMJ surgical procedures, the use of autografts and alloplastic materials (with primary emphasis on TMJ implants) for TMJ reconstruction, and some suggestions for future research. Past incidents of clinical failures of TMJ implants have been attributed to several reasons. The important factors that are responsible for the past failures include lack of a sound scientific approach and inadequate basic research to study the underlying causes for pathologies and their remedies of the TMJ. All these previously mentioned concerns have prompted current biomedical researchers to address many overlooked issues in relation to studying temporomandibular disorders and TMJ implants. Future research should be aimed toward addressing TMJ problems with a multidisciplinary approach, emphasizing simultaneous involvement from clinical (i.e., dentists and physicians) and nonclinical personnel (i.e., oral biologists, bioengineers, biostatisticians, physiotherapists, and pain management specialists).

New hope for Treacher-Collins syndrome: a surgical case report.

The objective of this case report is to discuss the possibility of developing a surgical treatment paradigm for patients with some of the noted characteristics of Treacher-Collins syndrome, mainly mandibular ankylosis and/or retrognathia (mandibular retrusion), in a way that would provide lasting, predictable results and minimize the frequently seen mandibular ankylosis. Through various medical imaging techniques, mainly computed tomography (CT) scan, the radiology imaging technologist produces accurate CT scan images of the particular patient's osseous cranial structures. These images can then be used by the stereolithography (SLA) technician to construct accurate SLA models. The SLA models can then be used by the surgical and implant design team to not only prescribe the surgical correction necessary, but also design and construct the actual temporomandibular joint (TMJ) and mandibular implants, as well as perform mock surgery, which will be needed to restore function and esthetics for the patient. The early results from this alloplastic reconstructive surgery have provided the anticipated results of relieving the ankylosis, improving jaw function and frequently dental occlusion, as well as improving the esthetics. Without this breakthrough surgical development, many of these Treacher-Collins syndrome patients will not be able to enjoy normal breathing, mastication, jaw function, esthetics, oral and dental health, and the emotional relief these corrections allow. Many patients who suffer the disfiguring and functionally damaging affects of Treacher-Collins syndrome never receive the surgical correction necessary. Many have had autogenous reconstruction of missing mandibular and TMJ structures, only to sometimes relapse into a more disfiguring and lasting condition. By simply placing a Christensen Fossa-Eminence Prosthesis(r) (TMJ Implants, Inc., Golden CO, USA) between the cranial base and any bone graft, one is more likely to achieve satisfactory TMJ mobility. If a condylar or mandibular reconstruction is necessary, the Christensen Total TMJ Prostheses(r) (TMJ Implants, Inc., Golden CO, USA) are available and provide excellent results.

Hemi and total TMJ reconstruction using the Christensen prostheses: a retrospective and prospective evaluation.

This chapter further affirms the safety and efficacy of hemi and total temporomandibular joint (TMJ) reconstruction with the Christensen TMJ Prostheses (TMJ Implants, Inc., Golden, CO, USA). Hemi and total TMJ reconstruction with the Christensen TMJ prostheses was first introduced by Robert W. Christensen, DDS in 1961 and 1965, respectively, and is gaining widespread acceptance as a viable alternative in the treatment of temporomandibular joint disorders (TMD). The Christensen TMJ devices have been used to treat various disorders in large numbers of patients, and the pertinent results of 10 years of study are reported in this chapter.

Use of the Christensen TMJ Fossa-Eminence Prosthesis System: a retrospective clinical study.

Disc displacements develop from alterations in the structural integrity of the condyle-disc complex. A definitive treatment that may be considered for such derangements is surgical correction. The goal of surgery is to return the disc to normal functional relationship with the condyle, or replace the disc with an alloplast. Surgery, is, therefore, considered when conservative therapy fails to adequately resolve the symptoms, progression of the disorder occurs, or both.