Outcomes of temporomandibular joint replacement using an endaural incision and endoscopic assistance – A report of 104 cases

Abstract

Temporomandibular joint replacement is performed in patients with severe disorders of the temporomandibular joint with the aim of improving quality of life, function and pain. Traditionally, this has been carried out using a preauricular or endaural incision in addition to a submandibular incision. In this study, a novel technique was used wherein a total temporomandibular joint replacement was performed through an endaural incision with endoscopic assistance. This negated the need for a submandibular incision, with the aim of minimising the complications of open joint surgery. This is a retrospective cohort study of 104 joint replacements in 82 patients using this technique for the treatment of pathology or end-stage joint disease. The primary outcome variable was improvement in pain and quality of life measurements, whilst secondary outcome variables were facial nerve function and mouth opening. Pain intensity (/10) decreased postoperatively for worst pain score (8.4 to 4.5, p < 0.001) and average pain score (6.1 to 3.0, p < 0.001). The average Graded Chronic Pain Scale score decreased postoperatively from 67.7 to 32.7 (p < 0.001). The Jaw Function Limitation Scale had an overall reduction from 4.29 to 1.55 postoperatively (p < 0.001). There were 20 cases (19.4%) of temporary facial nerve weakness, all of which had resolved by six months. Mouth opening increased from 31.6mm preoperatively to 36.5 mm postoperatively (p < 0.01). This study shows similar or reduced rates of temporary facial nerve weakness compared to other studies whilst still significantly improving patients’ quality of life postoperatively, demonstrating that good clinical outcomes can be achieved through an endaural incision with endoscopic assistance.