Alternative to the cervical approach for total temporomandibular joint prosthesis: A case series

Abstract

Purpose

New-generation total temporomandibular joint prostheses have demonstrated their efficacy and low morbidity. However, their implantation requires a dual external approach, which can result in significant aesthetic and functional sequelae. The authors have therefore developed an alternative technique that avoids the cervical route.

Materials and methods

The authors describe their technique for implanting a temporomandibular joint prosthesis using a combination of pre-auricular and intraoral approaches. They share the outcomes from a series of 16 patients treated with this technique, reporting complications as well as improvements in range of motion (ROM) and patient-reported outcomes regarding pain, eating ability, and overall satisfaction.

Results

A total of 16 patients and 22 prostheses were included. The functional results demonstrated a significant average increase in ROM of 34.4 mm (p < 0.001), a one-point reduction on the visual analogue scale (VAS) for pain (p = 0.19), and a 1.1-point improvement in feeding ability on our scale of 1 to 4 (p < 0.001). Complications included one case of transient facial paralysis with complete recovery, and one case of implant-related infection requiring removal of the prosthesis.

Discussion

this technique appears to provide comparable functional outcomes, with less scarring, and avoids the risk of facial nerve injury associated with the traditional approach. However, a potential disadvantage that needs further evaluation on a larger scale is the risk of infection, which does not appear to be increased in this series.