Authors
Epifanov S.A.1, Shtempel M.S.1, Zangieva O.T.1, Fedotov R.N.2, Vyselceva U.V.3, Shomin E.A.1
1 Pirogov National Medical and Surgical Center, Moscow
2 A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow
3 Privolzhsky Research Medical University, Nizhnij Novgorod
Abstract
Aim: to evaluate the results of the total temporomandibular joint replacement for patients with ankylosis of temporomandibular joint (TMJ).
Methods and materials: the research includes the retrospective analysis of patients with tmj ankylosis and total tmj replacement from 2010 to 2018.
Inclusion criteria: 1) Xray confirmation of ankylosis, 2) Restriction of mouth opening, 3) Post operation period more than 12 months, 4) Use of a custom-made total TMJ endoprosthesis. For each patient the number of previous surgical interventions in the affected TMJ was assessed (in case it happened) and the duration of the post operation period before the disease recurrance. Subjective assessment of the patient’s condition was made by the method of questioning the visual-analog scale (VAS) from 0 to 10 for the following parameters: 1) pain in the TMJ, 2) facial pain and headaches, 3) TMJ function, 4) ability to chew solid food, 5) subjective impact assessment of the total TMJ endoprosthesis on life quality. The subjective assessment of the impact total MJ endoprosthesis has on day-to-day life.
Objective methods of research consisted of an evaluation of the interstitial distance at maximum mouth opening (MOP) and an assessment of mandibula lateral movements. Non-parametric functions were used for statistical analysis.
We examined and treated 32 patients (22 women, 10 men) with 48 TMJ ankyloses (16 bilateral, 16 unilateral), average age of patients was 39 years (spread from 18 to 68), 69% with 2 or more previous surgeries in the TMJ area, and the average observation period 24 months (spread from 12 to 84). Injury as the main cause of ankylosis was registered in 17 out of 32 cases (53%). As a result of surgical treatment, the following results were achieved: average subjective assessment of pain in the TMJ before surgical treatment — 8.0, after — 1.5; headache: before — 8, after — 3.5; facial pain: before — 8, after — 4.0; TMJ functions: before — 8.0, after — 2.5; Ability to chew solid food: up to — 7.0, after — 3.0; patients assessed the legal capacity before the operation as 7, after — 1.5.
Before the surgical treatment the average MR was 14.5 mm (spread from 6.3 to 20 mm) and in the postoperative period 35 mm (spread from 30 to 40 mm). The average lateral excursion of the lower jaw improved from 0.5 to 2.0 mm with left-sided ankylosis and from 1.0 to 1.3 mm on the right side. All improvements had statistically significant indicators (p<0.001).
Equally significant improvements were registered for patients with observation period 12–48 months and more than 48 months.
Conclusions: total endoprosthesis at the patients with TMJ ankylosis is an affordable and predictable method of surgical treatment aimed to improve the function of the TMJ, reduce the level of pain and increase life quality.
Keywords: temporomandibular joint, TMJ, ankylosis, total endoprosthesis, arthroplasty.
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