Current thinking about medicolegal aspects of temporomandibular joint surgery.

This paper considers the current situation regarding medicolegal risks in temporomandibular joint surgery from three perspectives: the law, the patient, and the surgeon. The law relating to successful claims of clinical negligence requires that a cause-and-effect relationship is demonstrated by the claimant. Complications are considered in the light of recent research on their stratification in other fields of surgery.

Clinical negligence in temporomandibular joint surgery.

This study reviewed the medical reports of 25 patients (21 female and 4 male) who were found to have been treated inappropriately by temporomandibular joint (TMJ) surgery. One of more Breaches of Duty and resultant harms (Causation) were identified for each of the patients in this series. Their ages ranged from 18-64 (mean 36.

Modification of an extended total temporomandibular joint replacement (eTMJR) classification system.

The aims of this paper were to validate a modification of an extended total temporomandibular joint replacement (eTMJR) classification system and develop a classification schematic for ease of reference. High-volume TMJ surgeons were asked to score 20 separate eTMJR devices using the updated classification system, and inter-rater variability was calculated. Using the modified classification system developed, a Conger's kappa (κ) coefficient of 0.

Validation of an extended total joint replacement (eTJR) classification system for the temporomandibular joint (TMJ).

The aim of this paper was to validate a previously described classification system for extended total joint replacements (eTJRs) of the temporomandibular joint (TMJ). We engaged an expert panel to review 60 TMJ eTJR devices and classify them using the system, examining their responses for inter-rater agreement and concordance with the correct response as determined by the authors. Conger's kappa was 0.

Review of emerging temporomandibular joint total joint replacement systems.

Total temporomandibular joint (TMJ) replacement has been documented as a viable option for the management of end-stage TMJ disease, but data on long-term outcomes have been reported for only two established systems: TMJ Concepts, and Zimmer Biomet. Other devices are now emerging globally, but reports of preclinical laboratory and clinical outcomes are limited. We retrieved information on the design, material composition, preclinical laboratory tests, regulatory status, and clinical outcomes of new TMJ replacement systems from PubMed and Google, and from personal correspondence with surgeons worldwide.

Extended total temporomandibular joint replacements: a classification system.

Prosthetic total temporomandibular joint (TMJ) replacement (TJR) is well established in the United Kingdom, with clear guidelines for indications and nationally published outcomes. CAD/CAM technology has made it possible to push the boundaries of custom-made TJR to include extended versions (eTJR), which may replace segmental mandibular defects or defects in the skull base with extended components for the ramus and fossa, respectively. Such prostheses are uncommon, and published reports are restricted to isolated cases and series of cases.

UK temporomandibular joint replacement database: a report on one-year outcomes.

Alloplastic temporomandibular joint (TMJ) replacements are increasingly subspecialised, and supraregional centres that treat sufficient numbers to ensure high standards are emerging. Having recently reported the introduction of a national TMJ joint replacement database that is endorsed by the British Association of TMJ Surgeons (BATS), we now present the first-year outcomes. This was a review of all data in the BATS National Case Registration of TMJ Replacement as of June 2014.

Training in surgery of the temporomandibular joint: perceptions of trainees in oral and maxillofacial surgery in the United Kingdom.

Surgery of the temporomandibular joint (TMJ) is emerging as a subspecialty in its own right within Oral and Maxillofacial Surgery (OMFS). Recent guidelines on training and practice within this area have laid down standards of competence in certain procedures, and asked for evidence of "exposure" to others at the point of completion of higher training in OMFS. Provision of surgery of the TMJ is becoming more centralised within tertiary referral centres, with resulting disparity in opportunities for clinical experience in different training regions.

Training in TMJ surgery: experience of a one-year fellowship.

In the United Kingdom, most training programmes in oral and maxillofacial surgery (OMFS) do not sufficiently cover management of the temporomandibular joint (TMJ) to enable newly appointed consultants to practise independently as TMJ surgeons. We describe a one-year fellowship programme for a senior OMFS trainee who had just completed training, which included various international courses in the USA and Europe on specific aspects of TMJ surgery. Under the direct supervision of a consultant, the trainee completed 70 arthroscopic procedures, 13 TMJ cryotherapies, 16 TMJ arthrocenteses, 9 TMJ arthroplasties, and 20 total prosthetic TMJ replacements.

UK temporomandibular joint replacement database: report on baseline data.

Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually.

Technique of temporomandibular joint replacement using a patient-specific reconstruction system in the edentulous patient.

The dental occlusion sets the intermaxillary relation during planning, construction of a prosthesis, and surgery for total replacement of the temporomandibular joint (TMJ), and enables accurate placement of the prosthesis. However, in edentulous patients this no longer exists. We describe techniques to overcome the problems encountered in such patients having TMJ replacement using the patient-specific TMJ Concepts(®) system (Ventura, California, USA).

Oral and maxillofacial surgery and chronic painful temporomandibular disorders--a systematic review.

Purpose: To provide a systematic review of the best available research literature investigating the relation of oral and maxillofacial surgical procedures to the onset or relief of chronic painful temporomandibular disorder (TMD).

Materials And Methods: A comprehensive review of the databases CINAHL, Cochrane Library, Embase, Medline, NHS Evidence--Oral Health, PsycINFO, Web of Knowledge, and MetaLib was undertaken by 2 authors (P.S.

One stage management of ankylosis of the temporomandibular joint with a custom-made total joint replacement system.

Alloplastic joint prostheses have been used in the treatment of severe diseases of the temporomandibular joint (TMJ) for many years. Treatment of ankylosis of the TMJ has been difficult, with many surgical approaches being used that traditionally involved multistage procedures, long treatment times, and increasing expense. We report a single stage technique for replacement of an ankylosed joint using a custom-made prosthesis, and discuss the technical aspects of the procedure, including our use of a custom-made acrylic glenoid fossa template.

Current status of replacement of the temporomandibular joint in the United Kingdom.

Total replacement of the temporomandibular joint (TMJ) has been done in the UK since 1987. The three currently available systems are the Christensen system, the TMJ Concepts system and the Lorenz (BMF) system. Data from surgeons who replace TMJ were collated up to May 2007.

Foreign body response around total prosthetic metal-on-metal replacements of the temporomandibular joint in the UK.

Replacements for the temporomandibular joint were developed in the early 1960s. Problems with various prostheses, notably the Kent VK1, led to detailed analysis of their risks and complications. In 1999 one type of prosthesis (the Christensen) was converted from an acrylic condyle on cobalt-chromium fossa to metal-on-metal cobalt-chrome condyle and fossa.