Quality of life, chronic pain, insomnia, and jaw malfunction in patients after alloplastic temporomandibular joint replacement: a questionnaire-based pilot study.

Studies of patients undergoing alloplastic total temporomandibular joint replacement seldom report on quality of life (QoL) and sleep. The aim of this pilot study was to assess these factors in such a patient cohort using validated psychometric questionnaires. Data were collected via online surveys comprising the following six questionnaires: Short Form-12 Health Survey (SF-12), Patient Health Questionnaire-15, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Insomnia Severity Index, Graded Chronic Pain Scale, and Jaw Disability List. Pain intensity, limitation in nutrition, and treatment satisfaction were assessed using numerical rating scales. Mouth opening was measured at follow-up. The SF-12 Physical Composite Score was markedly lower than that of the age-matched general population, whereas the Mental Composite Score did not differ significantly. Participants indicated a low somatization level and low level of disability due to pain, but reduced QoL. Clinically relevant insomnia was reported by 36% of participants. In conclusion, the results of this pilot study indicate that QoL and sleep in patients with a total temporomandibular joint replacement differ from those in the general population, indicating the need for a comprehensive outcome assessment utilizing validated psychometric tools in accordance with the current biopsychosocial model of chronic disorders.

Alterations of mandibular movement patterns after total joint replacement: a case series of long-term outcomes in patients with total alloplastic temporomandibular joint reconstructions.

According to recognized guidelines, a total alloplastic replacement may be indicated to resolve temporomandibular pain and functional limitations in cases where conservative and less aggressive surgical management strategies have failed. It is broadly believed that, as a result of the surgical procedure, the function of the lateral pterygoid muscle is lost and so are the laterotrusive and protrusive jaw movements. Furthermore, the joint prosthesis design may not be conducive to lateral and protrusive movements. Using a dynamic stereometry technique, it was possible to perform a quantitative analysis of kinematics in TJR patients. The cases of four patients who showed preserved lateral and/or protrusive motion are presented here. During mouth opening, prosthetic condyle translation ranged from 3.18mm to 10.09mm and it was also possible to observe this clinically. It has been suggested that changes in prosthesis design may have improved postoperative jaw kinematics. Considering the large diversity in treatment outcomes, it is recommended that the individual prognosis should always be discussed with the patient prior to surgery.

Alloplastic total temporomandibular joint replacements: do they perform like natural joints? Prospective cohort study with a historical control.

The aim of this study was to qualitatively and quantitatively describe the biomechanics of existing total alloplastic reconstructions of temporomandibular joints (TMJ). Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via dynamic stereometry technology. This non-invasive method combines three-dimensional imaging of the subject's anatomy with jaw tracking. It provides an insight into the patient's jaw joint movements in real time and provides a quantitative evaluation. The patients were also evaluated clinically for jaw opening, protrusive and laterotrusive movements, pain, interference with eating, and satisfaction with the joint replacements. The qualitative assessment revealed that condyles of bilateral total joint replacements displayed similar basic motion patterns to those of unilateral prostheses. Quantitatively, mandibular movements of artificial joints during opening, protrusion, and laterotrusion were all significantly shorter than those of controls. A significantly restricted mandibular range of motion in replaced joints was also observed clinically. Fifty-three percent of patients suffered from chronic pain at rest and 67% reported reduced chewing function. Nonetheless, patients declared a high level of satisfaction with the replacement. This study shows that in order to gain a comprehensive understanding of complex therapeutic measures, a multidisciplinary approach is needed.

[Chronic myofacial pain. Reduced pain through psychoeducation and physiotherapy]. / Chronische Kiefer- und Gesichtsschmerzen. Verringerte Schmerzen durch Psychoedukation und Physiotherapie.

