Temporomandibular Joint Total Joint Replacement – TMJ TJR (eBook)

Dedication 6
Foreword 8
Preface 10
Contents 14
Contributors 16
Part I: Biomechanics and Biomaterials 18
Chapter 1: TMJ Biomechanics 19
1.1 Anatomy 19
1.1.1 Contact Surfaces 19
1.1.2 Ligaments 20
1.1.3 Muscles 21
1.2 TMJ Kinematics 22
1.2.1 Mouth Opening and Closing 23
1.2.2 Mandibular Protrusion and Retrusion 25
1.2.3 Lateral Deviation 26
1.2.4 Kinematics of TMJ TJRs 26
1.3 TMJ Forces and Muscle Forces 28
1.3.1 Animal Models 28
1.3.2 In Vitro Models 29
1.3.3 Mathematical Modeling 30
1.3.3.1 Static Models 31
1.3.3.2 Dynamic Multibody 37
1.3.3.3 TMJ TJR Finite Element Modeling 40
1.4 Summary 40
References 41
Chapter 2: TMJ TJR Biomaterials 45
2.1 Introduction 45
2.2 Materials Utilized in the Manufacture of TMJ TJR Fossae and Ramus/Condyle Components 47
2.3 Titanium (ASTM F-64) and Ti6AlV4 Alloy 48
2.4 Cobalt–Chromium–Molybdenum Alloys (ASTM F-75) 49
2.5 Ultrahigh Molecular Weight Polyethylene 50
2.6 Polyethylene Wear Particulation and Third Body Wear Phenomena 50
2.7 Surface Quality of Implanted Devices 51
2.8 Future Prospects 52
References 53
Chapter 3: History of TMJ TJR 56
3.1 Historical Perspective 56
3.2 Silicone Elastomers 57
3.3 Teflon and Proplast 59
3.4 Acrylics 67
3.5 Hemiarthroplasty 68
3.6 Total TMJ Replacement 70
References 72
Part II: TMJ TJR Devices 81
Chapter 4: Stock Prostheses for Total Reconstruction of the Temporomandibular Joint 82
4.1 Planning and Preparation 89
4.2 Preparation and Surgery 89
4.2.1 Two-Step Condylectomy 93
4.3 Fossa Placement 94
References 102
Chapter 5: Custom TMJ TJR Devices 104
5.1 Introduction 104
5.2 Goals of TMJ Reconstruction 105
5.3 Indications for Total Alloplastic TMJ Replacement 105
5.3.1 Inflammatory Arthritis Involving the TMJ Not Responsive to Other Modalities of Treatment 105
5.3.2 Recurrent Fibrosis and/or Bony Ankylosis Not Responsive to Other Modalities of Treatment 107
5.3.2.1 TMJ Ankylosis in Growing Subjects 109
5.3.3 Failed Tissue Grafts (Bone and Soft Tissue) 110
5.3.4 Failed Alloplastic Joint Reconstruction 112
5.3.5 Loss of Vertical Mandibular Height and/or Occlusal Relationship Due to Bony Resorption, Trauma, Developmental Abnormalities, or Pathologic Lesions 113
5.4 Relative Contraindications for Total Alloplastic TMJ Replacement 114
5.4.1 Age of the Patient 114
5.4.2 Mental Status of the Patient 115
5.4.3 Uncontrolled Systemic Disease 116
5.4.4 Active Infection at the Implantation Site 116
5.4.5 Documented Allergy to the Implant Component Materials 116
5.5 Established Criteria for Successful Alloplastic TJR Devices 116
5.5.1 The Components of Any TJR Device Must Be Stable In Situ at Implantation 117
5.5.2 The Materials from Which TJR Devices Are Manufactured Must Be Biocompatible 118
5.5.3 TJR Devices Must Be Designed to Withstand the Loads Delivered over the Full Range of Function of the Joint to Be Replaced 119
5.5.4 The Implantation Surgery Must Be Performed for the Proper Indications and Aseptically 122
5.6 Relative Disadvantages of Custom TMJ Devices 122
5.6.1 Cost 122
5.6.2 Two-Stage Procedure Required for Ankylosis Cases 123
5.6.3 Material Wear, Design, and Long-Term Stability 124
5.7 TMJ Concepts Custom TMJ TJR Surgical Technique [73] 126
5.7.1 Preparation for Surgery 126
