Dr Esben Aagaard was a Consultant Surgeon at the Department of Oral and Maxillofacial Surgery, Odense University Hospital, Denmark from 2000 to 2017 and from 2017 at a Private Hospital in Copenhagen Denmark. He is a clinical temporomandibular joint consultant for Zimmer Biomet Microfixation.
He is a past president of European Society of TMJ Surgeons (ESTMJS) and a moderator at ACMF Controversies in Orthognathic Surgery (International course), Copenhagen, Denmark; the TMJ Symposium (International course), Copenhagen, Denmark; and the ESTMJS Annual Meeting, Copenhagen, Denmark. He is a member of the American Society of TMJ Surgeons, the (ESTMJS),. Past President 2015-2016, the Scandinavian Society of OMF Surgeons, the Danish Society of OMF Surgeons and the Stryker Global Advisor Board.
Dr Aagaard has given numerous international lectures and authored a chapter in the e-book 'Orthognathic surgery and alloplastic reconstruction; surgical management of temporomandibular joint Vols 1 and 2’ ( Florencio Monje Gil).
Surgical management of temporomandibular joint disorders (TMD) when traditional conservative management fails.
Traditionally, treatment of temporomandibular disorders was based on diagnostic assessments, patient information, splint therapy, arthroscopies, arthrocentesis and finally, open joint surgery. Earlier results of alloplastic temporomandibular joint (TMJ) surgery revealed inconsistent outcomes. In recent years, promising results have been published with total joint reconstruction using new types of prostheses. The aim of this prospective clinical study is to describe a wide range of pre- and post-operative clinical variables following uni- or bilateral total alloplastic TMJ reconstruction (TAR) using biomet microfixation patient matched TMJ implants.
Material and methods: Two hundred and nine adolescent patients underwent unilateral (n = 109) or bilateral (n = 110) TMJ replacement surgery. Their mean age was 42.5 ± 15.1 years; 89.5 per cent of joints were implanted in females. The patients were assessed pre- and post-operatively at 1 week and 1, 3, 12, 18, 24, 36, 48, 60, 72 and 84 months. The patients were classified using the Wilkes Classification and jaw pain intensity (visual analogue scale), maximum incisal opening (MIO) and adverse events were assessed.
Results: The mean follow-up was 55.4 ± 24.5 months (range: 1-7 years). Wilkes Classification was Class V (n = 94), Class IV (n = 70) or Class III (n = 21). Previous non-surgical treatment and surgical treatment occurred in 96.7 and 91.9 per cent of enrolled joints, respectively. Significant improvements in MIO relative to baseline (28,7 ± 11.1mm) were observed, beginning at 3 months (36.4 ± 7.6 mm; P < 0.005), and were maintained long term to 7 years (40.3 ± 9.6 mm; P < 0.005). Patients experienced significant reduction in pain scores relative to baseline (6.92 ± 0.8), beginning at 4 weeks (1.9 ± 0.2; P < 0.005) and observed long-term up to 7 years (1.59 ± 0.2; P < 0.005). The incidence of adverse events related to total alloplastic joint reconstruction was low. In 6 per cent (12/219) of alloplastic joints, adverse events such as haematoma, infection, swelling and heterotopic bone formation were observed. Most events were resolved through correct treatment according to clinical diagnosis. In two joints (0.6%) the alloplastic reconstruction had to be removed due to infection. In one of them, a CrCo-implant was changed to a titanium implant. Eight joints (3.7%, 8/219) were revised without explantation. The remaining adverse events were resolved through antibiotic treatment.
Conclusions: The present study indicates that TAR is a relevant treatment option, even in patients with a broad range of TMD. The results show, that patients gained an acceptable range of mouth opening and a significant reduction in pain following surgery. Although, the results seem promising, it should be emphasized, that TAR is associated with side effects and, thus, should only be used as an end stage treatment when less invasive procedures fail. A comprehensive pre-surgical work up is important. Furthermore, the level of patient information should be high in order to obtain realistic expectations. Ongoing prospective studies are needed to consolidate possible significant treatment outcomes.
Aims: To provide an overview of surgical management of TMD problems
Objectives: To present the different surgical possibilities after unsuccessful conservative treatment of TMD problems thereby enhancing the attendees’ understanding of the options available for patients with complex TMJ problems.
Learning outcomes: After the presentation, the delegates should have acquired contemporary knowledge of the international evidence based literature in the field of surgical modalities for patients with TMD problems