Alloplastic TMJ replacement in the skeletally immature patient - A systematic review

• Published in: Journal of cranio-maxillo-facial surgery 2024-07, Vol.52 (7), p.821-828
• Main Authors: Sultan, Daniel, Pellecchia, Robert, Mercuri, Louis G.
• Format: Article
• Language: English
• Subjects: Alloplastic joint reconstruction; Temporomandibular joint; TMJ; Total prosthetic joint reconstruction
• ISSN: 1010-5182; 1878-4119; 1878-4119
• DOI: 10.1016/j.jcms.2024.03.028

This study assessed the current evidence for the use of TMJR reconstruction in skeletally immature patients. A systematic review was conducted according to PRISMA guidelines. An electronic search in PubMed and Embase was performed. Meta-analysis randomized controlled trials (RCTs), cohort studies, observational studies, case series, and case reports were eligible for inclusion. Case reports were also included due to the limited number of publications identified with the predefined terms. Exclusion criteria were: (1) studies written in a language other than English; (2) full-text unavailability (i.e., posters and conference abstracts). The selected studies were assessed for risk of bias. A meta-analysis was not performed as it necessitates a substantial between-study design homogeneity; hence, a descriptive synthesis of data was performed. There were 9 TMJR device reconstruction studies involving 14 subjects 13 years of age or younger. Follow-up ranged from 7 months to 120 months. All papers reported significant decrease in pain and improvement of diet. All prostheses were functional. No material failures of the prosthesis components were observed. The mandible continued to show limited growth following TMJR and most of the cases required no secondary or revision surgery even when the patient reached skeletal maturity. This systematic review had some limitations. The studies included had a low level of evidence and a high risk of bias. Most of the studies had a small patient sample, and no study had a control group. The literature reviewed supports the use of TMJR devices in the restoration of mandibular function and form in skeletally immature patients. There has been increased discussion about how best to manage TMJ reconstruction in skeletally immature patients; namely, whether to utilize autogenous grafts or alloplastic devices. While autogenous grafts have been classically considered the first treatment option in such cases, those grafts are not without reports of complications and failures. Therefore, surgeons have recently looked to alloplastic reconstruction as a way to deliver more stable and predictable outcomes, especially in cases of relapse and prior failure. To provide some information on this issue, a systematic review of the literature was conducted to assess the current evidence for the use of the TMJR reconstruction option in skeletally immature patients.