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. 2023 Mar-Apr;13(2):367-372.
doi: 10.1016/j.jobcr.2023.01.005. Epub 2023 Mar 16.

Reconstruction of the mandibular condyle due to degenerative disease

Nicholas Wilken  1 , Gary Warburton  1
Affiliations

Reconstruction of the mandibular condyle due to degenerative disease

Nicholas Wilken et al. J Oral Biol Craniofac Res. 2023 Mar-Apr.

Erratum in

Abstract

Degenerative joint disease (DJD), also known as osteoarthritis is the most common form of arthritis and can affect the temporomandibular joint (TMJ). TMJ DJD is characterized by degradation of the articular cartilage and synovial tissues resulting in characteristic morphologic changes in the underlying bone. DJD can occur at any age, but it is more common in older age groups. TMJ DJD may be unilateral or bilateral. The American Academy of Orofacial Pain categorizes TMJ DJD into primary and secondary types. Primary DJD is seen in the absence of any local or systemic factors and secondary DJD is associated with a prior traumatic event or disease process. Frequently, these patients present with pain and limited residual mandibular function resulting in significantly diminished quality of life. Classic radiographic features on orthopantogram and CT imaging include loss of joint space, osteophytes (bird-beak appearance of the condyle), subchondral cysts, erosions, flattening of the condylar head, bony resorption and/or heterotopic bone (Figure 1). Conservative and medical management is successful in the majority of patients until the active degenerative phase burns out, but some will progress to end stage joint disease and require reconstruction of the TMJ. Reconstruction of the mandibular condyle should be considered to restore mandibular function and form to patients who have lost it secondary to degenerative joint disease affecting the glenoid fossa/mandibular condyle unit.

Keywords: Degenerative joint disease; Reconstruction; TMJ replacement; Temporomandibular joint.

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Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Coronal and sagittal reformats of end stage TMJ DJD. Note the degenerative/resorptive process affecting the condylar head and glenoid fossa.
Fig. 2
Fig. 2
FDA approved devices in the USA A) Stryker (TMJ Concepts) custom/patient specific device. B) Zimmer Biomet stock device.
Fig. 3
Fig. 3
Standard endaural and retromandibular access 1. First osteotomy to allow removal of the condyle 2. With the condyle removed, the remaining condylar neck can be mobilized further superiorly and the residual condylar needing to be removed can be accessed.
Fig. 4
Fig. 4
CT scan showing hyperplastic bone formation.
Fig. 5
Fig. 5
A) posterior dislocation. B) Posterior flange/lip design to minimize posterior dislocation.
See this image and copyright information in PMC

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