Extended total temporomandibular joint replacements: a classification system

Elledge, Ross; Mercuri, Louis G.; Speculand, B.

doi:10.1016/j.bjoms.2018.06.002

Cited by 38 publications

(34 citation statements)

References 13 publications

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“…Elledge et al . stated that any classification system for eTMJR must be “unambiguous and easy to use; exhaustive and mutually exclusive so that each possibility exists in only one class; clinically relevant and appropriate; and flexible enough to accommodate any advances or changes in technology.”[ 3 ] Considering our (albeit limited) experience, it appeared that unidimensional extension was not the only factor affecting technical difficulties and outcomes. Indeed, we found no difference between M1 and M2 eTMJR with respect to surgical difficulties or clinical outcomes.…”

Section: Discussionmentioning

confidence: 97%

“…agreed that other subclassifications can be considered when autogenous tissue transfer is used in conjunction with eTMJR. [ 3 ] We, therefore, suggest adding the aforementioned potential obstacles (contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy) as a subclassification system [ Table 3 ]. Identification and anticipation of these obstacles may lead to facilitating actions.…”

Section: Discussionmentioning

confidence: 99%

“… AMSJI=Additively manufactured subperiosteal jaw implant; Cl=Classification according to Elledge et al . [ 3 ]; Div=Suggested subclassification according to occlusal correction (O), C=Contralateral mandibular osteotomy; A=Extra contour correction by augmentation (A); eTMJR=Extended alloplastic TMJ replacement; TMJ=Temporomandibular joint; TPD=Transpalatal distraction osteogenesis …”

Section: Discussionmentioning

confidence: 99%

“…All operations were performed by the same surgeon (MYM). The following information was extracted from the records: age, sex, diagnosis, Elledge classification,[ 3 ] simultaneous corrections of occlusion and facial contours, intraoperative obstacles, and postoperative complications.…”

Section: Aterials and M Ethodsmentioning

confidence: 99%

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Extended total temporomandibular joint replacement with occlusal adjustments: Pitfalls, patient-reported outcomes, subclassification, and a new paradigm

Mommaerts

Nicolescu

Dorobanțu

et al. 2020

Ann Maxillofac Surg

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Context: Alloplastic temporomandibular joint (TMJ) replacement is a treatment strategy for segmental mandibular defects with occlusal abnormalities. Aims: To describe our experience with extended total TMJ replacement (eTMJR) by reporting operative obstacles, complications, and patient-reported outcomes, as well as to suggest a subclassification system and paradigm shift. Setting and Design: University hospital and private clinic; case series with retrospective follow-up. Methods and Materials: Five patients (6 eTMJRs) were followed for more than 1 year after surgery. Patient-reported outcomes were assessed using FACE-Q™ “Satisfaction with Outcome” questionnaires (sum and corresponding transformed Rasch scores). Statistical Analysis: Descriptive analyses were performed. Results: Problems were related to contralateral mandibular osteotomy healing (if performed), keying the prosthetic condyle into the fossa component, intra- and postoperative prosthetic lag, and intraoperative proper establishment of the occlusion when unilateral replacement was performed. Patients reported high satisfaction with the outcome, with a mean Rasch score of 89.2/100. Conclusions: Unilateral eTMJR obstacles related to three-dimensional rotational repositioning of the remaining mandible. We suggest a paradigm shift, considering primary alloplastic replacement instead of microvascular osseous transplantation for reconstruction when radiotherapy is not required. This can avoid donor site morbidity and long reconstructive surgery. An autologous osseous transplant is still available in case of implant failure. A subclassification system is proposed for eTMJR, which accounts for contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Aterials and M Ethodsmentioning

confidence: 99%

See 2 more Smart Citations

Extended total temporomandibular joint replacement with occlusal adjustments: Pitfalls, patient-reported outcomes, subclassification, and a new paradigm

Mommaerts

Nicolescu

Dorobanțu

et al. 2020

Ann Maxillofac Surg

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“…Thinking about the essential standards of an extended joint substitution [71][72][73] the consolidated prosthesis, temporal bone, as well as zygomatic curve were embedded and fitted with titanium sheet and screws (Stryker Fixation System, Kalamazoo, MI, USA) in perspective of the past occlusal relationship and the organizing condition between the prosthesis and the surface bone ( Figure 10(b)). Fat reaped from the buccal fat cushion (a few parts), just as under the skin in the pre-auricular or submandibular territories, was folded over the condylar head.…”

Section: Clinical Applicationsmentioning

confidence: 99%

A review on computer-aided design and manufacturing of patient-specific maxillofacial implants

Memon

Wang

et al. 2020

Expert Review of Medical Devices

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Introduction: Various prefabricated maxillofacial implants are used in the clinical routine for the surgical treatment of patients. In addition to these prefabricated implants, customized CAD/CAM implants become increasingly important for a more precise replacement of damaged anatomical structures. This paper reviews the design and manufacturing of patient-specific implants for the maxillofacial area. Areas covered: The contribution of this publication is to give a state-of-the-art overview in the usage of customized facial implants. Moreover, it provides future perspectives, including 3D printing technologies, for the manufacturing of patient-individual facial implants that are based on patient's data acquisitions, like Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). Expert opinion: The main target of this review is to present various designing software and 3D manufacturing technologies that have been applied to fabricate facial implants. In doing so, different CAD designing software's are discussed, which are based on various methods and have been implemented and evaluated by researchers. Finally, recent 3D printing technologies that have been applied to manufacture patient-individual implants will be introduced and discussed.

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New Technologies and Reconstruction of the Temporomandibular Joint (TMJ)

Sánchez-Jaúregui

Vega

2021

Innovations and New Developments in Craniomaxillofacial Reconstruction

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Extended total temporomandibular joint replacements: a classification system

Cited by 38 publications

References 13 publications

Extended total temporomandibular joint replacement with occlusal adjustments: Pitfalls, patient-reported outcomes, subclassification, and a new paradigm

Extended total temporomandibular joint replacement with occlusal adjustments: Pitfalls, patient-reported outcomes, subclassification, and a new paradigm

A review on computer-aided design and manufacturing of patient-specific maxillofacial implants

New Technologies and Reconstruction of the Temporomandibular Joint (TMJ)

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