Poster Board Number: 68: Outcomes in 90 Patients Reconstructed With Total Temporomandibular Joint Prostheses

Scientific Poster Session (P⬍0.001). The pre-arthroplasty median MIOs for patients with arthroplasty only and arthroplasty followed by TMJR were 28mm (range 12-55 mm) and 25mm (range 10-38mm), a statistically significant difference (P⬍0.05). The median pain scores for patients that underwent TMJR, prior to arthroplasty, 6 months after arthroplasty, and after TMJR, were 8 (range 6-10), 8 (range 5-10), and 5 (range 0-10) respectively, showing no significant decrease in pain after arthroplasty (P⬍0.16), but significant decrease after TMJR (P⬍0.006). The median MIOs during these same time points were 25mm (range 10-38 mm), 23mm (range 10-38mm), and 27mm (range 10-42mm) respectively, showing no significant difference. Conclusion: Previous studies have shown that patients with fewer TMJ surgeries achieve better outcomes after TMJR. It was our hope to determine if there was any validity in bypassing arthroplasty and moving directly to a total joint replacement in certain patients with internal derangement. The 17 patients that went on to have TMJR after arthroplasty did not show significant decrease in pain score or improvement in MIO with arthroplasty alone. Additionally, it was apparent that patients that went on to have TMJR had a lower MIO, higher pain scores, and higher Wilkes scores pre-arthroplasty than patients that underwent arthroplasty alone. Although final conclusions cannot be made TMJR should be considered after failure of non-surgical treatments if the patient has a high pain score, much decreased MIO, and advanced Wilkes stage. References: Guarda-Nardini L, Manfredini D, Ferronato G: Temporomandibular Joint Total Replacement Prothesis: Current knowledge and considerations for the future. Int J Oral Maxillofac Surg. 2008 Feb; 37 (2): 103-10. Trumpy IG, Lyberg T: Surgical Treatment of Internal Derangement of the Temporomandibular Joint: Long Term Evaluation of Three Techniques. Journal of Oral and Maxillofacial Surgery 53: 746,1995.

POSTER BOARD NUMBER: 68 Outcomes in 90 Patients Reconstructed With Total Temporomandibular Joint Prostheses

Materials and Methods: Ninety patients (81 female, 149 total joints) who had undergone total temporomandibular joint reconstruction with TMJ Concepts or Biomet prostheses from 2001-2009 by a single surgeon were retrospectively reviewed in this study. Multiple subjective and objective parameters were evaluated pre and/or post-operatively including pain, maximum interincisal opening (MIO), presence of malocclusion, and facial nerve injury. In addition, multiple operative variables were evaluated including incision type, type of intermaxillary fixation, and the need for revision or removal. The mean follow up was 34 months. The median age was 48 years. Methods of Data Analysis: pending Results of Investigation: There was objective improvement in MIO, from an average of 26.7mm preoperatively to 31.4 mm post-operatively. There was subjective improvement in pain from 7.6/10 pre-operatively to 4.3/10 post-operatively. Statistical analysis revealed that age, number of prior open TMJ operations, and laterality (unilateral vs. bilateral) do not contribute to the development of post-operative complications (malocclusion, revision, nerve injury, or failure). Analysis also revealed that there is an increased risk of facial nerve injury when the facelift incision was utilized, rather than the standard approach (pre-auricular incision with separate retromandibular incision), and that the type of intermaxillary fixation does not contribute to the development of post-operative malocclusion. Conclusion: The data confirm subjective and objective improvement in patients having undergone total TMJ replacement with alloplastic prostheses with minimal morbidity and short hospital stays, independent of how many prior joint operations the patient had undergone. There is an increased risk of transient facial nerve injury with the facelift incision. References: Subjective and Objective Outcomes in Patients Reconstructed with a Custom-Fitted Alloplastic Temporomandibular Joint Prosthesis Mercuri LG. J Oralmaxillofac Surg. 1999 Dec;57(12):1427-30. TMJ Concepts/Techmedica Custom-Made TMJ Total Joint Prosthesis: 5 Year Follow Up Study Wolford LM, Pitta MC, Reiche-Fischel O, Franco PF. Int J Oral Maxillofac Surg. 2003 Jun;32(3):268-74.

J.A. Lichty: UAB, P. Louis, L. Vega Statement of the Problem: This was a retrospective review of subjective and objective outcomes in patients reconstructed with alloplastic total temporomandibular joint (TMJ) prostheses over an eight year period. Total temporomandibular joint reconstruction with alloplastic prostheses is relatively common for treatment of end stage temporomandibular disorder (TMD), and other pathologic conditions of the mandible and articular apparatus. Few studies have looked at outcomes of patients treated with total TMJ prostheses. e-98

POSTER BOARD NUMBER: 69 The Relationship Between the Clinical Symptom of Pain and Ultrasonography and Magnetic Resonance Imaging Findings of Effusion in Temporomandibular Internal Derangements B. Bas¸: Ondokuz Mayis University, Faculty Of Dentistry, N. Yılmaz, G. Erkan, H. Akan AAOMS • 2010