The efficacy of patient-fitted total joint prostheses and orthognathic surgery to reconstruct patients with congenital craniofacial deformities and temporomandibular joint malformation: a systematic review

Background: Surgical correction of congenital craniofacial deformities (CCD) with temporomandibular joint (TMJ) malformations can be difficult to achieve acceptable functional and esthetic treatment outcomes. The purpose of this study was to perform a systematic literature review to determine effectiveness of TMJ patient-fitted total joint prostheses (TJP) in conjunction with orthognathic surgery for correcting CCD patients with TMJ malformation. Methods: Systematic literature review identified studies in English for surgical correction of CCD patients with TMJ malformation using TMJ TJP with orthognathic surgery. Pub Med, Cochrane, Scopus, Web of Science, and Ovid (from inception through December 2022) and manual searches were used with the following MeSH filters: TMJ prosthesis AND craniofacial deformities OR hemifacial microsomia OR Goldenhar’s syndrome OR Treacher-Collins syndrome OR Nager syndrome OR congenital ankylosis OR congenital deformity OR congenital anomaly. Inclusion criteria: (I) patients with CCD and TMJ malformation; (II) TMJ reconstruction with TJP; and (III) orthognathic surgery performed. Exclusion criteria: (I) CCD and TMJ malformation not present; (II) case reports; (III) technical reports; (IV) TMJ TJP were not used; and (V) orthognathic surgery not performed. Results: The search identified 13 papers meeting the filtered requirements, but only 4 papers with a total of 27 patients met the inclusion criteria and received unilateral or bilateral patient-fitted TJP and orthognathic surgery. All 4 studies reported good outcomes relative to stability and increased maximal incisal opening (MIO). Major complications included infection and cranial nerve VII injury. Only one paper had low risk of bias while the others had high risk. Conclusions: This study indicates patient-fitted TJP and orthognathic surgery may provide predictable and stable outcomes with improved MIO for CCD patients with TMJ malformation. The small sample size indicates surgeons should use caution with this surgical protocol until further verification.