BACKGROUND: Psychological factors are associated with the emergence and persistence of pain perception. The aim of this pilot study was to assess the psychological factors relating to pain perception in patients with chronic myofacial pain and to investigate the influence of patient information, education and physiotherapy on pain perception and functional jaw opening examined over a 6-month period. PATIENTS AND METHODS: In accordance with the research diagnostic criteria for temporomandibular disorders (RDC/TMD), 40 patients (31 females and 9 males, mean age 38.6 years) with chronic myofacial pain were assessed at 3 time points: on admission (T1), after 3 months (T2) and 6 months (T3). The study included a structured interview and five psychological questionnaires. At all time points patients were informed about the development of pain and the relationship between chronification of pain and psychological risk factors. RESULTS: After 6 months significant improvements in jaw function and quality of life, as well as a decrease in psychological parameters, such as fear and depression were found. Improvement was related to the severity of pain chronification. CONCLUSION: The results show the necessity of early identification of patients with severe pain chronification and the need for psychological pain therapy.

Novel approach to the study of jaw kinematics in an alloplastic TMJ reconstruction.

Total alloplastic temporomandibular joint (TMJ) reconstruction is a reliable treatment modality in patients with severely diseased TMJ with good clinical behaviour. TMJ mandibular function after alloplastic reconstruction has scarcely been analysed as a biomechanical parameter and investigation has generally been limited to interincisal measurements without deeper insight into joint kinematics. Dynamic stereometry to assess condylar movements relative to the fossa was performed at the 5 year follow-up of a patient who underwent condylar resection of the right TMJ followed by total alloplastic joint reconstruction to treat pigmented villonodular synovitis. The patient could achieve wide mouth opening, but overall mandibular kinematics showed a strong deviation towards the prosthetic side due to the lack of mandibular translation caused by the absence of the lateral pterygoid attachment. Possible overloading of the joint contralateral to the TMJ prosthesis might be prevented by optimizing replacement joint design.

[HIV-associated lymphoma -- an unusual cause of pathological mandibular fracture]. / HIV-assoziiertes Lymphom -- ungewöhnliche Ursache einer pathologischen Unterkieferfraktur. Fallbericht und Behandlungsoptionen bei Immundefizienz.

Despite the introduction of highly active antiretroviral therapy (HAART), diffuse large B-cell lymphoma (DLBCL) remains a common malignancy in human immunodeficiency virus (HIV)-infected patients, especially the plasmablastic variant. About 50% of lymphomas in HIV patients are extranodal and half of them occur in the head and neck area. The main oral symptoms are pain, swelling, numbness and tooth mobility. We report the case of a 52-year-old patient with a known HIV infection and fracture of the angular region of the mandible. The fracture did not unite following open reduction and osteosynthesis. A biopsy performed at the time of revision revealed the diagnosis of a primary lymphoma in the mandible. After chemotherapy had induced complete remission of the lymphoma and autogenous iliac crest bone grafting had been performed the fracture united. Primary lymphoma in the mandible is a disease that presents with a nonspecific radiological appearance which may mimic osteomyelitis or periodontal pathology. A rapid and accurate diagnosis is critical for the appropriate treatment. In our experience HIV-positive patients with mandibular fracture should be treated according to the guidelines established for HIV-negative patients. However, risky compromises such as intraoral approach or hazardous fracture fixation should be avoided.

[Pigmented villonodular synovitis of the temporo mandibular joint. Differential diagnosis and therapy]. / Pigmentierte villonoduläre Synovitis des Kiefergelenks. Differenzialdiagnose und Therapie.

For the temporomandibular joint (TMJ), functional disorders are common but tumors and tumor like lesions are rare, although these are often mistaken for functional ailments. Early examination by computed tomography or, as a method of choice, magnetic resonance imaging is recommended in case of persisting TMJ problems. Pigmented villonodular synovitis (PVNS) is a rare benign but locally destructive fibrohistiocytic lesion originating in synovial tissue. Involvement of the temporomandibular joint is extremely rare, with the average age of patients being 44.6 years. This paper reports on a 13-year-old patient with diffuse PVNS involving the middle ear and middle cranial fossa. The treatment of choice involves wide local excision and reconstruction of the temporomandibular joint with long-term follow-up. Pathogenesis and differential diagnosis are discussed.