On the reinsertion of the lateral pterygoid tendon in total temporomandibular joint replacement surgery

This report aims to present the concept of reestablishing lateral pterygoid muscle function during total temporomandibular joint (TMJ) replacement surgery. The key feature is a lattice structure (scaffold) located in the condylar neck of a titanium, three-dimensionally (3D)−printed mandibular component that houses morselized autologous bone from the resected condyle and osteogenic stem cells from iliac bone marrow aspirate, and to which the fibrous enthesis component (collagen attachments to a bone fragment) is fixed via suture cerclage prior to the development of the bony union. Five TMJs were replaced using enthesis reconstruction in three patients who were followed for 1 year and more. Laterotrusion to the contralateral side measured on average 6.4 mm preoperatively, 2.3 mm at 1 month, 3 mm at 3 months, 4 mm at 6 months, and at 1–1.5 years (62,5% of the preoperative laterotrusion/40% of a normal laterotrusion). Subjective normalization of mastication after 1 year was present in all patients. A successful reattachment of the enthesis to an alloplastic endoprosthesis suggests that patients will not only be able to open and close their mouths properly with reduced pain but will also be able to actually chew. The technique has potential applications in orthopedic alloplastic reconstruction.