Total temporomandibular joint replacement: A clinical case with a proposal for post-surgical rehabilitation

Objective: The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements' outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, a better standardization of both surgical and post-surgical phases should further improve the efficacy of treatment. Materials and methods: The case report describes the surgical and post-surgical phases of treatment in a patient who underwent a total unilateral joint replacement for TMJ ankylosis, along with a proposal for a post-surgical rehabilitation protocol providing strong passive and active physiotherapy and hyaluronic acid injections to the contralateral joint. Results: The postoperative (PO) course was uneventful. The patient showed a marked improvement up to about 60% in mouth opening and had no pain on either side at the 1-year follow-up. Conclusion: In a patient with unilateral TMJ ankylosis, total TMJ replacement was successful. A carefully tailored post-surgical rehabilitation protocol helped the patient to gain a clinically significant improvement in jaw function. Longer follow-up periods are needed to assess the long-term maintenance of results. Clinical trials are strongly recommended to assess the relative efficacy of different PO protocols. (C) 2008 European Association for Cranio-Maxillofacial Surgery.