Total temporomandibular joint replacement (TMJR)

What is a jaw joint (TMJ) replacement?

A jaw joint or TMJ replacement involves removing your native joint and replacing this with a prosthetic alternative. Whilst this is relatively common for hips and knees, it is far less common for the TMJ, with only a handful of surgeons performing this procedure nationally. I have significant experience in providing this treatment and was formerly the national lead for the British Association of Oral and Maxillofacial Surgeons (BAOMS) Subspecialty Interest Group (SSIG) in temporomandibular joint (TMJ) surgery. I have published widely on the subject of TMJ Replacement and have designed a classification system (the Elledge classification) for extended temporomandibular joint replacements (eTMJRs). Your joint will be custom (bespoke), made for you, from a leading international manufacturer with me guiding every step of the way.

Where is my jaw joint made?

I am very particular about the devices I use and currently provide alloplastic replacement using the Stryker Ventura TMJ Concepts device. These are bespoke devices made in California, USA and shipped to the United Kingdom for each individual patient. They are fabricated from and alloy of titanium, vanadium and aluminium, with a standard device having a cobalt, chromium and molybdenum head with traces of nickel. The fossa component is fabricated from ultrahigh molecular weight polyethylene (UHMWPE). I will ensure that you have allergy testing prior to implantation and engage with you at multiple points during the manufacturing process of your new jaw joint, making certain that your joint is right for you. All titanium devices are available for patients with allergies.

What are the possible risks?

TMJ replacement surgery is not to be undertaken lightly, but as a high-volume provider and one of only a handful of surgeons providing this treatment nationally, I am well placed to keep these risks to an absolute minimum. Risks can include pain, swelling, bleeding, infection, scar, hypertrophic/keloid scar, mechanical failure, temporarily/permanent facial weakness/paralysis, numbness of scalp and/or lip, chin and/or tongue, malocclusion, failure to resolve symptoms, foreign body reaction, allergy, need for subsequent removal and replacement, heterotopic bone formation and ankylosis (fusion of the joint). The vast majority of patients in my hands have an uneventful recovery with significant improvements in pain, function, quality of life and dietary intake following this surgery. I regularly self-audit my own results, which I am happy to provide upon request. I am actively engaged with contributing to the REDCap® national registry for this surgery and previously published the only national outcomes paper, being committed to ensuring patients have transparency of performance among TMJ replacement surgeons.

What does my aftercare involve?

TMJ replacement surgery is a very niche procedure and relatively few of these are performed within the United Kingdom, a large proportion being provided at one of the highest volume providers in Birmingham where my NHS practice is based. I am the only private provider of this surgery in the West Midlands region.

In the post-operative period, you will have an average of two nights in hospital, the first of these nights being spent in a high dependency unit (HDU) level care with a more favourable nurse to patient ratio, ensuring that you get the very best support. As with all my inpatients, I will be personally on call for you throughout the night.

You can expect to see me at one week, six weeks, three months, six months and twelve months post-surgery, with further reviews annually up until five years. This is a lifelong relationship potentially, and I know all my joint replacement patients very well as I am significantly invested in their care. You will have some swelling and pain in the initial few weeks to months post-surgery, but even at early stages patients will talk about the relief they feel from the joint being removed and replaced.

I will get you started with physiotherapy using a Therabite® Jaw Motion Rehabilitation System™ early in your recovery and monitor you closely. In some instances, the restoration of jaw function may lead to some muscular pain as the jaw is opening in ways it hasn’t done in years. This may require supplementary treatment with Dysport® and/or physiotherapy.