Management of the infected temporomandibular joint total joint prosthesis

Abstract

Purpose: Patients with specific temporomandibular joint (TMJ) conditions and pathology may benefit from TMJ reconstruction by use of total joint prostheses. A potential risk to patients receiving TMJ total joint prostheses is infection. The purpose of this study was to present our experience in treating infected TMJ total joint prostheses over a 12-year period, as well as the protocol we have developed to manage acute infections and the protocol we follow for chronic infections of TMJ total joint prostheses.

Patients and methods: This retrospective study evaluated the records of 316 consecutive patients (290 female and 26 male patients) who had TMJ reconstruction from 1997 to 2009 by 1 surgeon, using patient-fitted TMJ Concepts total joint prostheses (TMJ Concepts, Ventura, CA), with a total of 579 prostheses placed, to determine the occurrence and management methods of postoperative infections. Postoperative infections involving the TMJ prostheses developed in 8 of 316 patients (2.5%) and 9 of 579 prostheses (1.6%): 7 patients unilaterally and 1 patient bilaterally. Patients were divided into 2 groups: group 1 (n = 5) had acute infections in 6 joints and group 2 (n = 3) had chronic infections in 3 joints. Patient 5 began in group 1 but was transferred to group 2. One patient with Munchausen syndrome and self-induced infections was eliminated from the study. Patients were treated by our protocol for management of acute or chronic infections.

Results: In group 1 (n = 5) the onset of infection symptoms averaged 12 days after surgery (range, 5-24 days). The time from onset of symptoms to surgical intervention was 3.4 days (range, 2-5 days). We found that 4 of 5 patients (80%) and 5 of 6 joints (83%) were successfully treated with retention of the prostheses. Patient 5 varied from the protocol and maintained a chronic infection of her right TMJ prosthesis that transferred her to group 2. In group 2 (n = 3) all 3 patients (including patient 5) had chronic infections with draining fistulas that were successfully treated by the chronic infection protocol including prosthesis removal and replacement.

Conclusions: TMJ total joint prostheses can become infected. The earlier the diagnosis is made and the acute infection protocol initiated (within 2-5 days), the greater the chance of salvage of the prosthesis. For chronic infections, the treatment protocol has likewise been very successful, but it does require 2 surgical stages for removal and replacement of the prosthesis. Management of infected total joint prosthesis can be challenging, but with aggressive treatment following the appropriate protocol, infected prostheses can be successfully managed.