Abstract
Background / Introduction
Surgical management of TMJ ankylosis involves various techniques from which interpositional
arthroplasty involves using several materials.
Objectives
To assess and compare post-arthroplasty Maximum Mouth Opening (MMO), symptoms like
pain and discomfort in jaw opening and movements, failures such as reankylosis, neurosensory
disturbances and effect of confounding variables such as age, gender, physiotherapy,
etc.
Methodology
Search (as on September 2021) included studies published in English on otherwise healthy
individuals (11 months to 88 years) having undergone arthroplasty with a minimum of
6 months follow-up. We used search engines such as Cochrane database, PubMed, Embase,
Scopus, EBSCO host, Pro quest, J gate, Google Scholar and manual search to include
books and grey literature. Randomized (RCTs) and non- randomized trials, observational
studies, case series and reports meeting the inclusion criteria were selected. Two
reviewers (HD and NP) independently extracted the data. Risk of bias was assessed
using Cochrane tool, Rangel checklist and JBI. Data were analyzed using RevMan (Version
5.4).
Main results
Fifty studies with 1524 participants (442 bilateral and 891 unilateral joints) were
included; 6 RCTs, 31 retrospective, 10 prospective, and 3 case series and reports.
A total of 442 bilateral and 891 unilateral joints were Amongst all interpositional
materials, the highest increase in mouth opening was seen with dermis fat graft with
the mean difference of pre and post op readings i.e. Pooled MD being 35.29mm CI (32.36,
38.22)]. Comparison of Temporalis myofascial with gap arthroplasty showed significant
increase in MMO [Pooled MD in mm 1.30 95% CI (0.14, 2.45)]. Recurrence was significantly
reduced when IPA was used, compared with GA [Risk difference 0.08mm 95% CI (-0.15,
-0.02)] and for TMF when compared with GA [Risk difference -0.07mm 95% CI (-0.15,
0)]. Higher odds for developing neurosensory disturbances were seen with Al-Kayat
Bramley incision [Pooled OR 0.11 95% CI (0.04, 0.34)] compared to pre-auricular incision
[Pooled OR 0.03 95% CI (0.01, 0.09)]. IPA was superior to GA with respect to maximum
mouth opening (MMO) [Pooled MD in mm 1.21 95% CI (0.41, 2.07)].
Authors' conclusions
Dermis fat graft offers the highest MMO. The overall quality of evidence for RCTs
is poor while that of observational studies is moderate as per the relevant assessment
of quality of evidence. More research with appropriate study designs is needed. Similar
to the findings from the previous reviews, outcomes with IPA were superior when compared
to GA in terms of mouth opening and less recurrence.
Keywords
Abbreviations:
TMJ (Temporo Mandibular Joint), MMO (Maximum Mouth Opening), RCT (Randomized Clinical Trial), ROBv (Risk of Bias), JBI (Joanna Briggs Institute), RevMan (Review Manager), MD (Mean Difference), OR (Odds Ratios), CI (Confidence Interval), RD (Risk difference), FEM (Fixed effects model), REM (Random effects model), QoL (Quality of Life), CA (Autologous Costochondral Graft), TSFF (Temporalis Superficial Fascia Flap), TM (Temporalis Muscle), TMF (Temporalis Myofascial flap), BFP (Buccal Fat Pad), ACPG (Autogenous Coronoid Process Graft), GA (Gap Arthroplasty), IPA (Interpositional Arthroplasty), RCU (Ramus Condyle Unit), CCG (Costo Chondral Graft), TDO (Transport Distraction Osteogenesis), TMJR (Temporo Mandibular Joint reconstruction), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), TJR (Total Joint Replacement), GRADE (The Grading of Recommendations Assessment, Development and Evaluation), PROSPERO (The International Prospective Register of Systematic Reviews), * (Statistically significant)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
May 16,
2022
Received in revised form:
May 1,
2022
Received:
December 23,
2021
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
