Total bilateral TMJ reconstruction for pain and dysfunction: Case report

Abstract

Introduction: Temporomandibular disorders encompass a set of clinical conditions that affect the temporomandibular joint, the masticatory muscles and the associated tissues. Many therapeutic alternatives can be considered, being divided into non-invasive, minimally invasive and invasive interventions. This work aims to report a case of inflammatory joint pain and dysfunction treated with bilateral TMJ full reconstruction with alloplastic prosthesis stock.

Case report: Patient D.J.S.S., female, 41 years old, hypertensive, for six years had constant pain in TMJ bilaterally, with limitation of mouth opening, with a clinical signs of joint disc displacement without reduction. Initially treated only by conservative approaches. Without improvement, arthrocentesis of the TMJ was performed. The symptoms do not regress, leading the patient to bilateral discopexy procedure. We opted for the alloplastic substitution of the temporomandibular joint with prostheses of stock in both joints through an established protocol.

Discussion: The main objective of the reconstruction of the temporomandibular joint in cases of joint bone degeneration is the restoration of form and function, considering the reduction of pain as a secondary result. Alloplastic replacement of TMJ can be considered as an alternative therapy to improve the quality of life of a small group of patients showing signs and symptoms of TMD as a reduction of maximum mouth opening, pain, etc.

Conclusion: The use of total joint prostheses has been configured as a good therapeutic alternative for severe conditions of TMJ that do not respond to conservative treatments. However, further studies are needed to demonstrate whether these results are long term.

Keywords: Joint prostheses; Temporomandibular joint; Temporomandibular joint disorders.

Fig. 1

Magnetic Nuclear Resonance of the right and left TMJs in the closed mouth.

Fig. 2

Nuclear Magnetic Resonance of right and left TMJs in open mouth maneuvers.

Fig. 3

Preoperative panoramic radiography.

Fig. 4

A) Component of the joint fossa installed by pre-auricular access B) Condylar component installed by submandibular access C) Resected condyles.

Fig. 5

Medial panoramic radiography showing articular prostheses in position.

Fig. 6

Postoperative panoramic radiography of 1 year.

Fig. 7

Satisfactory mouth opening, no deviations or pain.

Fig. 8

A) Preoperative buccal opening (13 mm) B) Buccal opening after 1 year of surgery (39 mm). Both measurements without the upper denture.