CCA posts a monthly blog series called, "Ask the Doctor." You can submit your questions to Annie Reeves (firstname.lastname@example.org) and we will ask Dr. Earl Gage of Kids' Plastic Surgery in St. Louis to answer them. Thanks Dr. Gage for helping spread information and resources for our cranio families!
Ask the Doctor
Earl Gage, MD, Kids Plastic Surgery, MercyChildren’s Hospital
Ask The Doctor
Ask The Doctor
Earl Gage, MD
Kids Plastic Surgery, Mercy Children’s Hospital – St Louis, MO
Question: We are considering a new procedure for Peter's upcoming jaw surgery. It involves a TMJ joint replacements (vs a rib graft & jaw distraction). The company making the joint is TMJ Concepts (www.TMJConcepts.com) in California. I'd love to hear if Dr. Gage has any thoughts about this new procedure.
Answer: Thanks for your question. I do not have any personal experience with artificial TMJ replacement in children. At the most recent meeting of the American Cleft Palate Association in Atlanta, I asked a number of my colleagues and mentors if they had any experience or thoughts, as well. Nobody I spoke with had ever used an artificial joint in a child. None of my colleagues were aware of any surgeon who is doing a large volume of artificial joint replacements in children either.
I would be concerned about placing an artificial TMJ replacement in a child because no artificial joint is likely to last a lifetime, particularly when you consider the high load and stress placed on the TMJ. This makes future replacement surgery likely, in contrast to using bone and cartilage which is perhaps more likely to last. In addition, I worry about how the changing, growing facial skeleton will affect an artificial joint since the artificial material will not grow and change with your child. Finally, any time you place something artificial in the body, whether it is an artificial knee, an artificial heart valve or a synthetic facial implant, there is a risk of that artificial material becoming infected and needing to be removed. When biologic tissue (like bone or cartilage graft) is used, this risk is much, much lower.
I recognize that innovation and technologic advancements in joint replacement may produce an artificial joint that outperforms bone grafts. At this time, however, I am not sure there is enough data and experience to recommend it if bone grafting is also an option.