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Scleroderma and the temporomandibular joint: reconstruction in 2 variants
Robert Bruce MacIntosh1, Prasanna-Kumar Shivapuja2, Rabia Naqvi3
1Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Detroit Mercy School of Dentistry, Detroit, MI.
Purpose:
This article reviews the pathophysiology of scleroderma (systemic sclerosis [SSc]) and its destructive effects on the mandible in general and the temporomandibular joint (TMJ) in particular. It discusses the considerations of operating on patients with devastating chronic disease and presents 2 cases of TMJ reconstruction in patients with the diagnosis.
Patients And Methods:
Two patients with different degrees of SSc involvement underwent TMJ reconstruction with costochondral grafts. The patients represent the surgical considerations pertinent to this disease and different outcomes as determined by the variance in severity of their afflictions.
Results:
The 2 patients tolerated the surgeries well and exhibited improvement in function in the long-term. One patient thrives and continues to do well despite her SSc approximately 10 years postoperatively; the second patient died of her disease approximately 9 years after her initial surgical care.
Conclusions:
The experience with these 2 cases showed that patients with SSc can safely undergo TMJ reconstruction with anticipated good results, but that the overall severity of the disease remains paramount in determining the feasibility of corrective surgery under this diagnosis.
