PDF: TMJ Total Joint Prosthesis for Condylar Fracture Malunion

A 54-year-old man with history of condylar fracture 16 months ago was referred with limitation of mouth openning and pain. 

condylar-fracture


Intraoral examinations showed a patient with a severely periodontal disease and treatment with implants and dental prosthesis related to infection and implant mobility.

The patient had less than 15 mm interincisal distance in open mouth and showed pain related to mandibular fracture treated previously. Previously to TMJ treatment all remaining teeth and implant were removed due to periodontal disease for further rehabilitation using a new dental implants installed in an adequately position with good bone support. Computed tomography (CT) confirmed condylar fracture malunion by failure of the internal fixation.

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A series of CT sections (1mm cuts) was used to reconstruct a stereolithographic model. A mock operation was done on the model and sent to TMJ for fabrication of customized prosthesis. 


To maintain the occlusal vertical dimension (OVD), provisional dental prostheses were made and these values were used during the manufacture and installation of the TMJ. Surgical approach was through preauricular and submandibular incisions. The condyle was removed and fixation system.

The glenoid fossa implant was inserted followed by the condylar implant and into surgical room the patient presented an open mouth almost to 35 mm. After 12 months of follow- up, the TMJ showed good skeletal and occlusal stability, mouth opening was 35 mm and no pain is present.

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