Genovesi Wladimir, Comenale Iara Cristina, Genovesi Filho Wladimir, Veloso Fernandes Moises
Presidente Hospital, São Paulo, Brazil.
Oral and Maxillofacial Surgery, São Paulo, Brazil.
J Oral Biol Craniofac Res. 2022 Sep-Oct;12(5):529-541. doi: 10.1016/j.jobcr.2022.06.006. Epub 2022 Jul 7.
This article reviews the design of the temporomandibular joint (TMJ) prostheses used for TMJ joint replacement from 2000 to 2020. The TMJ is a complex joint, with distinct anatomical and functional characteristics making it challenging to maintain. Many authors from the early 20th century reported techniques for TMJ reconstruction, with the goal of restoring its shape and ideal function. Many prototypes have been developed in pursuit of an ideal prosthesis that adheres to the principles of biomechanics and biocompatibility, with good long-term performance and lower cost. The TMJ prosthesis is divided in two parts: the glenoid fossa and the mandibular ramus component. These two parts are fixed with metal screws in the glenoid fossa and fixed in the zygomatic arch with 4 or 5 screws. The mandibular part is fixed to the mandible ramus with 8 or 9 titanium screws. In our review, since 2000 to 2020, little has changed to improve the design and allow for natural mandible movement. From 2000 to 2006, 48 TMJ surgeries were performed using UHMWPE with this design. All patients had good results, preserving opening mouth and lateral movements. All the designs are similar in principle. The glenoid fossa, which resembles a box, limiting the rotation and translation movement. It is known that lateral movements are lost in function as the lateral pterygoid muscle is detached.
本文回顾了2000年至2020年用于颞下颌关节置换的颞下颌关节(TMJ)假体的设计。颞下颌关节是一个复杂的关节,具有独特的解剖和功能特征,使其维护具有挑战性。20世纪早期的许多作者报道了颞下颌关节重建技术,目的是恢复其形状和理想功能。为了追求一种符合生物力学和生物相容性原则、具有良好长期性能且成本较低的理想假体,人们开发了许多原型。颞下颌关节假体分为两部分:关节窝和下颌升支部件。这两部分用金属螺钉固定在关节窝内,并用4或5颗螺钉固定在颧弓上。下颌部分用8或9颗钛螺钉固定在下颌升支上。在我们的综述中,自2000年至2020年,在改进设计以实现自然下颌运动方面几乎没有变化。2000年至2006年,采用这种设计使用超高分子量聚乙烯(UHMWPE)进行了48例颞下颌关节手术。所有患者均取得良好效果,保留了张口和侧向运动。所有设计在原理上相似。关节窝类似一个盒子,限制了旋转和平移运动。众所周知,随着翼外肌被分离,侧向运动功能丧失。