Alloplastic temporomandibular joint replacement following resection of mandibular neoplasms involving the ramus-condyle unit: a systematic review

Background Resection of tumours involving the mandibular condyle, ramus, or temporomandibular joint region removes the joint and, when the ramus or body is included, mandibular continuity. This review examined outcomes, prosthetic approaches, and complications of alloplastic total temporomandibular joint replacement (TMJR) after such resections. Methods PubMed/MEDLINE, Scopus, and Embase were searched to 30 May 2026, with a supplementary search on 15 October 2026 and citation searching. Studies of contemporary total TMJR with at least one identifiable neoplasm-related ramus-condyle resection were eligible; case series required at least three patients. Studies were appraised with ROBINS-I or the JBI case-series checklist. Synthesis followed SWiM by tumour stratum (vote counting by direction of effect), supplemented by an exploratory random-effects meta-analysis of the change in mouth opening; neither was prespecified. Certainty was rated with GRADE (PROSPERO CRD420261406211​). Results Forty studies (1169 total TMJR patients) included 232 neoplasm-related patients (209–210 unique): 124 with benign tumours confined to the condyle or joint, 50 with benign tumours requiring ramus or ramus–body resection, and 38 with malignant tumours. After condyle-confined resection, opening increased by about 6 mm in the two largest series, and joint-preserving low condylectomy gave similar pain relief and better lateral excursion in one comparison. After ramus or ramus–body resection, opening reached about 30–37 mm, but permanent facial nerve deficits followed 29–41% of extended reconstructions, and one cohort lost one in five extended prostheses, mostly after radiotherapy. Pain decreased in all 7 studies with a change; exploratory pooling of 7 studies (88 patients) gave a mean pre-to-postoperative opening gain of 11.7 mm (95% CI 6.0 to 17.5; prediction interval − 3.2 to 26.7). One of 63 patients with recurrence data had a recurrence; only nine of 38 patients with malignant tumours had such data. Certainty was very low for all outcomes. Conclusions Alloplastic total TMJR is feasible in selected patients with benign or locally aggressive tumours of the condyle, ramus, or temporomandibular joint region, but its benefit over other reconstructions is very uncertain. Evidence for malignant tumours is limited and short-term. Prospective multicentre studies with standardised outcomes and long-term oncological follow-up are required.