5.7.2 Incisions 129
5.7.2.1 Preauricular (Modified Al-Kyatt [74]) Incision for Exposure of the TMJ Fossa 129
5.7.2.2 Retromandibular (Modified Risdon [75]) Incision for Exposure of the Mandibular Ramus 132
5.7.3 Condylar Resection 134
5.7.4 Fossa Preparation 135
5.7.5 Setting the Occlusion 135
5.7.6 Component Fixation 136
5.7.7 Confirmation of Occlusion, Function, and Position 137
5.7.8 Postoperative Auditory Canal Examination and Pressure Dressing 138
5.7.9 Postoperative Management 139
References 140
Part III: Advanced TMJ TJR Techniques 144
Chapter 6: Concomitant TMJ Total Joint Replacement and Orthognathic Surgery 145
6.1 Introduction 145
6.2 Patient Evaluation 146
6.3 Imaging 148
6.3.1 MRI Evaluation 148
6.3.2 Disk Displacement 148
6.3.3 Adolescent Internal Condylar Resorption 150
6.3.4 Reactive Arthritis 150
6.3.5 Perforations 151
6.3.6 Connective Tissue/Autoimmune Diseases 151
6.3.7 Cephalometric Analysis 152
6.3.8 Airway 153
6.4 Occlusal Plane Alteration 153
6.4.1 High Occlusal Plane Facial Type 154
6.4.2 Surgical Decrease of the Occlusal Plane 155
6.5 Concomitant TMJ Total Joint Replacement and Orthognathic Surgery (C-TJR-OS) 156
6.6 Protocol for Traditional C-TJR-OS 156
6.7 Protocol for Traditional C-TJR-OS 158
6.8 Steps in Traditional Orthognathic Surgery and Intermediate and Palatal Splint Fabrication for C-TJR-OS 159
6.9 Virtual Surgical Planning 159
6.9.1 Protocol for C-TJR-OS Using CASS 159
6.10 Protocol of C-TJR-OS Using CASS 162
6.10.1 Surgical Sequencing for C-TJR-OS 163
6.11 Case 1 164
6.12 Case 2 168
6.12.1 Treatment Outcomes Using These Treatment Protocols 168
6.12.2 Age for Surgical Intervention 168
6.13 Summary 172
References 172
Chapter 7: Mandibular Replacement Utilizing TMJ TJR Devices 176
7.1 Indications 177
7.2 Evaluation and Planning 178
7.2.1 Immediate Primary TMJ TJR Reconstruction 178
7.2.2 Delayed Primary TMJ TJR Reconstruction 179
7.2.3 Secondary TMJ TJR Reconstruction 180
7.2.4 Delayed Secondary TMJ TJR Reconstruction 180
7.3 Surgery and Its Sequence 181
7.3.1 Case #1 Immediate Primary TMJ TJR Reconstruction (Fig. 7.1) 181
7.3.2 Case #2 Delayed Primary TMJ TJR Reconstruction (Fig. 7.2) 185
7.3.3 Case #3 Delayed Secondary TMJ TJR Reconstruction (Fig. 7.3) 187
7.3.4 Case #4 Delayed Secondary TMJ TJR Reconstruction (Fig. 7.4) 189
7.4 Summary 193
References 193
Part IV: Complications 195
Chapter 8: Complications Associated with TMJ TJR: Management and Prevention 196
8.1 Introduction 196
8.2 Periprosthetic Joint Infection 196
8.2.1 TMJ TJR PJI Diagnosis and Management Algorithm 199
8.2.1.1 Early TMJ TJR PJI 199
8.2.1.2 Delayed TMJ TJR PJI 200
8.3 Preventive Measures 201
8.3.1 Preoperative Patient Assessment 202
8.3.1.1 Nutrition 202
8.3.1.2 Systemic Disease Control 202
8.3.1.3 Smoking 203
8.3.2 Preexisting Remote and Local Site Infections 203
8.4 Preoperative Patient Preparation 204
8.4.1 Skin 204
8.4.2 Preincision Antibiotic Prophylaxis 204
8.4.3 Anesthesia 205
8.4.4 Eyes 205
8.4.5 Hair 205
8.4.6 Ear 206
8.4.7 Oral Cavity 206
8.5 Intraoperative Considerations 206
8.5.1 Incisions 206
8.5.2 Saliva 206
8.5.3 Device Contamination 207
8.5.4 Hemostasis and Irrigation 207
8.6 Immediate Postoperative Considerations 207
8.6.1 Auditory Canal 207
8.6.2 Dressing 208
