Lange Edouard, Varazzani Andrea, Bach Emma, Bouletreau Pierre, Brochet Louis, Cousin Anne-Sabine
Maxillofacial Surgery Department, Hôpital Lyon Sud, 165 chemin du Grand-Revoyet, Pierre-Bénite, 69495, France.
Université Claude Bernard Lyon 1, 43 boulevard du 11 novembre 1918, Villeurbanne, 69100, France.
Clin Oral Investig. 2025 Sep 16;29(10):458. doi: 10.1007/s00784-025-06556-2.
Total temporomandibular joint (TMJ) replacement is indicated when conservative treatments fail in conditions that significantly alter joint anatomy. This study evaluated the impact of early and prolonged physiotherapy on functional outcomes after TMJ prosthetic replacement.
Thirty-six patients (94.4% female; mean age, 49.8 years) underwent TMJ prosthetic replacement between July 2020 and December 2023, with a mean follow-up of 23.5 months. Functional outcomes included TMJ range of motion (ROM), pain according to a visual analog scale (VAS), and masticatory function (diet and chewing score on the TMJ-S-QoL scale). Patients were divided into two groups based on physiotherapy: early and prolonged (initiated within the first month and continued for ≥ 6 months) vs. absent/delayed/non-prolonged.
Overall, patients showed significant (p < 0.001) improvements in ROM (+ 9.8 mm), pain score (-5.2 points), and diet and chewing score (+ 1.7 points). At 1 year, early and prolonged physiotherapy was associated with significantly better masticatory outcomes. Recovery kinetics showed faster and greater improvements between 1 and 6 months in this group. ROM and pain improvements also favored early rehabilitation, although the differences were not statistically significant.
Early and sustained physiotherapy initiated within the first postoperative month significantly enhances masticatory recovery following TMJ prosthetic replacement. These findings support the integration of structured rehabilitation protocols to optimize long-term functional outcomes.
当保守治疗在显著改变关节解剖结构的情况下失败时，需进行全颞下颌关节（TMJ）置换。本研究评估了早期和长期物理治疗对TMJ假体置换后功能结局的影响。
36例患者（94.4%为女性；平均年龄49.8岁）于2020年7月至2023年12月接受了TMJ假体置换，平均随访23.5个月。功能结局包括TMJ活动范围（ROM）、视觉模拟量表（VAS）疼痛评分以及咀嚼功能（TMJ-S-QoL量表上的饮食和咀嚼评分）。根据物理治疗情况将患者分为两组：早期和长期（在第一个月内开始并持续≥6个月）与无/延迟/非长期。
总体而言，患者在ROM（增加9.8mm）、疼痛评分（降低5.2分）以及饮食和咀嚼评分（增加1.7分）方面均有显著改善（p<0.001）。在1年时，早期和长期物理治疗与显著更好的咀嚼结局相关。恢复动力学显示，该组在1至6个月之间改善更快且更大。ROM和疼痛的改善也有利于早期康复，尽管差异无统计学意义。
术后第一个月内开始的早期和持续物理治疗可显著提高TMJ假体置换后的咀嚼恢复。这些发现支持整合结构化康复方案以优化长期功能结局。
