Prevalence of tinnitus in patients with different temporomandibular disorders symptoms.

OBJECTIVE: To compare the prevalence of tinnitus in temporomandibular disorder (TMD) patients affected by either jaw muscle pain, temporomandibular joint (TMJ) internal derangements, or TMJ arthrosis. METHODS: The presence of self-reported tinnitus was assessed in 250 consecutive TMD patients and correlation analysis was performed with clinical TMD signs and symptoms. RESULTS: Tinnitus prevalence in the TMD population was 30.4%. Any significant patterns of correlation were shown for the overall study group, despite a higher tinnitus prevalence in patients with (32.8%) than without masseter pain (24.8%; p = 0.176) as well as in those with (33.7%) than without TMJ arthrosis (26.1%; p = 0.082). Age-stratified analysis showed correlations with masseter pain in older patients (48.3% vs 16; p < 0.05), and with arthrosis in younger patients (57.1% vs 22.2%; p < 0.05). CONCLUSIONS: Any correlation patterns were shown between tinnitus and TMD. Age-stratified analysis suggested possible hypotheses for a symptom-specific clinical correlation that should be assessed with future research.

Long-Term Symptoms Onset and Heterotopic Bone Formation around a Total Temporomandibular Joint Prosthesis: a Case Report.

BACKGROUND: 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, some adverse events, such as heterotopic bone formation around the implanted prosthesis, may occur. In consideration of that, the present manuscript describes a case of heterotopic bone formation around a total temporomandibular joint prosthesis, which occurred several years after the implant. METHODS: The present manuscript describes a case of heterotopic bone formation around a total TMJ prosthesis, which occurred several years after the implant in patients, who previously underwent multiple failed TMJ surgeries. RESULTS: Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening. A computerized tomography showed evidence of marked heterotopic bone formation in the medial aspects of the joint, where a new-born ankylotic block occupied most part of the gap created by resecting the coronoid process at the time of the TMJ prosthesis insertion. CONCLUSIONS: Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement. It can be suggested that an accurate assessment of pre-operative risk factors for re-ankylosis (e.g., patients with multiple failed temporomandibular joint surgeries) and within-intervention prevention (e.g., strategies to keep the bone interfaces around the implant separated) should be better standardized and define in future studies.

A conservative surgical approach to temporomandibular joint ankylosis.

The current article describes a case of a patient with temporomandibular joint (TMJ) ankylosis undergoing surgery performed with a tailored technique for condylar reshaping. A patient with posttraumatic bilateral TMJ ankylosis underwent interpositional arthroplasty with temporalis fascia, and focus was put on the need to maintain the vertical height of the mandible. The postoperative course was uneventful, and positive outcomes were kept during a 1-year follow-up span. The adoption of surgical strategies aiming at restoring a condylar shape as similar as possible to the natural one may be important in the light of the search for surgeries providing and/or recreating normal function of the TMJ.

Spring-bite: a new device for jaw motion rehabilitation. A case report.

The present paper describes the design features, potential indications and a clinical application of a newly designed device for jaw motion rehabilitation, the Spring-Bite. This device is characterized by a first class lever mechanism, which allows performing passive jaw motion rehabilitation at constant load without an active participation by the patient. Spring-Bite was developed for the management of temporomandibular joint (TMJ) hypomobility and its application may be much useful in the post-operatory phases of TMJ or orthognathic surgeries as well as in patients with reduced muscular force.

Chronic oroantral fistula: combined endoscopic and intraoral approach under local anesthesia.

OBJECTIVE: To evaluate the outcome of combined surgical treatment of oroantral communications associated with chronic maxillary sinusitis. PATIENTS AND METHODS: 8 consecutive patients affected by complicated oroantral fistula were included in the study. The protocol consisted of: clinical, endoscopic and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy 2 weeks before surgery; one-stage surgical procedure under local anaesthesia consisting in uncinectomy with enlargement of the osteomeatal complex through endoscopic nasal approach associated with the closure of the oroantral communication by means of a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy. Follow-up consisted of weekly clinical evaluation during the first month, and nasal endoscopy at 3, 8 and 24 weeks after surgery. RESULTS: After surgical treatment, all patients were symptom-free and had no endoscopic and radiological evidences of maxillary sinusitis at the 6-month follow-up. No recurrent oroantral fistulas were found. CONCLUSIONS: The current prospective study showed that a one-stage, combined endoscopic and intraoral approach under local anaesthesia represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated oroantral communications. Moreover, it represents an easily applicable approach also in outpatient clinics with minor patient discomfort.

