Total Joint Replacement
In some cases, joint” pathology results in destruction of [oint structures so that reconstruction or replacement ofcomponents of the TMJ is necessary (Fig. 30-30, A). Examples of such situations include severe degenerative
or rheumatoid arthritic disorders, severe cases of ankylosis, neoplastic pathology, posttraumatic destruction of joint components, and multiple failed surgical procedures. Surgical techniques may involve rep lacement
of the co ndyle or fossa but most commonly include both elements.
One method of joint reconstruction involves grafting autogenous .tissue using a .•costochondral bone graft.v’ These grafts are most frequently used in growing individuals but also can be used effectively in the treatment of a
variety of adult disorders. figure 30-30, B shows the use of a costochondral graft for replacement of a severely degenerated mandibular condyle. In this situation the graft replaces only the condylar portion of the joint .and
does not address significant abnormalities of the fossa, Problems with costochondral grafting include recurrent ankylosis, degenerative changes of the graft, and (in some cases) excess and asymmetric growth of the graft.
, In the past several types of prosthetic joint replacement have been avallable.P Long-term results of prosthetic [oint replacements have been somewhat disappointing’ because of a variety of technical and biologic
‘problems. However, for many patients with significantdestruction of TMJ structures who have had poor results from other surgical treatment, no other viable surgical options ‘exist, In these cases thejoint destruction results in severe pain,. limited motion or complete ankylosis, and severe malocclusions (see Fig. 30-30, A). Current technologicadvances include the use of three dimensional (3-D) reconstructed stereolithic models and custom fabrication of a total joint prosthesis, including the fossa and
condyle (Fig. 30-30, C and D). These recent advantages have provided significant improvement in outcome after total joint replacernent.