Alloplastic Total Temporomandibular Joint Reconstruction: A 10-Year Experience of the University of the Witwatersrand, Johannesburg.

Aim: This study aimed to retrospectively analyze our 10-year experience with total alloplastic reconstruction of the temporomandibular joint prostheses. Indications and clinical outcomes were also evaluated.Methodology: This was a cross-sectional study in which 31 patients who had alloplastic total Temporomandibular Joint prosthesis implanted between 2007 and 2017 were reviewed.

Objective: Outcomes (maximum mouth opening distance and occlusion), subjective outcomes (pain, diet consistency and chewing, quality of life), and complications were evaluated.

Results: There were 16 females and 15 males with a mean age of 36.94 years (range 11-72 years). In total, 51 prostheses (20 bilateral, 11 unilateral) were implanted. The stock prostheses were used in 28 patients (90.32%) and only 3 (9.68%) were of custom-made type. Fifty-eight percent of patients were diagnosed with temporomandibular joint ankylosis, 22.58% had degenerative conditions, 9.68% had pathology (hemifacial microsomia, synovial chondromatosis, and osteochondroma), and 9.68% had malocclusion.The results showed that there was a significant improvement in maximum mouth opening distance (P-value < 0.0001), particularly in patients who had ankylosis.There was improvement in diet consistency (P-value < 0.0001) and quality of life (P-value 0.013). Postoperative complications ranged from facial nerve injuries (n = 4), keloids (n = 2), and heterotopic bone formation (n = 2).

Conclusion: TMJ alloplasts provide satisfactory clinical and functional outcomes for patients with end-stage TMJ diseases, evidenced by overall improvement in maximum mouth opening, chewing ability and quality of life and reduction in pain. Previously operated joints and a preoperative diagnosis of ankylosis increase the risk of occurrence of complications postimplantation of total alloplastic joints.