Comparison of 2 hyaluronic acid drugs for the treatment of temporomandibular joint osteoarthritis.

PURPOSE: To compare the effectiveness of 2 treatment protocols providing 5 weekly temporomandibular joint (TMJ) arthrocenteses immediately followed by injections of 2 different molecular weight hyaluronic acid (HA) drugs to manage symptoms in patients with inflammatory-degenerative TMJ disease. MATERIALS AND METHODS: Patients with a Research Diagnostic Criteria for Temporomandibular Disorders diagnosis of osteoarthritis were randomly assigned to 1 of 2 study groups receiving either low- or medium-molecular weight HA after arthrocentesis. The level of maximum pain at chewing was the primary outcome variable, and maximum pain at rest, subjective chewing efficiency, functional limitation, treatment tolerability, perceived treatment effectiveness, and jaw range-of-motion function in millimeters were the secondary outcomes. All variables were assessed and compared between groups at baseline, at the end of treatment, and 3 months later. RESULTS: Forty subjects entered the study. At the end of the follow-up period, all the outcome variables improved in both groups of patients. A between-group comparison of changes over time showed that differences were not significant for any of the outcome variables, that is, pain at chewing (F = 0.056, P = .815), pain at rest (F = 0.383, P = .541), chewing efficiency (F = 0.050, P = .825), functional limitation (F = 0.268, P = .609), and mouth opening (F = 0.003, P = .954). In addition, no between-group differences were shown for perceived treatment effectiveness and treatment tolerability. CONCLUSIONS: Similar positive effectiveness was shown for 2 treatment protocols for TMJ osteoarthritis (ie, 5-session single-needle arthrocentesis plus low- or medium-molecular weight HA).

Treatment effectiveness of arthrocentesis plus hyaluronic acid injections in different age groups of patients with temporomandibular joint osteoarthritis.

PURPOSE: To investigate for treatment effectiveness in different age groups of patients with temporomandibular joint osteoarthritis who underwent a cycle of 5 weekly arthrocenteses plus hyaluronic acid injections. MATERIALS AND METHODS: We implemented a retrospective study on 76 patients followed up for 1 year. Outcome variables were pain levels at rest and during chewing, subjective masticatory efficiency, functional limitation, perceived efficacy, and jaw range of motion. Three age groups of patients were identified, and treatment effectiveness was compared among groups by means of a multistrata permutation test. RESULTS: All the partial P values of the subtests related to the age groups, adjusted according to the close testing method for controlling multiplicity, were significant: P = .009 (aged <45 years), P = .001 (aged 45-65 years), and P = .001 (aged >65 years). For the younger age group, the treatment had a significant effect only on the pain at mastication and on the subjective efficacy. For the other age groups, the treatment effectiveness was evident with regard to almost all the considered symptoms. CONCLUSIONS: Our findings suggested that the treatment protocol was more effective in patients older than 45 years, thus having important clinical implications regarding attempts to define tailored treatment protocols for patients with temporomandibular disorders.

Osteomalacia: the missing link in the pathogenesis of bisphosphonate-related osteonecrosis of the jaws?

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented adverse event from treatment with nitrogen-containing bisphosphonates (NBPs). During a preliminary histomorphometric study aimed at assessing the rate of bone remodeling in the jaws of patients with surgically resected BRONJ, we found a defect of bone mineralization (unpublished data). We hypothesized that osteomalacia could be a risk factor for BRONJ in patients taking NBPs. Therefore, we looked for static and dynamic histomorphometric evidence of osteomalacia in biopsies from subjects with and without BRONJ. METHODS: This case-control study used histomorphometric analysis of bone specimens of patients using NBPs (22 patients with BRONJ and 21 patients without BRONJ) who required oral surgical interventions for the treatment/prevention of osteonecrosis. Patients were given tetracycline hydrochloride according to a standardized protocol before taking bone biopsies from their jaws. Biopsies with evidence of osteomyelitis or necrosis at histology were excluded from the study. Osteomalacia was defined as a mineralization lag time >100 days, a corrected mean osteoid thickness >12.5 mm, and an osteoid volume >10%. RESULTS: In all, 77% of patients with BRONJ were osteomalacic compared with 5% of patients without BRONJ, according to histomorphometry. Because osteomalacia was found almost exclusively in NBP users with BRONJ, this is likely to be a generalized process in which the use of NBPs further deteriorates mechanisms of bone repair. CONCLUSIONS: Osteomalacia represents a new and previously unreported risk factor for disease development. This finding may contribute to a better understanding of the pathogenesis of this disease and help with the development of strategies to increase the safety of NBP administration.

