Reconstruction of the temporomandibular joint with customized prostheses

Temporomandibular joint (TMJ) reconstruction after postraumatic ankylosis resection is a challenge for maxillofacial surgeons. Sliding osteotomies, autogenous grafts and prostheses (stock o custom-made prostheses) are described among these reconstructive options. The purpose of this study is to evaluate the advantages of TMJ reconstruction by means of custom-made prostheses, performing CAD/CAM technology, in the treatment of severe craniofacial deformities. The sample included 4 males (average age at surgery 54 years, range 48-70 years). All of them had suffered severe facial trauma involving the TMJ complex, resulting in a limited mouth opening (average mouth opening 12.25 mm, range 9mm17 mm) and masticatory restrictions (average masticatory restriction 6.75 points, range 5.5-8 points), measured by means of a visual analogic scale (VAS), VAS= 0 no function and VAS= 10 normal function. The average number of previous surgical procedures that suffered the patients was 2.75 (range 1-4 procedures). As part of the presurgical workup, a craniofacial computed tomography (CT) was obtained at all the patients and a CAD/CAM model of the craniofacial skeleton was created (1: 1 scale). The planned surgical procedures and the prostheses samples were executed on the model and after the definitive prosthetic devices were manufactured. The postsurgical results showed an improvement in mouth opening (average postsurgical mouth opening 31.5 mm, range 29-34 mm) and masticatory function (average postsurgical masticatory function, 0.75 points, range 0-1.5 points). No permanent complications were found, and no failure neither infection of the alloplastic fitted components was observed, after a 26.7 months follow-up (range 8-46 months). In conclusion, TMJ reconstruction by means of custom made prostheses is a valid choice (or sometimes the only one) to treat patients with severe deformities after craniofacial trauma.