Assistant Professor, Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Bonn, Germany.
Assistant Professor, Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Bonn, Germany.
J Oral Maxillofac Surg. 2021 Oct;79(10):2016-2029. doi: 10.1016/j.joms.2021.01.025. Epub 2021 Jan 29.
Unilateral alloplastic total temporomandibular joint reconstruction (TMJR) might influence the contralateral side joint function. This study's purpose was to estimate the risk for contralateral TMJR and the jaw function of the contralateral untreated temporomandibular joint (TMJ).
A prospective cohort study design was used for patients who underwent unilateral alloplastic TMJR. The primary predictor was time after TMJR, and the secondary predictors were pre-TMJR mandibular angle resection, prior ipsilateral TMJ surgeries, and TMJR design (custom, stock). The primary outcome variable was the need for contralateral TMJR. The secondary outcome variables were the results of jaw function-jaw tracking, maximum voluntary clenching, surface electromyography, and pressure pain thresholds (PPT) and patient's quality-of-life (oral health-related quality-of-life [OHrQoL]). Data were collected preoperatively (T0), and 1 year (T1), 2-3 years (T2), and ≥ 4 years postoperatively (T4). Analysis of variance with post hoc Tukey -HSD test and multiple linear regression analysis were used for statistical analysis. P < .05 was considered significant.
Thirty-nine patients were enrolled, 15 males and 24 females, with an average age of 48.9 ± 16.2 years. Two patients (5.1%) required a contralateral TMJR. Contralateral condylar motion, incisal laterotrusion, and protrusion slightly decreased, while incisal opening (P = .003), rotation angle (P = .013), opening deflection, surface electromyography activity, maximum voluntary clenching (P = .01), PPTs, and OHrQoL all increased. Pre-TMJR mandibular angle resection had an impact on PPTs and subjective outcomes and prior ipsilateral TMJ surgeries on the opening rotation angle.
Based on this study, bilateral TMJR does not appear necessary when the contralateral TMJ is healthy. Unilateral alloplastic TMJR is associated with improved contralateral jaw function and OHrQoL.
单侧全关节置换术重建颞下颌关节（TMJ）可能会影响对侧关节功能。本研究的目的是评估对侧 TMJ 置换的风险以及未治疗的对侧 TMJ 的下颌功能。
采用前瞻性队列研究设计，对单侧全关节置换术患者进行研究。主要预测因素是 TMJ 置换术后的时间，次要预测因素包括术前下颌角切除术、同侧 TMJ 手术史和 TMJ 设计（定制、库存）。主要结局变量是对侧 TMJ 置换的需求。次要结局变量为下颌功能-下颌跟踪、最大自主紧咬、表面肌电图和压力疼痛阈值（PPT）以及患者的生活质量（口腔健康相关生活质量[OHrQoL]）。数据在术前（T0）、术后 1 年（T1）、2-3 年（T2）和≥4 年（T4）收集。采用方差分析和事后 Tukey -HSD 检验以及多元线性回归分析进行统计学分析。P<0.05 被认为具有统计学意义。
共纳入 39 例患者，男 15 例，女 24 例，平均年龄 48.9±16.2 岁。2 例患者（5.1%）需要对侧 TMJ 置换。对侧髁突运动、切向外侧移位和前伸稍减少，而切牙开口（P=0.003）、旋转角度（P=0.013）、开口偏斜、表面肌电图活动、最大自主紧咬（P=0.01）、PPTs 和 OHrQoL 均增加。术前下颌角切除术对 PPTs 和主观结果有影响，同侧 TMJ 手术对开口旋转角度有影响。
根据本研究，当对侧 TMJ 健康时，无需进行双侧 TMJ 置换。单侧全关节置换术与改善对侧下颌功能和 OHrQoL 相关。
