• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.6.1-6.6
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• 2017

Background: The purpose of this study is to evaluate the outcomes of four patients receiving stock Biomet TMJ prosthesis for reconstruction of the TMJs. Methods: TMJ reconstruction with stock Biomet TMJ prosthesis was performed in four patients who had joint damages by trauma, tumor, resorption, and ankylosis, which represent the indications of alloplastic prosthesis. Results: Loss of condyle from trauma and resorption of joint are good indications for prosthesis, but the patients should be informed about limitation of jaw movement. In case of structural damage of TMJ by tumor, tumor recurrence should be considered before planning TMJ reconstruction. Considering heterotopic bone formation in case of ankylosis, periodic follow-up and special surgical technique are required. Conclusions: Given careful treatment planning and understanding the functional limitation of TMJ prosthesis, alloplastic prosthesis is a safe and effective management option for the reconstruction of TMJs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.6
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• pp.297-303
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• 2013

Alloplastic total replacement of the temporomandibular joint (TMJ) was developed in recent decades. In some conditions, previous studies suggested the rationale behind alloplastic TMJ replacement rather than reconstruction with autogenous grafts. Currently, three prosthetic products are available and approved by the US Food and Drug Administration. Among these products, customized prostheses are manufactured, via computer aided design/computer aided manufacturing (CAD/CAM) system for customized design; stock-type prostheses are provided in various sizes and shapes. In this report, two patients (a 50-year-old female who had undergone condylectomy for the treatment of osteochondroma extending to the cranial base on the left condyle, and a 21-year-old male diagnosed with left temporomandibular ankylosis) were treated using the alloplastic total replacement of TMJ using stock prosthesis. The follow-up results of a favorable one-year, short-term therapeutic outcome were obtained for the alloplastic total TMJ replacement using a stock-type prosthesis.

• The Journal of the Korean dental association
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• v.50 no.5
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• pp.256-261
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• 2012

Temporomandibular joint (TMJ) prosthesis have been hesitated to use because of bitter memories about Proplast-Teflon interpositional TMJ implants. Many clinicians, however, are trying to use total TMJ prosthesis with getting continuous long-term follow-up results. Alloplastic total TMJ replacement have been applied to much more patients who have failed previous TMJ prostheses or TMJ implants, fibrous/bony ankylosis, severe osteoarthritis, degenerative joint disease, idiopathic condylar resorption, condyle loss by trauma or tumor resection, and other bony destructive diseases. Nowadays three types of total TMJ prosthesis are widely used. In this article, indications, types of prosthesis, safety and stability would be demonstrated with a case report.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.2
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• pp.162-167
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• 2010

This is a case report about patient who had suffered from degenerative joint disease and treated by TMJ reconstruction with condylar prosthesis. The patient visited Korea University An-am hospital on 2007 complaining symptom about both TMJ pain, mouth opening limitation and open bite. From CT view there was severe resorption of both condylar head, therefore condylar prosthesis reconstruction was planned. After 3D RP model analysis for preparation, the patient was operated under general anesthesia for condylar prosthesis reconstruction and the symptom was alleviated. (increased mouth opening, reduced anterior open bite, full mouth occlusal contact achieved) Follow up was carried out monthly, but after this, patient refused follow up. After 26 months from the operation, the patient revisited for anterior open bite. In clinical evaluation, occlusal contact was remained, but anterior open bite was relapsed. From cephalometry analysis, severe resorption of glenoid fossa was found. Therefore, Autogenous disc reconstruction with alloplastic material was planned on August 2009. After another surgery, condylar prosthesis was regained its normal position in glenoid fossa, and occlusion was recovered properly.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.6
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• pp.412-420
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• 2013

The literature on alloplastic total temporomandibular joint (TMJ) replacement is encouraging, with acceptable improvement of treatment outcomes in terms of both pain level and jaw function. This is a case report on patients who suffered from degenerative joint disease and ankylosis after mandibular condyle fracture or prior TMJ surgery and were treated by TMJ replacement with condyle prosthesis. We obtained good results from the procedures, including total TMJ replacement.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.39.1-39.6
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• 2016

Background: Temporomandibular joint (TMJ) ankylosis in children often leads to facial deformity, functional deficit, and negative influence of the psychosocial development, which worsens with growth. The treatment of TMJ ankylosis in the pediatric patient is much more challenging than in adults because of a high incidence of recurrence and unfavorable growth of the mandible. Case report: This is a case report describing sequential management of the left TMJ ankylosis resulted from trauma in early childhood. The multiple surgeries including a costochondral graft and gap arthroplasty using interpositional silicone block were performed, but re-ankylosis of the TMJ occurred after surgery. Alloplastic TMJ prosthesis was conducted to prevent another ankylosis, and signs or symptoms of re-ankylosis were not found. Additional reconstruction surgery was performed to compensate mandibular growth after confirming growth completion. During the first 3 years of long-term follow-up, satisfactory functional and esthetic results were observed. Conclusions: This is to review the sequential management for the recurrent TMJ ankylosis in a growing child. Even though proper healing was expected after reconstruction of the left TMJ with costal cartilage graft, additional surgical interventions, including interpositional arthroplasty, were performed due to re-ankylosis of the affected site. In this case, alloplastic prosthesis could be an option to prevent TMJ re-ankylosis for growing pediatric patients with TMJ ankylosis in the beginning.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.4
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• pp.135-139
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• 2014

Purpose: We review published research on temporomandibular joint (TMJ) total replacement that compares costochondral graft and customized total joint reconstruction (especially TMJ concepts), focusing on effectiveness. Methods: We searched PubMed databases, including prospective, retrospective, case-control or longitudinal studies and significant statistical analysis. In data analysis, we divided outcomes into 'Acceptable' or 'Non-acceptable'. Results: There were seven articles found dealing with costochondral graft and 180 patients. The majority of patients had satisfactory treatment outcomes (n=109, 61%). There were six articles including 275 patients using the alloplastic material TMJ concepts. Almost all patients had satisfactory treatment outcomes (n=261, 95%). Conclusion: Comparing customized total joint reconstruction with costochondral graft, use of TMJ concepts resulted in increased quality of life and fewer complications. In conclusion, we judged that alloplastic material such as TMJ concepts is more effective device in total joint replacement than costochondral graft.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.3
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• pp.128-135
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• 2018

Objectives: The role of alloplastic materials in maxillofacial reconstruction is still controversial. Determining the utility of porous, high-density, polyethylene implants as a highly stable and flexible, porous alloplast, with properties such as rapid vascularization and tissue ingrowth, is crucial in cases of maxillofacial deformities and aesthetic surgery. Materials and Methods: Thirty high-density porous polyethylene implants were implanted in 16 patients that had been referred to a private office over a three-year period. These implants were used for correcting congenital deformities, posttraumatic defects and improving the aesthetic in nasal, paranasal, malar, chin, mandibular angle, body and orbital areas. Results: The outcomes of the cases in this study showed good aesthetic and functional results. The majority of patients had no signs of discomfort, rejection or exposure. Two implants suffered complications: a complicated malar implant was managed by antibiotic therapy, and an infected mandibular angle implant was removed despite antibiotic therapy. Conclusion: Based on the results, the Medpor implant seems to be an excellent biomaterial for correcting various facial deformities. Advantages include its versatility and relatively ideal pore size that allows for excellent soft tissue ingrowth and coverage. It is strong, flexible and easy to shape.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.4
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• pp.239-248
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• 2021

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.