8.6.3 Postimplantation Antibiotic Coverage 208
8.6.4 Nosocomial Infections 209
8.6.5 Discharge Considerations and Information 209
8.7 Heterotopic Bone Formation 209
8.8 Dislocation 212
8.9 Continued or Increasing Post-TMJ TJR Pain 213
8.10 Intrinsic Etiologies 214
8.10.1 Neuroma Formation 215
8.10.2 Synovial Entrapment Syndrome 216
8.10.3 Extrinsic Etiologies 219
8.10.4 Prior Misdiagnosis 219
8.10.5 Chronic Centrally Mediated Pain 220
8.11 Persistent Myofascial/Muscular Pain 221
8.12 Complex Regional Pain Syndrome I and II 222
8.12.1 Rehabilitation Therapy 224
8.12.2 Psychotherapy 224
8.12.3 Medications 224
8.12.4 Sympathetic Nerve Block 225
8.12.5 Surgical Sympathectomy 225
8.12.6 Spinal Cord Stimulation 225
8.12.7 Other Types of Neural Stimulation 225
8.13 Temporalis Tendonitis 226
8.14 Coronoid Impingement 226
8.15 Frey’s Syndrome and Frey’s Neuralgia 227
8.16 Integrin Formation 228
References 229
Chapter 9: Material Hypersensitivity 236
9.1 Material Sensitivity 236
9.1.1 Metal Sensitivity Mechanism 238
9.1.2 Testing for Metal Sensitivity 239
9.1.2.1 Dermal Testing 240
9.1.2.2 Lymphocyte Transformation Testing 240
9.2 Case Studies in Metal Implant-Related Metal Sensitivity 244
9.3 Cohort Studies of Implant-Related Metal Sensitivity 245
9.4 Clinically Relevance 248
9.5 Conclusions 251
References 252
Chapter 10: Tribocorrosion and TMJ TJR Devices 259
10.1 Introduction 259
10.2 Tribocorrosion: Definition and Fundamentals 259
10.3 Tribocorrosion: Basic Principles 261
10.4 Tribocorrosion Testing in the Laboratory 261
10.5 Tribocorrosion: Synergism or antagonism 263
10.6 Tribocorrosion: Current Status 264
10.6.1 Evidence of Tribocorrosion from TMJ TJR Retrieval Studies: Preliminary Observation 265
10.7 TMJ TJR and Hip Replacement in Orthopedics: Tribocorrosion Research 267
10.8 Tribocorrosion: Future Perspective 268
10.9 Summary 269
References 270
Chapter 11: Management of Failing and Failed TMJ TJR Devices 272
11.1 Introduction 272
11.2 Classification of Failures 272
11.2.1 Failure of the Concept 273
11.2.2 Failure of Embodiment 273
11.2.3 Failure of Implantation Technique 275
11.2.4 Limitations of the Technology 276
11.3 Indications for Revision 277
11.4 Important Considerations Before Revision/Replacement 277
11.4.1 Medical 277
11.4.2 Anesthetic 277
11.4.3 Local Skin Disorders 277
11.4.4 Uncooperative or Drug Dependent Patient 278
11.4.5 Local Resources 278
11.5 Evaluation of the Patient 278
11.5.1 TMJ History 278
11.5.2 Physical Examination 279
11.5.3 Imaging 279
11.6 Guiding Principles of Revision/Replacement of Failed or Failing TMJ TJR Devices 280
11.6.1 Establish Failure Mechanism 280
11.6.2 Rule Out Sepsis 281
11.6.3 Perform Adequate Preoperative Planning 281
11.6.4 Utilize the Appropriate Revision System 281
11.6.5 Minimize Complications 281
11.6.6 Optimize Rehabilitation 281
References 282
Part V: Future Considerations 285
Chapter 12: Bioengineered Tissue TMJ TJR 286
12.1 Introduction 286
12.2 Scaffolds 288
12.3 Role of Interactive Scaffolds 289
12.4 Importance of Intra-architectural Scaffold Geometry 290
12.5 Cells 291
12.6 Biophysical Manipulation of Cells 293
12.7 The Fabrication of a TMJ Disc 295
12.8 Vision of the Process of Tissue Engineering a TMJ 296
References 301
Index 304