Extended temporomandibular joint prostheses: a retrospective analysis of feasibility, outcomes, and complications

Prostheses for extended total temporomandibular joint replacement (eTJR) include modifications to the traditional alloplastic fossa-condyle joint that extend to adjacent bone defects. The aim of this retrospective study was to assess the feasibility, postoperative complications, and functional and aesthetic outcomes after eTJR. Patients aged ≥18 years undergoing eTJR between 2013 and 2022 were included. Data recorded were age, sex, comorbidities, indication for eTJR, prosthesis brand, classification, concomitant surgical procedures, postoperative complications, maximum inter-incisal opening (MIO), pain, quality of life (QoL), and aesthetic outcome. Twenty-five patients (mean age 40 years), with a total of 30 joint prostheses, were included. Over a median follow-up of 42 months, there was a significant improvement in MIO in patients with reduced mouth opening at baseline (P = 0.003), as well as in pain (P = 0.007) and QoL (P = 0.004). Both patients and surgeons judged facial appearance as improved or unchanged in 88% of cases. Postoperative complications included permanent trigeminal nerve hypoesthesia (44%), permanent facial nerve dysfunction (35%), infection (8%), salivary leak (4%), and lingual nerve impairment (4%). The findings suggest that eTJR is a safe and effective treatment for temporomandibular joint deficits extending to adjacent structures, yielding satisfactory functional and aesthetic outcomes.