Amit Dattani, Ross Elledge, Alan Attard, Jason Green
Introduction & aims
This was a departmental re-audit of outcomes for prosthetic temporomandibular joint (TMJ) replacements undertaken at University Hospitals Birmingham against National Institute for Health and Care Excellence (NICE) guidance. The original audit was against the now outdated NICE Interventional Procedure Guidance (IPG) 329 published in 2009. This has now been superseded by NICE IPG 500 published in 2014. In addition, we have examined for consistency against further guidance published by Sidebottom in 2008 for and on behalf of UK TMJ replacement surgeons.
A retrospective review of all case records of patients undergoing prosthetic TMJ replacement at the Queen Elizabeth Hospital, Birmingham over a 12-month period (June 2016 – June 2017 inclusive). Sources of information were Clinical Portal, PACS and theatre logbooks.
A total of 17 cases were performed during the period of review with a total of 24 prosthetic TMJ replacements undertaken. The most common reasons for total joint replacement were osteoarthritis (n=8) and ankylosis (n=4). The most common complication was temporary facial weakness (n=7), resolving eventually in all cases where this occurred. All patients had cross-sectional imaging, having undergone a CT scan with Protomed protocol preoperatively (all replacements were custom TMJ Concepts). Most patients had undergone prior surgery with 10/17 having had prior open TMJ surgery at another Trust.
All cases reported were for indications as specified in both the NICE guidance and Sidebottom (2008) and all patients met at least one criterion for prosthetic joint replacement as specified in the latter guideline. Complication rates were comparable to those reported in the NICE guidance. With a national data registry by the British Association of TMJ Surgeons (BATS) now well established, collection of key outcomes in our department allow for regular appraisal of regional outcomes against a national standard.