Does Unilateral Temporomandibular Total Joint Reconstruction Result in Contralateral Joint Pain and Dysfunction?

Publication date: Available online 23 February 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Daniel Perez, Larry M. Wolford, Emet Schneiderman, Reza Movahed, Campbell Bourland, Enrique Perez
PurposeThe purpose of this study was to evaluate patients requiring unilateral TMJ total joint reconstruction and the risk for development of post-surgical contralateral TMJ pain and dysfunction over time requiring subsequent contralateral total joint reconstruction. Long-term subjective and objective outcomes of unilateral TMJ reconstruction were also evaluated.Methods and MaterialsSeventy patients had unilateral total joint reconstruction using a patient-fitted total joint prosthesis from a single private practice from 1990 through 2012. The inclusion criteria were: 1) Unilateral TMJ reconstruction with TMJ Concepts/Techmedica patient-fitted total joint prosthesis; 2) Operated by one surgeon (LMW); 3) Minimum of 12 month follow-up; and 4) Adequate records. There were no specific exclusion criteria. The primary outcome variable was to evaluate the effects of unilateral TMJ reconstruction with a total joint prosthesis on the contralateral TMJs relative to development of pain and dysfunction requiring subsequent contralateral reconstruction with a total joint prosthesis. Secondary outcome variables for all patients included; TMJ pain, facial pain, headaches, diet, disability, quality of life, maximum incisal opening, and lateral excursion movements following unilateral TMJ reconstruction with the patient-fitted total joint prosthesis. Student's-t tests and Wilcoxon tests were used for statistical analyses with a p-value of <0.01 for statistical significance.ResultsThere were 61 of 70 patients (87%) that met the inclusion criteria; 47 females (77%) and 14 males (23%); average age 38 years (range 11 to 69 years); and average follow-up 44 months (range 12 to 215 months). Eight of 61 patients (13%) required contralateral TMJ reconstruction with a total joint prosthesis at a later time related to contralateral pain, dysfunction, and arthritis, but all 8 (8 of 27 or 29.6%) had previous contralateral TMJ disc repositioning surgery. Relative to the secondary outcomes; TMJ pain decreased 63% and jaw function improved 61%, facial pain decreased 59% and headaches 57%, diet improved 52%, disability 58.5% and maximal incisal opening increased a mean 7.4 mm, from 31.4 to 38.8 mm. All subjective factors and MIO had statistically significant improvements at longest follow-up (p<0.01)ConclusionsPatients requiring unilateral TMJ reconstruction with a patient-fitted total joint prosthesis have a high probability of improving their clinical condition and do not require bilateral reconstruction if the contralateral TMJ is healthy. Patients with previous or concomitant contralateral TMJ surgery (articular disc repositioning) have about a 30% chance of requiring a total joint prosthesis in the future.

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