Professor and Head, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
Scientist, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
J Oral Maxillofac Surg. 2021 Jan;79(1):75-87. doi: 10.1016/j.joms.2020.07.214. Epub 2020 Aug 5.
Adult temporomandibular joint ankylosis (TMJA) lacks a uniform management protocol. The purpose of the study was to evaluate the outcome of stock total joint replacement (TJR) along with fat grafting around the joint in adult TMJA patients. Specific aim was to find out whether TJR can be a definitive management for adult TMJA.
The investigators implemented a prospective study on adult TMJA patients treated with ostearthrectomy of ankylosis and stock temporomandibular joint (TMJ) TJR with fat grafting. Concomitant orthognathic correction of facial asymmetry was performed in some unilateral cases. Follow-up was carried out at regular intervals for assessing primary outcome variable of maximal incisal opening (MIO) and reankylosis. Secondary outcome variable included demographic data, etiology, duration of ankylosis (DOA), correlation between DOA and preoperative and postoperative MIO, occlusion and complications of hemorrhage, facial nerve paresis, periprosthetic joint infection, dislocation, and implant failure.
The study sample was composed of 41 patients (54 joints) (bilateral, n = 13; unilateral, n = 28 [right side, n = 12; left side, n = 16]). The number of recurrent cases was 15. Trauma as etiology of ankylosis was seen in n = 30 (73.2%), infection in n = 7 (17.1%), unknown in n = 3 (7.3%), and ankylosing spondylitis in n = 1 (2.4%) cases. Mean DOA was 11.95 years. Paired t test revealed a statistically significant difference between preoperative and follow-up MIO (P < .001). None of the cases showed reankylosis in the follow-up period. Pearson correlation revealed statistically negative correlation between DOA and postoperative MIO.
The result of this study suggests that stock TMJ TJR along with fat grafting around the joints provides adequate mouth opening without any sign and symptoms of reankylosis. Stock TMJ TJR with fat grafting can be considered as a definitive treatment modality in adult TMJA with minimum comorbidity.
成人颞下颌关节强直（TMJA）缺乏统一的治疗方案。本研究旨在评估髁突关节置换（TJR）联合关节周围脂肪移植治疗成人 TMJA 的疗效。具体目的是确定 TJR 是否可作为成人 TMJA 的一种确定性治疗方法。
研究者对接受强直切除术和髁突关节 TJR 联合关节周围脂肪移植的成人 TMJA 患者进行了前瞻性研究。部分单侧病例同期行正颌矫正。定期随访，评估最大张口度（MIO）和再强直的主要结局变量。次要结局变量包括人口统计学数据、病因、强直持续时间（DOA）、DOA 与术前和术后 MIO 的相关性、咬合关系和并发症（出血、面神经麻痹、假体周围关节感染、脱位和植入物失败）。
研究样本由 41 例（54 侧）患者（双侧，n=13；单侧，n=28[右侧，n=12；左侧，n=16]）组成。复发病例 15 例。强直病因中创伤 30 例（73.2%），感染 7 例（17.1%），原因不明 3 例（7.3%），强直性脊柱炎 1 例（2.4%）。平均 DOA 为 11.95 年。配对 t 检验显示术前与随访 MIO 差异有统计学意义（P<.001）。随访期间无再强直病例。Pearson 相关性分析显示 DOA 与术后 MIO 呈负相关。
本研究结果表明，髁突关节 TJR 联合关节周围脂肪移植可提供足够的张口度，且无再强直的迹象和症状。髁突关节 TJR 联合关节周围脂肪移植可作为成人 TMJA 的一种确定性治疗方法，并发症少。