Myositis ossificans traumatica of the temporalis muscle: a case report and diagnostic considerations.

BACKGROUND: The present paper reported the case of a trauma-related myositis ossificans, with focus on considerations for a differential diagnosis process. CASE REPORT: A 50-year-old male with a severe painful limitation (12 mm) of jaw opening referred a trauma to the right temporomandibular joint (TMJ) area occurring about 40 days before. Posttraumatic TMJ ankylosis was ruled out on the basis of negative magnetic resonance and cone-beam computerized tomography findings, and the patient underwent treatment with arthrocentesis, botulinum toxin injections, and physiotherapy on the basis of two diagnostic hypotheses, viz., an anchored disk phenomenon or a myofibrotic contracture of the right masseter muscle due to prolonged myospasm. After 4 months, jaw opening was slightly increased to 23 mm, but limitation and pain persisted. A new CT was performed to investigate for the emerging clinical picture compatible with traumatic myositis ossificans of the right temporalis muscle. Once the diagnosis was confirmed, the patient underwent surgery for coronoidectomy. At the 6-month follow-up, mouth opening was increased to up to 35 mm and pain was absent. DISCUSSION: It is fundamental that patients suspected of having uncommon clinical pictures leading to mouth opening restriction are promptly referred to specialized centers, where the differential diagnosis process should be based on a comprehensive assessment taking into account for the potential etiologic factors described in the literature.

Long-term outcomes of surgical resection of the jaws in cancer patients with bisphosphonate-related osteonecrosis.

Surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is controversial. Current recommendations contraindicate aggressive surgery because its results are unpredictable and may trigger disease progression. In this prospective study, we assessed the effectiveness of surgical resection of the jaws in cancer patients with BRONJ. Between June 2004 and July 2009, 30 cancer patients with refractory BRONJ underwent surgical resection of the jaws at our Units. They were followed-up weekly for the first month, at 3-month intervals up to 1 year, and at 6-month intervals up to 2 years. Panoramic radiographs and CT-scan were obtained at 3, 6, 12, 18 and 24 months. Primary outcomes were the 24-month recurrence rate of BRONJ and the 24-month mortality rate. Secondary outcomes were post-operative complications, duration of hospital stay after surgery, time to return to oral diet, and degree of oral pain. The 30 patients had a median age of 66 years and were mostly females (80%). Twenty-eight underwent a single resection and two had both jaws resected, for a total of 32 resected jaws. The cumulative recurrence rate of BRONJ in resected jaws 3.1% and 9.4% at 3 and 6 months, respectively. All the jaws with recurrent BRONJ had osteomyelitis at the margins of bone resection. The cumulative incidence of death was 3%, 12% and 16% at 12, 18 and 24 months. Surgical resection of BRONJ was highly effective, with few post-operative complications and were not associated with long-term mortality.

Predictive value of combined clinically diagnosed bruxism and occlusal features for TMJ pain.

Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.

Modified enucleation for choroidal melanoma with large extrascleral extension.

PURPOSE: To report the technique and the outcome of modified (enlarged) enucleation via lateral orbitotomy for choroidal melanomas with massive extrascleral extension. METHODS: 5 patients with choroidal malanoma with massive, circumscribed perioptic/posterior extrascleral extension underwent modified enucleation via lateral orbitotomy. After lateral orbitotomy and orbital mass exposure with direct tumor visualization, a long optic nerve stump was cut and the orbital component of the tumor was completely (macroscopically) removed along with the globe in all cases. After haemostasis and orbital reconstruction an orbital implant was then placed. Follow-up was longer than 12 months. RESULTS: Excellent cosmetic outcome was acheived in all patients (100%) without operative or postoperative complications. At pathologic examination, tumors were completely removed in all cases (100%). CONCLUSIONS: Modified (enlarged) enucleation via lateral orbitotomy for selectd choroidal melanomas with massive, circumscribed perioptic/posterior extrascleral extension allows complete tumor removal and placement of an orbital implant, avoiding the long healing process of orbital exenteration with excellent clinical and cosmetic outcome.

Imaging of facial soft tissues in multislice computerized tomography: a new geometric method of analysis and its statistical validation.

