DOI: 10.25881/20728255_2022_17_1_9


Epifanov S.A.1, Shtempel M.S.1, Zangieva O.T.1, Fedotov R.N.2, Vyselceva U.V.3, Shomin E.A.1

1 Pirogov National Medical and Surgical Center, Moscow

2 A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

3 Privolzhsky Research Medical University, Nizhnij Novgorod


Aim: to evaluate the results of the total temporomandibular joint replacement for patients with ankylosis of temporomandibular joint (TMJ).

Methods and materials: the research includes the retrospective analysis of patients with tmj ankylosis and total tmj replacement from 2010 to 2018.

Inclusion criteria: 1) Xray confirmation of ankylosis, 2) Restriction of mouth opening, 3) Post operation period more than 12 months, 4) Use of a custom-made total TMJ endoprosthesis. For each patient the number of previous surgical interventions in the affected TMJ was assessed (in case it happened) and the duration of the post operation period before the disease recurrance. Subjective assessment of the patient’s condition was made by the method of questioning the visual-analog scale (VAS) from 0 to 10 for the following parameters: 1) pain in the TMJ, 2) facial pain and headaches, 3) TMJ function, 4) ability to chew solid food, 5) subjective impact assessment of the total TMJ endoprosthesis on life quality. The subjective assessment of the impact total MJ endoprosthesis has on day-to-day life.

Objective methods of research consisted of an evaluation of the interstitial distance at maximum mouth opening (MOP) and an assessment of mandibula lateral movements. Non-parametric functions were used for statistical analysis.

We examined and treated 32 patients (22 women, 10 men) with 48 TMJ ankyloses (16 bilateral, 16 unilateral), average age of patients was 39 years (spread from 18 to 68), 69% with 2 or more previous surgeries in the TMJ area, and the average observation period 24 months (spread from 12 to 84). Injury as the main cause of ankylosis was registered in 17 out of 32 cases (53%). As a result of surgical treatment, the following results were achieved: average subjective assessment of pain in the TMJ before surgical treatment — 8.0, after — 1.5; headache: before — 8, after — 3.5; facial pain: before — 8, after — 4.0; TMJ functions: before — 8.0, after — 2.5; Ability to chew solid food: up to — 7.0, after — 3.0; patients assessed the legal capacity before the operation as 7, after — 1.5.

Before the surgical treatment the average MR was 14.5 mm (spread from 6.3 to 20 mm) and in the postoperative period 35 mm (spread from 30 to 40 mm). The average lateral excursion of the lower jaw improved from 0.5 to 2.0 mm with left-sided ankylosis and from 1.0 to 1.3 mm on the right side. All improvements had statistically significant indicators (p<0.001).

Equally significant improvements were registered for patients with observation period 12–48 months and more than 48 months.

Conclusions: total endoprosthesis at the patients with TMJ ankylosis is an affordable and predictable method of surgical treatment aimed to improve the function of the TMJ, reduce the level of pain and increase life quality.

Keywords: temporomandibular joint, TMJ, ankylosis, total endoprosthesis, arthroplasty.


1. Epifanov SA. Disorders of the temporomandibular joint — it’s an interdisciplinary problem: rethinking established concepts in the practice of a maxillofacial surgeon. Vestnik Natsionalnogo mediko-khirurgicheskogo Tsentra im. N.I. Pirogova. 2020; 15(3 part 2): 102-105 (In Russ). doi: 10.25881/BPNMSC.2020.57.96.019.

2. Roychoudhury A, Parkash H, Trikha A. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: A report of 50 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 87(2): 166-9. doi: 10.1016/s1079-2104(99)70267-2.

3. Erol B, Tanrikulu R, GoÅNrgun B: A clinical study on ankylosis of the temporomandibular joint. J Craniomaxillofac Surg. 2006; 34(2): 100-6. doi: 10.1016/j.jcms.2005.07.008.

4. Topazian RG: Etiology of ankylosis of temporomandibular joint: Analysis of 44 cases. J Oral Surg Anesth Hosp Dent Serg. 2008; 12(2): 61-6. doi: 10.1007/s10006-008-0103-y.

5. Miyamoto H, Kurita K, Ogi N, Ishimaru JI, Goss A. The role of the disk in sheep temporomandibular joint ankylosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88(2): 151-8. doi: 10.1016/s1079-2104(99) 70109-5.

6. Sawhney CP. Bony ankylosis of the temporomandibular joint: Follow-up of 70 patients treated with arthroplasty and acrylic spacer interposition. Plast Reconstr Surg. 1986; 77(1): 29-40.

