AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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A Review of Costo-Chondral Arthroplasty for TMJ Reconstruction
Douglas J. Courtemanche, MD, MS, FRCSC.
University of British Columbia, Vancouver, BC, Canada.

PURPOSE: To critcally review the outcomes of a series of 56 consecutive TMJ reconstructions using cost-chondral arthroplasty.
METHODS: Retrospective review of a consecutive case series. Patient sex, age, disease diagnosis, symptoms, signs and previous management were documented pre-operatively. Narcotic use, joint specific symptoms and joint function and diet were documented pre and post-operatively
RESULTS: Between 1991 and 2003, 45 patients underwent 56 costo-chondral arthroplasty (CCA) for TMJ reconstruction. 37 were female; 8 were male. Mean age at reconstruction was 39 years. 28 were primary unilateral (1U), 9 primary bilateral (1B) (18 joints), 2 sequential R and L unilateral (1S) and 6 secondary unilateral (2U). The indications for reconstruction were osteoarthritis (30), ankylosis (13) and graft fracture (2, group 2B). Mean duration of symptoms prior to reconstruction was 12 years.
47 joints had had an average of 2 previous operative procedures. 23 patients required secondary arthrolysis after CCA to decrease symptoms and improve function.
Long-term follow-up from initial CCA averages 6 years and from secondary arthrolysis 2.5 years.
For the 1U and 1B groups: there was a decrease in narcotic requirement from 20 to 11 patients, there was a decrease in joint specific symptoms from 23 to 3 patients, there was an improvement in diet quality.
For all groups there was an improvement in interincisal (iio) opening and lateral-trusive motion (group 1U iio 22.5 mm to 29.8 mm p=0.007).
Overall 20 patients improved with primary CCA and an additional 18 with secondary procedures; 4 were unchanged (9%) and, importantly, there were 3 failures (7%) with patients worse after surgery.
CONCLUSIONS: Costochondral arthroplasy is effective in the operative management of degenerative TMJ disease, decreasing symptoms and narcotic requirements and increasing function. Almost 50% of patients will require a secondary arthrolysis.


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