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Can growing patients with end-stage TMJ pathology be successfully treated with alloplastic temporomandibular joint reconstruction? – A systematic review

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Abstract

Introduction

The use of alloplastic total temporomandibular joint reconstruction (TMJR) in growing patients is controversial, mainly due to immature elements of the craniomaxillofacial skeleton. The aim of this systematic review was to evaluate the use of alloplastic TMJR in growing patients, focusing on the patient’s clinical presentation, surgical and medical history and efficacy of alloplastic TMJR implantation.

Materials and methods

The literature search strategy was based on the Population, Intervention, Comparator, Outcomes and Study type (PICOS) framework. We searched Pubmed, Google Scholar, Dimension, Web of Science, X-mol, Semantic Scholar and Embase to January 2023, without any restriction on the type of publication reporting alloplastic TMJR in growing patients (age ≤ 18 years for boys and age ≤ 15 years for girls).

Results

A total of 15 studies (case reports: 09, case series: 02, cohort studies: 04) met the inclusion criteria, documenting 73 patients of growing age from 07 countries. Thirty-eight (~ 52%) cases were female. The mean ± SD (range) age and follow-up of patients in all studies was 13.1 ± 3.2 (0–17) years and 34.3 ± 21.5 (7–96) months, respectively. A total of 22 (30%) patients were implanted with bilateral alloplastic TMJR. Over half of the studies (n = 10) were published in the last 3 years. All patients underwent multiple surgeries prior to implantation of alloplastic TMJR. In extreme cases, patients underwent a total of 17 surgeries. Different types of studies reporting inconsistent variables restricted our ability to perform quality assessment measures for evidence building.

Conclusions

Clinical experience with alloplastic TMJR in growing patients is limited to cases showing poor prognosis with other types of reconstruction. Nevertheless, studies show promising results for the use of alloplastic TMJR in growing patients, highlighting the need for well-controlled prospective studies with long-term follow-up.

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Acknowledgements

The authors are thankful to Dr. Hasan Nisar for his valuable inputs and comments during manuscript preparation.

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Authors and Affiliations

  1. Hayatabad Medical Complex, Peshawar, Pakistan

    Yasir Rehman Khattak

  2. Avicenna Medical College, Lahore, Pakistan

    Nabila Ghaffar

  3. University of Veterinary and Animal Sciences, Lahore, Pakistan

    Muhammad Assad Gulzar

  4. Peshawar Medical and Dental College, Peshawar, Pakistan

    Sundas Rahim

  5. Type D Hospital, Latamber, Karak, Pakistan

    Faisal Rafique

  6. Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan

    Zainab Jan, Shaheen Iqbal & Iftikhar Ahmad

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Contributions

All authors contributed to the study conception and design. Literature review was performed by ZJ, NG, MAG. Material preparation, data collection and analysis were performed by YRK, SR, SI, NG, MAG and FR. Project supervision, administration and resource management was done by IA. YRK, FR, NG, SR and ZJ prepared the first draft of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Iftikhar Ahmad.

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Khattak, Y.R., Ghaffar, N., Gulzar, M.A. et al. Can growing patients with end-stage TMJ pathology be successfully treated with alloplastic temporomandibular joint reconstruction? – A systematic review. Oral Maxillofac Surg (2023). https://doi.org/10.1007/s10006-023-01180-4

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