Autogenous Tissues Versus Alloplastic TMJ Condylar Replacement
End-stage temporomandibular joint (TMJ) disease due to a multitude pathophysiologic process can benefit from TMJ replacement. The traditional method has been used to reconstruct the TMJ using autogenous tissues from various donor sites in the body. Howeve
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Autogenous Tissues Versus Alloplastic TMJ Condylar Replacement Larry Wolford
Abstract
End-stage temporomandibular joint (TMJ) disease due to a multitude pathophysiologic process can benefit from TMJ replacement. The traditional method has been used to reconstruct the TMJ using autogenous tissues from various donor sites in the body. However, as materials and understanding how to use those materials have advanced, the pendulum is now moving much more toward alloplastic reconstruction. This chapter will compare and contrast the two types of reconstruction methods for reconstructing the diseased TMJ.
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Introduction
End-stage temporomandibular joint (TMJ) pathology or conditions that may benefit from TMJ condylar replacement include (1) TMJ arthritis with non-salvageable articular discs; (2) advanced stages of adolescent internal condylar resorption (AICR); (3) traumatic injuries; (4) reactive arthritis; (5) osteoarthritis; (6) tumors; (7) absent or deformed anatomical structures resulting in loss of posterior mandibular vertical dimension (i.e., fractured displaced condyles, absence of condyles and portions of the ramus/body as the result of previous trauma, surgery, pathology, or congenital deformity); (8) high or low inflammatory, metabolic arthritic diseases; (9) connective tissue/autoimmune diseases (i.e., rheumatoid arthritis, juvenile idiopathic arthritis, scleroderma, Sjogren’s syndrome, lupus, etc.); (10) fibrous or bony ankylosis; (11) multiply operated TMJs (two or more previous surgeries); (12) failed autogenous grafts; (13) failed TMJ alloplastic implants; and (14) other L. Wolford (*) Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University College of Dentistry, Dallas, TX, USA e-mail: [email protected] © Springer Nature Switzerland AG 2019 S. T. Connelly et al. (eds.), Contemporary Management of Temporomandibular Disorders, https://doi.org/10.1007/978-3-319-99909-8_8
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end-stage TMJ pathologies. The purpose of this chapter is to describe the various methods of condylar replacement using autogenous tissues or alloplastic total joint replacement and present reports on outcomes of the various techniques. For many years, the primary method to replace the mandibular condyle when affected by any of the aforementioned conditions and pathologies was to use autogenous tissue grafts. There have been numerous biological structures used for condylar reconstruction, and these include (1) costochondral (rib) graft, (2) sternoclavicular graft (SCG), (3) coronoid graft, (4) chondro-osseous iliac crest graft, (5) vertical ramus osteotomy, (6) distraction osteogenesis, (7) vascularized metatarsal graft, and (8) vascularized fibula graft. There is scant literature on outcome data available to evaluate these various autogenous condylar replacement techniques. Indications of using bone grafting as a condylar replacement include the following: (1) condylar replacement required, (2) pain, (3) zero to one previous TMJ surgeries (for free grafts), (4) good vasc
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