[Custom-made implant for complex facial reconstruction: A case of total replacement of temporo-mandibular joint, zygomatic arch and malar bone]

Abstract

Introduction: Total prosthetic replacement of the temporo-mandibular joint (TMJ) has become a common procedure, but it is usually limited to the TMJ itself. We report about one case of complex prosthetic joint reconstruction extending to the neighbouring bony structures.

Case: A 57-year-old patient, operated several times for a cranio-facial fibrous dysplasia, presented with a recurring TMJ ankylosis and a complexe latero-facial bone loss on the right side. We performed a reconstruction procedure including the TMJ, the zygomatic arch and the malar bone by mean of custom made composite prosthesis (chrome-cobalt-molybdenum-titanium and polyethylene). Five years postoperatively, mouth opening, nutrition, pain and oral hygiene were significantly improved.

Discussion: Nowadays technical possibilities allow for complex facial alloplastic reconstructions with good medium term results.

Keywords: Agenesis; Agénésie; Ankylose; Ankylosis; Articulation temporo-mandibulaire; Bone dysplasia; Dysplasie osseuse; Prosthesis; Prothèse; TMJ; Zygomatic; Zygomatique.