7. He D, Yang C, Chen M, Zhang X, Traunatic Temporomandibular joint ankylosis: Our classification and treatment experience. J Oral Maxillofac Surg. 2011; 69(6): 1600-7. doi: 10.1016/j.joms.2010.07.070.

8. Epiphanov SA, Poliakov AP, Skuredin VD. Tmj prosthesis. Vestnik Natsionalnogo mediko-khirurgicheskogo Tsentra im. N.I. Pirogova. 2014; 9(4): 17-22. (In Russ).

9. Epiphanov SA, Skuredin VD. The evolution of total endoprosthesis of the temporo-mandibular joint. Vestnik Natsionalnogo mediko-khirurgicheskogo Tsentra im. N.I. Pirogova. 2018; 13(2): 141-145. (In Russ).

10. Wolford LM, Henry CH, Nikaein A, Newman JT, Namey TC: The Temporomandibular Joint Alloplastic Implant Problem. In Sessle BJ, Bryant PS, and Dionne RA, (Editors), Temporomandibular Disorders and Related Pain Conditions, IASP Press, Seattle. WA. 1995. pp.443-447.

11. Henry CH, Wolford LM: Treatment Outcomes for TMJ Reconstruction After Proplast-Teflon Implant Failure. J Oral Maxillofac Surg. 1993; 51(4): 352-8. doi:10.1016/s0278-2391(10)80343-x.

12. Matukas VJ, Szvmela VF, Schmidt JF: Surgical treatment of bony ankylosis in a child using a composite cartilage-bone iliac crest graft. J oral Surg. 1980; 38(12): 903-5.

13. MacIntosh RB, Henny FA: A spectrum of application of autogenous costochondral grafts. J Maxillofac Surg. 1977; 5(4): 257-67. doi: 10.1016/ s0301-0503(77)80120-3.

14. Wolford LM, Cottrell DA, Henry CH: Sternoclavicular grafts for temporomandibular joint reconstruction. J Oral Maxillofac Surg. 1994; 52(2): 119-28. doi: 10.1016/0278-2391(94)90391-3.

15. Epifanov S, Ruidel D. Total temporomandibular joint replacement with use of custom 3-D printed TMJ prosthetics // Craniomaxillofacial Trauma & Reconstruction. 2020; 13(3): 19.

16. Loveless TP, Bjornland T, Dodson TB, Keith DA. Efficacy of temporomandibular joint ankylosis surgical treatment. J Oral Maxillofac Surg. 2010; 68(6): 1276-82. doi: 10.1016/j.joms.2009.10.014.

17. Wolford LM, Pitta MC, Reiche-Fischel O, Franco PF: TMJ Concepts/Techmedica custom- made TMJ total joint prosthesis: 5-year follow-up study. Int J Oral Maxillofac Surg. 2003; 32(3): 268-74. doi: 10.1054/ijom.2002.0350.

18. Mercuri LG, Wolford LM, Sanders B, White RD, Giobbie-Hurder A. Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system. J Oral Maxillofac Surg. 2002; 60(12): 1440-8. doi: 10.1053/joms.2002.36103.

19. Mercuri LG, Edibam NR, Giobbie-Hurder: Fourteen-year follow-up of a patient-fitted total temporomandibular joint reconstruction system. J Oral Maxillofac Surg. 2007; 65(6): 1140-8. doi: 10.1016/j.joms.2006.10.006.

20. Wolford LM, Morales-Ryan CA, Garcia-Morales P, Cassano DS. Autologous fat grafts placed around temporomandibular joint (TMJ) total joint prostheses to prevent heterotopic bone. Proc (Bayl Univ Med Cent). 2008; 21(3): 248-54. doi: 10.1080/08998280.2008.11928404.

21. Wolford LM, Cassano DS: Autologous Fat Grafts Around Temporomandibular Joint (TMJ) Total Joint Prostheses to Prevent Heterotopic Bone. In M.A. Shiffman (Ed.) Autologous Fat Transfer. Springer-Verlag Berlin Heidelberg. 2010. pp. 361-382.

22. Mercuri LG, Ali FA, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint. J Oral Maxillofac Surg. 2008; 66(9): 1794-803. doi: 10.1016/j.joms.2008.04.004.

23. Wolford LM, Rodrigues DB, McPhillips A: Management of the Infected Temporomandibular Joint Total Joint Prosthesis. J Oral Maxillofac Surg. 2010; 68(11): 2810-23. doi: 10.1016/j.joms.2010.05.089.

For citation

Epifanov S.A., Shtempel M.S., Zangieva O.T., Fedotov R.N., Vyselceva U.V., Shomin E.A. Total temporomandibular joint replacement in TMJ ankylosis. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(1):9-15. (In Russ.)