SA2 - Alloplastic Total Temporomandibular Joint Replacement in Pediatric Patients: A Case Series and Systematic Review

Oral Abstract Presenter(s)

• 

  Ajoy Roychoudhury (he/him/his)

  Professor and Head of department
  All India Institute of Medical Sciences, New Delhi
  New Delhi, Delhi, India

Co-Author(s)

• PY

  Poonam Yadav

  Assistant Professor
  ESIC Dental College, New Delhi
  New Delhi, Delhi, India
• GK

  Garima Khandelwal

  Senior Resident
  All India Institute of Medical Sciences, New Delhi
  New Delhi, Delhi, India
• SD

  Shanmuga Sundaram D

  Assistant Professor
  CAPFIMS maidan garhi, New Delhi
  New Delhi, Delhi, India
• SP

  Suraj Premanand

  Senior Resident
  All India Institute of Medical Sciences, New Delhi
  New Delhi, Delhi, India
• KB

  Krushna Bhatt

  Associate Professor
  All India Institute of Medical Sciences, New Delhi
  New Delhi, Delhi, India

Abstract:
Background and

Purpose: Total temporomandibular joint replacement (TMJ TJR) is traditionally reserved for skeletally mature patients. Its use in pediatric patients remains controversial due to concerns about growth disturbances and the potential need for revision surgeries.
Materials and

Methods: We present a case series of four pediatric patients who underwent TMJ TJR, supplemented by a systematic literature review. A comprehensive search of PubMed, Medline, Google Scholar, and the Cochrane Library was conducted following PRISMA guidelines. Due to high heterogeneity, meta-analysis was not performed. Studies reporting clinical outcomes of alloplastic TMJ TJR in pediatric patients (≤17 years) were included. The primary outcome measure was maximal incisal opening (MIO).

Results: TMJ TJR was performed on 4 patients (6 joints) aged 8 to 14 years. Etiologies included post-traumatic ankylosis (n = 2) and juvenile idiopathic arthritis (n = 2). Patient-specific implants were used in three cases, while one received a Biomet stock narrow implant. Follow-up ranged from 6 to 18 months. No facial asymmetry or midline deviation was observed. A statistically significant improvement in MIO was noted (P = .003), along with airway enhancement (P = .008). One patient developed heterotopic bone formation at 18 months.
The systematic review included 12 studies comprising 33 pediatric patients (54 joints). Ankylosis (39.3%) was the most common etiology, followed by idiopathic condylar resorption (24.24%). Most patients had prior surgical interventions, including gap/interpositional arthroplasty or costochondral graft reconstruction. Follow-up periods ranged from 8 months to 16 years. Literature findings showed improved MIO, reduced pain (especially in JIA cases), absence of facial asymmetry or midline deviation, favorable mandibular growth, absence of retrognathia, and airway improvement. Reported complications included temporary facial nerve palsy (n = 1), heterotopic bone formation (n = 1), and biofilm formation (n = 1). The primary limitation of this study is the inclusion of case reports/case series with relatively short follow-up durations. Long-term follow-up through growth spurts is recommended.

Conclusion: TMJ TJR is an emerging, promising treatment modality for pediatric patients, demonstrating favorable functional and anatomical outcomes. Further long-term studies are warranted to assess its impact on craniofacial growth and the need for revision surgeries.
References
1. Sinn DP, Tandon R, Tiwana PS. Can Alloplastic Total Temporomandibular Joint Reconstruction be Used in the Growing Patient? A Preliminary Report. J Oral Maxillofac Surg. 2021 Nov;79(11):2267.e1-2267.e16.
2. Keyser BR, Banda AK, Mercuri LG, Warburton G, Sullivan SM. Alloplastic total temporomandibular joint replacement in skeletally immature patients: a pilot survey. Int J Oral Maxillofac Surg. 2020 Sep;49(9):1202-1209
Bilateral TJR for re-ankylosis in a skeletally immature patient. Characteristic and outcome of the included studies in systematic review.