OBJECTIVE: The main purpose of this preliminary study was to propose an original analysis of facial soft tissues' depth to detect their topographic variability, which causes are intrinsic (depth) and extrinsic (bone shape and reciprocal correlations with soft tissues themselves). To check the utility and accuracy of the method in recognizing measures' differences, other aims were comparison of two different groups of people and statistical validation. STUDY DESIGN: The study sample was composed of 100 consecutive patients (56 females and 44 males) undergoing a routine CT scanning. The images, obtained through the reference plane of the palate, were post-processed on a PC workstation. A goniometer construction was superimposed and centered on the posterior nasal spine, where a grid of eighteen rays was developed to calculate the superficial soft tissues' depths of the face. To test the validity of the method, three of the rays were measured twice, by the same as by another observer. Step-by-step procedures were attained to get maximum standard in measures' reliability. RESULTS: Superficial soft tissues' depths were obtained and sex differences were analyzed (Student's t and Wilcoxon rank-sum test). The statistical reliability was proven with Bland-Altman statistics and the upper 95% limit of agreement was 1.459 mm for intraobserver repeatability and 1.886 mm for interobserver reproducibility. Validation of the method was proven by intraclass correlation coefficient (0.99 both for repeatability and reproducibility) and mean differences (respectively 0.6% and 0.4%). CONCLUSION: The method appeared easy to be applied, reliable and not observer dependent, so suitable for study single as multiple patients with CT images. Future analyses shall be possible.

Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction.

PURPOSE: To evaluate the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients exposed to nitrogen-containing bisphosphonates (NBPs) requiring surgical tooth extraction. PATIENTS AND METHODS: Sixty high-risk patients exposed to NBPs underwent surgical tooth extraction with bone biopsy and were treated with a 7-day cycle of oral antibiotics and discontinuation of NBPs for 1 month. BRONJ was defined as the occurrence of any BRONJ stage (0-3) at 3, 6, or 12 months of follow-up. Inferential analysis was performed on a per-bone (maxilla and/or mandible) basis (n = 72). The time to BRONJ was calculated, and age, gender, cancer diagnosis, and baseline osteomyelitis were evaluated as potential predictors. Exact logistic regression was used to model the time-to-outcome relationship, and hazard rates were calculated from logistic probabilities. RESULTS: BRONJ was detected at 3 months' follow-up in 4 bones and at 6 months in 1 further bone. In the whole cohort of bones, the hazard rate of BRONJ was 5.6% at 3 months and 1.5% at 6 months. Baseline osteomyelitis was a strong risk factor for BRONJ development (odds ratio, 156.96; exact 95% confidence interval, 18.99 to infinity; exact P < .0001). CONCLUSION: In this 12-month follow-up study, BRONJ was a rare outcome in high-risk NBP users who underwent surgical tooth extraction. Moreover, baseline osteomyelitis was a very strong risk factor for BRONJ development.

Age peaks of different RDC/TMD diagnoses in a patient population.

AIMS: To evaluate the prevalence of different Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnoses in a population of patients seeking for TMD treatment at a tertiary clinic in Northern Italy; to evaluate the pattern of age distribution of RDC/TMD diagnoses and to compare data with those from similar studies in the literature. MATERIALS AND METHODS: Two-hundred-forty-three (N=243) consecutive patients seeking TMD treatment at the TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Italy, during the period from July 1st to December 31st, 2008, underwent a RDC/TMD axis I assessment by the use of a systematically translated Italian version of the RDC/TMD guidelines. RESULTS: One-hundred-ninety-nine (N=199) patients (female:male ratio 5:1, mean age 39.7+/-17.1 years, range 18-80) satisfied the RDC/TMD consortium inclusion criteria. Group I disorders (muscle disorders) were diagnosed in 49.7% of patients, group II disorders (disc displacements) in 57.3%, and group III disorders (arthralgia, osteoarthritis, and osteoarthrosis) in 81.4%. The majority of patients (64.3%) received RDC/TMD diagnoses of more than one group. On the basis of the age distribution of RDC/TMD diagnoses, two main distinct groups of TMD patients could be identified: a first group of patients showing disc displacement in the absence of degenerative disorders (any group II diagnoses alone or combined with group I diagnoses of muscle disorders and/or group IIIa diagnosis of arthralgia), and a second group of patients with signs and symptoms of inflammatory-degenerative joint disorders (group IIIb diagnosis of osteoarthritis and/or group IIIc diagnosis of osteoarthrosis). The former comprised 107 patients (20 males, 18.7%; 87 females, 81.3%) with a mean age of 32.7+/-14.5 years, while the latter comprised 46 patients (4 males, 8.7%; 42 females, 91.3%) with a mean age of 54.2+/-15.1 years, thus accounting for about 80% of the study population and being characterized by a significantly different age peak. CONCLUSIONS: Along with descriptive relative frequencies of the RDC/TMD diagnoses, which have been compared with other similar studies in the literature, the main findings of the present investigation were that at least two distinct age peaks are identifiable within this population of patients seeking for TMD treatment. These data might be useful to gather data on the specific epidemiologic features of each single RDC/TMD diagnoses. These findings have to be confirmed by means of multicenter studies involving many calibrated investigators.

