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Alloplastic TMJ replacement in the skeletally immature patient - A systematic review
Daniel Sultan1, Robert Pellecchia1, Louis G Mercuri2
1Department of Oral & Maxillofacial Surgery, Lincoln Medical Center, Bronx, NY, USA.
Insights
Temporomandibular joint reconstruction (TMJR) devices show promise for improving function and reducing pain in young patients. While evidence is limited, TMJR appears safe and effective for restoring mandibular form and function in skeletally immature individuals.
Area of Science:
- Oral and Maxillofacial Surgery
- Pediatric Dentistry
- Biomaterials Engineering
Background:
- Skeletally immature patients with mandibular defects require specialized reconstructive approaches.
- Temporomandibular joint reconstruction (TMJR) offers a potential solution for restoring form and function.
- Evidence on TMJR in pediatric populations is limited, necessitating a comprehensive review.
Approach:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searches were performed in PubMed and Embase, including RCTs, cohort studies, observational studies, case series, and case reports.
- Data were synthesized descriptively due to heterogeneity, and studies were assessed for risk of bias.
Key Points:
- Nine TMJR studies involving 14 pediatric subjects (≤13 years) were analyzed.
- All studies reported significant pain reduction and improved diet post-reconstruction.
- Prostheses were functional, with no material failures observed; limited mandibular growth occurred post-TMJR.
Conclusions:
- TMJR devices appear to effectively restore mandibular function and form in skeletally immature patients.
- Most patients did not require secondary or revision surgery, even after reaching skeletal maturity.
- Despite limitations in evidence quality and sample size, TMJR is supported for pediatric mandibular reconstruction.
Abstract:
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.
