Clinical Briefing: Prosthetic Replacement for
Temporomandibular Joint Degeneration
May/June 2008
The Penn TMJ and Facial Pain Clinic is one of a handful
of centers nationwide offering the Lorenz Total TMJ Replacement System prosthesis for functional reconstruction of
the temporomandibular joint in patients with severe late-stage
degeneration of the disc and condyle refractory to conservative
treatment, arthroscopy and arthroplasty.
Developed by clinic co-director Peter
D. Quinn, DMD, MD, the Total TMJ Replacement System was
approved by the FDA after a 10-year clinical trial, and
is currently the only FDA-approved stock prosthesis.
“The Lorenz prosthesis
allows patients with advanced TMJ deterioration
to have improved function with greatly reduced
pain.”
– Peter
D. Quinn, DMD, MD
Schoenleber Professor and Chairman
of Oral and Maxillofacial Surgery |
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Advantages of the
Lorenz prosthesis over autogenous grafts include its capacity
to discourage heterotopic bone formation, obviating the need
for rib or hip grafting, and the opportunity to correct a
pre-existing malocclusion. In the clinical study population,
the average patient had five previous surgeries, with some
undergoing as many as 29 previous surgical procedures.
Total Temporomandibular Joint (TMJ)
Replacement System
Developed by Dr. Quinn, the Total TMJ Replacement
System (Walter Lorenz Surgical, Inc.) was
the first stock device of its type approved
by the FDA for the functional reconstruction
of diseased and/or damaged jaw joints.
 The
prosthesis (shown right) consists of two
components (mandibular condyle and glenoid
fossa) that are available as right- and
left-side specific designs in multiple sizes.
Approved indications
for the TMJ prosthesis include arthritic conditions such
as:
- osteoarthritis, traumatic arthritis, or
rheumatoid arthritis;
- ankylosis including
but not limited to recurrent ankylosis with
excessive heterotopic bone formation;
and
- revision procedures in which other
treatments have failed (eg, alloplastic
reconstruction, autogenous grafts).
Case Study
Mrs. T, a 43 year-old-woman, presented with a history
of facial trauma secondary to an automobile accident 12
years earlier. She sustained a right subcondylar fracture
with displacement of the condyle out of the fossa. At the
time, she was treated conservatively with inter-maxillary
fixation. Based on her current CT scan, however, she had
malunion of the right condyle.
She complained of limited opening, jaw
locking, functionally exacerbated right-sided preauricular
pain and headache, and a "change in her occlusion." She
was treated for several years with intraoral acrylic splints
to "unload" the
joint and went through numerous courses of physical therapy
and medical therapy, including non-steroidal anti-inflammatory
medications and muscle relaxants.
On presentation to the TMJ and Facial Pain Clinic,
she had evidence of advanced traumatic osteoarthritis of
the right temporomandibular joint (Figure 1). She had a limited
interincisal opening of 21mm (45 to 50mm normal) and her
CT scan showed gross deformity of the right condylar head.
In
a procedure approximately three hours in length, she underwent
total alloplastic replacement of the temporomandibular joint
(Figure 2). She is now completely recuperated and functioning
without the need for daily narcotic pain medications.
Our Team of Faculty
The Penn Department of Oral and Maxillofacial
Surgery is
comprised of
a multidisciplinary team of dental/medical specialists whose
expertise encompasses
non-surgical and surgical treatment of oral and maxillofacial
disorders,
traumatic injuries, congenital defects, oral lesions and
temporomandibular
joint dysfunction.
Peter D. Quinn, DMD, MD
Chair, Department of Oral and
Maxillofacial Surgery;
Schoenleber
Chair and Professor of Oral and
Maxillofacial Surgery and
Pharmacology, School of
Dental Medicine
Lee R. Carrasco, DDS, MD
Assistant Professor of
Oral and Maxillofacial Surgery
Joli Chou, DMD, MD
Instructor, Oral and Maxillofacial
Surgery
Joseph W. Foote, DMD, MD
Clinical Associate Professor of
Oral and Maxillofacial Surgery
Helen Giannakopoulos, DDS,
MD
Assistant Professor of
Oral and Maxillofacial Surgery
Barry H. Hendler, DDS, MD
Associate Professor of
Oral and Maxillofacial Surgery
Lawrence
M. Levin, DMD, MD
Associate Professor of Oral and Maxillofacial Surgery
David C. Stanton, DMD, MD
Associate Professor of
Oral and Maxillofacial Surgery
Oral and Maxillofacial Rehabilitation Periodontics
Jonathan
Korostoff, DMD, PhD
Associate Professor of Periodontics
Najeed Saleh, DMD
Clinical Associate Professor of
Restorative Dentistry
Maxillofacial Prosthodontics
Kendra S. Schaefer, DMD
Maxillofacial Prosthodontist
Oral Medicine
Martin S. Greenberg, DDS
Professor of Oral Medicine
Thomas P. Sollecito, DMD
Professor and Chair of
Oral Medicine
Eric T. Stoopler, DMD
Assistant Professor of
Oral Medicine
Access
Patient appointments are available at:
Department of Oral and Maxillofacial Surgery
Hospital of the University of Pennsylvania,
5 White
3400 Spruce Street
Philadelphia, PA 19104
To refer a patient and/or consult with
a doctor call 800-789-PENN (7366) or you can also refer
a patient online.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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