From resection to reconstruction: patient-specific temporomandibular joint replacement in patients with ameloblastomas - a report of three cases

Abstract

Ameloblastomas involving the temporomandibular joint (TMJ) present unique reconstructive challenges. This case series introduces patient-specific TMJ prostheses as an innovative solution for complex mandibular defects, addressing critical limitations in traditional reconstruction methods by eliminating donor site morbidity and optimising functional outcomes. Three patients presented with follicular ameloblastomas in the posterior mandible, experiencing significant tumour involvement affecting mandibular function and facial aesthetics. Clinical findings included extensive tumour growth in the mandible extending towards the condyle and compromising TMJ function. Surgical management involved complete tumour resection followed by immediate reconstruction using custom TMJ replacement (TMJR) prostheses. The prosthetic solution comprised titanium alloy mandibular components with integrated dental implants and ultra-high-molecular-weight polyethylene glenoid fossa components. Virtual surgical planning facilitated precise prosthesis design, enabling complete tumour removal while maintaining facial symmetry and temporomandibular function. Patient-specific TMJR offers a transformative approach to managing complex mandibular defects. Key takeaways include the potential for precise anatomical reconstruction, reduced surgical complications, and simultaneous restoration of function and aesthetics.