Replacement Arthroplasty: Sidebottom AJ

Sidebottom AJ, Anonymous00025, Anonymous00026. · Maxillofacial Unit, Queens Medical Centre, Nottingham, UK. · Br J Oral Maxillofac Surg. · Pubmed #17223231 No free full text.

Abstract: BAOMS has requested that guidelines be formulated for the replacement of the temporomandibular joint (TMJ). This is an expensive and technique sensitive method of TMJ reconstruction and in the current climate warrants an agreed approach. The following document states the indications and contraindications for this technique as discussed and agreed amongst surgeons currently carrying out this procedure in the UK.

Sidebottom AJ. · Maxillofacial Unit, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom. · Br J Oral Maxillofac Surg. · Pubmed #19155105 No free full text.

Abstract: The management of temporomandibular joint (TMJ) disorders in secondary care has progressed through the 1990s from a condition dealt with by generalists to one with an increasing number of surgeons with a subspecialist interest. Within this latter group there is a subgroup of those with a specific training towards joint replacement surgery. Increasingly patients who previously had surgery for pain are being managed with non-surgical options. Alternative pain management regimens with the introduction of botulinum toxin as well as tricyclic medication have reduced the need for any invasive management. The surgical management of the TMJ has been revolutionised by the introduction of arthroscopy in the late 1970s. The use of arthroscopy and arthrocentesis has lead to a reduction in indications for open joint surgery. There is no longer a perceived need to correct internal derangement with disc repositioning surgery. The primary management of acute restriction of opening and joint pain is now with arthrocentesis and arthroscopy. Degenerative and ankylotic conditions of the joint can be safely treated by the use of alloplastic joint replacement, which has less morbidity and more predictable outcomes than costochondral grafting, with the latter still the method of choice in children. The revolution continues with the introduction of national guidelines and databases supported by BAOMS.

Sidebottom AJ, Speculand B, Hensher R. · Maxillofacial Unit, Queens Medical Centre, Nottingham, UK. · Br J Oral Maxillofac Surg. · Pubmed #18242801 No free full text.

Abstract: Replacements for the temporomandibular joint were developed in the early 1960s. Problems with various prostheses, notably the Kent VK1, led to detailed analysis of their risks and complications. In 1999 one type of prosthesis (the Christensen) was converted from an acrylic condyle on cobalt-chromium fossa to metal-on-metal cobalt-chrome condyle and fossa. This has been popular for the last 15 years in the UK, but since it was converted to the metal-on-metal variant there have been several cases of foreign body giant-cell reactions to the prosthesis. Of the 9 cases seen (out of 106 placed), 4 were found retrospectively to be sensitive to one of the metal components of the prosthesis; the others have not been tested to date. Other potential causes of this reaction are point contact, micromovement, or a lymphocyte-mediated response to the prosthesis.