Schlabe Juergen, Davies Rhodri O H L, Aagaard Esben, Cousin Gary, Edwards Andrew Ian, McAlister Kenneth, Cascarini Luke
Head and Neck Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Oral- and Maxillofacial Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Craniomaxillofac Trauma Reconstr. 2023 Sep;16(3):180-194. doi: 10.1177/19433875221094971. Epub 2022 May 14.
Retrospective case series. Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Included were all patients undergoing extended TMJ-replacements (TMJe), all operatrions were carried out by the senior author. Surgical technique was either single stage or two stage protocol. Surgical details and pitfalls and outcome of more than 2 years follow-up with reference to thirteen including twelve patients were recorded. The most common diagnosis was ameloblastoma of the mandibular ramus. Single stage or two stagge regime were carried out depending on resection requirements and involvement of teeth. Improved mouth opening of more than 30mm was achieved in 10 of 12 patients. One patient with previous TMJ replacement reported temporary weakness of the facial nerve, which resolved after 10 months. The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.
回顾性病例系列研究。异体颞下颌关节置换术已成为治疗终末期颞下颌关节（TMJ）病变的标准技术。当存在广泛的下颌骨缺损时，关节置换仍然是一个具有挑战性的临床问题。定制的延长型颞下颌关节置换术是一种可行的选择，但关于这项新兴技术的信息有限。纳入的患者均接受了延长型颞下颌关节置换术（TMJe），所有手术均由资深作者实施。手术技术采用单阶段或两阶段方案。记录了包括12例患者在内的13例患者的手术细节、陷阱以及超过2年随访的结果。最常见的诊断是下颌支成釉细胞瘤。根据切除要求和牙齿受累情况采用单阶段或两阶段方案。12例患者中有10例实现了张口度改善超过30mm。1例曾接受过TMJ置换术的患者报告出现面神经暂时麻痹，10个月后恢复。作者建议采用基于解剖学简化的单阶段或两阶段方案，两种方案均实现了出色的解剖重建、面部外观和功能，且手术并发症发生率低。定制的延长型颞下颌关节假体似乎是重建包括颞下颌关节在内的复杂下颌骨联合缺损的一种先进且可靠的解决方案。如果能够实现病变的手术清除，则倾向于采用单阶段方案。
