Agudelo L, Delgado A, Cock J

Language: Spanish
References: 22
Page: 42-51
PDF size: 2321.48 Kb.

ABSTRACT

Introduction: total temporomandibular joint (TMJ) replacement is indicated for advanced joint pathology refractory to conservative treatment. Its aim is to restore function, reduce pain, and improve quality of life. It requires comprehensive diagnosis with imaging support. Custom-made prostheses using CAD/CAM optimize anatomical adaptation and postoperative stability. In selected patients, it is an effective and safe therapeutic alternative. Objective: to describe the surgical management and clinical evolution of a patient with bilateral temporomandibular osteoarthritis secondary to Behçet’s disease, treated by bilateral total replacement of the TMJ with customized alloplastic prostheses. Case report: the patient had a history of polyneuropathy and multiple previous joint surgeries, without clinical response. Three-dimensional virtual planning, surgical guide design, and fabrication of custom prostheses were performed. The procedure included arthrectomy, meniscectomy, bilateral condylectomy, and placement of a custom prosthesis via preauricular and submandibular approaches. Postoperative clinical and radiological follow-up was performed, including functional evaluation and follow-up computed tomography. The patient experienced a significant decrease in pain, a progressive increase in mouth opening, and restoration of mandibular function. A follow-up computed tomography scan showed proper and symmetrical positioning of the prosthetic components, stable fixation, and no early complications. Occlusal stability was maintained, and the patient showed satisfactory recovery with no signs of infection, loosening, or heterotopic bone formation during the first two months. Conclusions: total bilateral temporomandibular joint (TMJ) replacement with custom-made prostheses is an effective alternative for managing end-stage joint disease in patients with complex surgical histories. Detailed virtual planning and the use of cutting guides contribute to improved surgical precision and a reduced risk of complications. Clinical implications: in cases of advanced joint disease associated with previous surgeries and extensive fibrosis, the use of CAD/CAM technology and custom-made prostheses can optimize functional outcomes and promote early recovery.

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