Terletskyi Rostyslav, Dowgierd Krzysztof, Chepurnyi Yurii, Kopchak Andrii, Neff Andreas
Department of Maxillofacial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kyiv, Ukraine.
Head and Neck Surgery Clinic for Children and Youth, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Poland.
Dent Med Probl. 2025 Jan-Feb;62(1):57-64. doi: 10.17219/dmp/174598.
Temporomandibular joint (TMJ) replacement may be indicated for various pathological conditions, and the type of condition can affect the surgical procedure and outcomes. The causes of limited range of motion after alloplastic TMJ replacement have not been extensively studied.
The present study aimed to evaluate the impact of preoperative jaw anatomy and functional status on the immediate and long-term outcomes of total TMJ replacement using a two-component patient-specific TMJ endoprosthesis.
This retrospective study included 31 patients who underwent total TMJ replacement surgery between 2016 and 2020. The main outcome variable was the maximal incisal opening (MIO) after treatment. Secondary outcome variables included MIO improvement and the presence and type of postoperative complications. The primary predictive variable was the preoperative initial MIO. Secondary predictive variables included sex, age, indications for TMJ replacement, preoperative occlusion, condition of the glenoid fossa and/or condyle, shortening of the mandibular ramus, sagittal mandible position, lateral chin deviation, shape of the coronoid process, and type of surgery.
The mean preoperative MIO was 13.0 ±8.0 mm, while the mean MIO 1 month after surgery was 20.6 ±5.5 mm, which was not statistically significant. However, at a later follow-up, functional parameters showed a significant improvement (p = 0.003), with a mean MIO of 32.5 ±5.0 mm 3 years after surgery. Statistical analysis indicated that the initial mouth opening is the strongest predictor of long-term functional recovery after TMJ replacement. Postoperative complications occurred in 4 cases (12.9%) following patient-specific endoprosthesis (PSE) placement.
The use of PSEs for TMJ replacement has enabled the restoration of anatomical relationships in complex clinical cases and an improvement in mouth opening. The preoperative MIO was the only factor that significantly influenced long-term functional outcomes.
颞下颌关节（TMJ）置换术适用于多种病理状况，且病情类型会影响手术过程及结果。关于人工材料颞下颌关节置换术后活动范围受限的原因尚未得到广泛研究。
本研究旨在评估术前颌骨解剖结构和功能状态对使用双组件定制型TMJ假体进行全TMJ置换术的近期和长期效果的影响。
这项回顾性研究纳入了2016年至2020年间接受全TMJ置换手术的31例患者。主要结局变量为治疗后的最大切牙开口度（MIO）。次要结局变量包括MIO改善情况以及术后并发症的发生情况和类型。主要预测变量为术前初始MIO。次要预测变量包括性别、年龄、TMJ置换的适应证、术前咬合情况、关节窝和/或髁突状况、下颌升支缩短情况、下颌骨矢状位、颏部侧方偏斜、冠突形状以及手术类型。
术前平均MIO为13.0±8.0毫米，而术后1个月时平均MIO为20.6±5.5毫米，差异无统计学意义。然而，在随后的随访中，功能参数显示出显著改善（p = 0.003），术后3年时平均MIO为32.5±5.0毫米。统计分析表明，初始开口度是TMJ置换术后长期功能恢复的最强预测指标。在使用定制型假体（PSE）植入后，有4例（12.9%）出现了术后并发症。
使用PSE进行TMJ置换能够在复杂临床病例中恢复解剖关系并改善开口度。术前MIO是唯一显著影响长期功能结局的因素。
