Modified surgical techniques for total alloplastic temporomandibular joint replacement: One institution's experience

Objective: To present three modified techniques of total alloplastic temporomandibular joint replacement (TMJ TJR) and to evaluate the outcomes regarding prosthesis stability and heterotopic bone formation. Material and methods: A total of 15 patients (19 joints), treated with the Biomet stock prosthesis from May 2006 to May 2013, were retrospectively analyzed. Surgical procedures were performed with the following three modifications: bone grafting of the glenoid fossa; salvage of TMJ discs; and harvesting of retro-mandibular subcutaneous fats. The glenoid fossa depth was measured preoperatively by Surgicase 5.0 software. All patients were evaluated by radiographic examination and surgical observation. Results: The fossa was grafted with an autogenous bone in 15 joints (78.9%). In 4 joints (21.1%), only bone repair was performed. Radiographic evaluation revealed a good integration between the autogenous and host bones. All patients showed postoperative occlusal stability. In 5 joints (26.3%), the discs were salvaged. Both bleeding and operation time were reduced. Fat grafts were harvested in 17 joints (89.5%), in which there were no abnormalities in the periprosthetic bone structure. In 2 joints (10.5%), with no fat grafting, heterotopic bone formation was found. Conclusions: The modified techniques of TJR help to improve prostheses stability, reducing heterotopic bone formation and avoiding additional scars. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.