Gerbino G, Sobrero F, Poelaert R, Borbon C, Ramieri G, Mommaerts M
Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
Int J Oral Maxillofac Surg. 2025 May;54(5):438-447. doi: 10.1016/j.ijom.2024.10.007. Epub 2024 Oct 31.
Prostheses for extended total temporomandibular joint replacement (eTJR) include modifications to the traditional alloplastic fossa-condyle joint that extend to adjacent bone defects. The aim of this retrospective study was to assess the feasibility, postoperative complications, and functional and aesthetic outcomes after eTJR. Patients aged ≥18 years undergoing eTJR between 2013 and 2022 were included. Data recorded were age, sex, comorbidities, indication for eTJR, prosthesis brand, classification, concomitant surgical procedures, postoperative complications, maximum inter-incisal opening (MIO), pain, quality of life (QoL), and aesthetic outcome. Twenty-five patients (mean age 40 years), with a total of 30 joint prostheses, were included. Over a median follow-up of 42 months, there was a significant improvement in MIO in patients with reduced mouth opening at baseline (P = 0.003), as well as in pain (P = 0.007) and QoL (P = 0.004). Both patients and surgeons judged facial appearance as improved or unchanged in 88% of cases. Postoperative complications included permanent trigeminal nerve hypoesthesia (44%), permanent facial nerve dysfunction (35%), infection (8%), salivary leak (4%), and lingual nerve impairment (4%). The findings suggest that eTJR is a safe and effective treatment for temporomandibular joint deficits extending to adjacent structures, yielding satisfactory functional and aesthetic outcomes.
用于全颞下颌关节置换术（eTJR）的假体包括对传统异质材料制成的窝-髁关节的改良，这种改良延伸至相邻的骨缺损处。本回顾性研究的目的是评估eTJR术后的可行性、并发症以及功能和美学效果。纳入了2013年至2022年间接受eTJR且年龄≥18岁的患者。记录的数据包括年龄、性别、合并症、eTJR的适应证、假体品牌、分类、同期手术、术后并发症、最大切牙间开口度（MIO）、疼痛、生活质量（QoL）和美学效果。共纳入25例患者（平均年龄40岁），共植入30个关节假体。在中位随访42个月时，基线时开口度减小的患者的MIO有显著改善（P = 0.003），疼痛（P = 0.007）和QoL（P = 0.004）也有改善。88%的病例中患者和外科医生均认为面部外观有所改善或无变化。术后并发症包括永久性三叉神经感觉减退（44%）、永久性面神经功能障碍（35%）、感染（8%）、唾液漏（4%）和舌神经损伤（4%）。研究结果表明，eTJR是治疗延伸至相邻结构的颞下颌关节缺损的一种安全有效的方法，可产生令人满意的功能和美学效果。