Chronic pain severity and depression/somatization levels in TMD patients.

PURPOSE: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II for psychosocial assessment was adopted to grade chronic pain severity and to correlate that severity with levels of depression and somatization in a population of chronic TMD patients. MATERIALS AND METHODS: A series of 111 consecutive patients who sought treatment for TMD symptoms lasting longer than 6 months were recruited and underwent assessment using the RDC/TMD axis II instrument. The frequencies of the different scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90R Depression (SCL-DEP) and Somatization (SCL-SOM) scales in the study population were recorded. Correlation between categories of patients identified by the GCPS items and the SCL-DEP and SCL-SOM scales was assessed by means of the Spearman rank correlation test. RESULTS: Severe or moderate somatization was shown by 47.7% and 26.1% of patients, and severe or moderate depression scores were recorded by 39.6% and 1.8% of the sample, respectively. GCPS scores showed that the vast majority of patients had a low disability or no disability at all, with only 5.4% of patients showing a severely limiting high disability. A significant correlation was found between SCL-SOM and GCPS scores, but not between SCL-DEP and GCPS, even if raw depression scores of patients with a high disability were greater than those of subjects with a low disability. CONCLUSIONS: Within the limitations of the present investigation, the external validity of which is far from optimal and should be improved in future studies on more representative samples, the RDC/TMD axis II for psychosocial assessment has provided interesting data regarding the prevalence of the different degrees of chronic pain severity and their relation with levels of depression and somatization.

Short-term effects of arthrocentesis plus viscosupplementation in the management of signs and symptoms of painful TMJ disc displacement with reduction. A pilot study.

AIM: To provide data on the short-term effect of a cycle of five weekly arthrocenteses plus hyaluronic acid injections in the management of signs and symptoms of painful disc displacements. METHODS: Thirty-one consecutive patients (25 females, six males; mean age 42.4) with a combined diagnosis of disc displacement with reduction and arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent a cycle of five arthrocenteses with injections (one per week) of 1 ml hyaluronic acid. A number of subjective and objective clinical parameters were assessed at the time of the diagnosis (baseline), at each appointment during the treatment, at the end of the treatment, and three follow-up appointments (1 week, 1 month, and 3 months). RESULTS: At the end of the treatment period, marked improvements with respect to baseline values were recorded in all the outcomes variables, and they were maintained over the 3-month follow-up span. Significant changes were shown in subjective outcome variables, viz., masticatory efficiency, maximum pain levels, functional limitation, perceived efficacy, and objective clinical parameters, viz., jaw range of motion on different movements. Tolerability of treatment was acceptable since the first intervention and was moderately improved over time. CONCLUSIONS: A cycle of five weekly hyaluronic acid injections performed immediately following arthrocentesis is effective to improve signs and symptoms in patients with painful temporomandibular joint disc displacement with reduction and to maintain them over a 3-month follow-up.

Unilateral masseter muscle hypertrophy: morphofunctional analysis of the relapse after treatment with botulinum toxin.

This is a case of unilateral masseter muscle hypertrophy (MMH) treated with botulinum toxin (NHAI-normalised hemi-facial asymmetry index improvement from 5.48 to 3.04). After 19 months the treatment was repeated because of hypertrophy relapse (NHAI increase up to 6.82). The volume variations in the masseter area were monitored during 25 months using a laser scanner to compute facial volume. In order to relate the cause of hypertrophy and relapse to the presence of parafunctional activities, a nocturnal electromyography (EMG) study was conducted with positive results (nocturnal parafunctions of patients 4074.99 microV to be compared with a control group value of 1644.63 microV). The lack of the left inferior molars and the consequent right occlusal support seemed to justify the hypertrophy of right masseter (MMRight-POC [percent overlapping coefficient] 91.9%). However, the prosthetic rehabilitation did not prevent relapse in the same muscle. The EMG analysis of both the muscular activation (MMRight-POC 66.0% after relapse) and inhibition activity in Maximum Voluntary Clench (MVC) resulted in contradictory conclusions. At present, the available knowledge regarding MMH physiopathology is very limited and does not support a therapeutic rationale for relapse prevention.

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 post-operative (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.