GP4d - Quality of Life Assessment After Temporomandibular Joint Replacement

Abstract: Statement of the problem: Today, there is still little evidence that attempts to quantify the quality of life of temporomandibular joint (TMJ) replacement (TJR) in all of its domains. The purpose of this investigation is to assess quality of life outcomes in patients who have undergone TMJ TJR using validated questionnaires that examine multiple domains of human experience including function, pain, psychosocial well-being, and oral health-related quality of life.

Methods and Materials: This was a retrospective and cross-sectional study of patients who underwent temporomandibular joint total joint replacement (TJR) surgery at Michigan Medicine (2015-2024). Patients were included if they underwent TJR at the established timeframe and at least 1 year of follow-up. Exclusion criteria was inability to reach the patient. Patients reported outcomes via internet Qualtrics surveys and were assessed by using the following instruments: 1) Overall Satisfaction Questionnaire, 2) Patient Global Impression of Change (PGIC), 3) Diet Consistency Assessment, 4) Graded Chronic Pain Scale (GCPS), 5) Jaw Functional Limitation Scale - 20 item version (JFLS-20), 6) Perceived Stress Scale - 4 item version (PSS-4), and 7) Oral Health Impact Profile - 14 item version (OHIP-14). Survey responses were quantified according to each instrument's validated scoring methodology. Descriptive statistics, including means, standard deviations, medians, ranges, and response distributions, were calculated for all outcome measures. Comparative analysis between preoperative and postoperative values was performed using paired t-tests, with statistical significance assessed at a 95% confidence interval.

Results: Survey was initially sent to a sample of 72 patients and was answered by 33, for a response rate of 46%. The mean follow-up time was 57.7 months (median 48.4 months; range 13.8-135.4 months). The mean age of our patient sample was 51 years old ± 13.85, and most patients were female (97%). Overall satisfaction scores were high, with 91% of patients being satisfied or very satisfied with overall surgical results. Satisfaction levels regarding pain relief (73%) and chewing ability (76%) were lower, and communication with the surgeon was the highest (91%). In PGIC, 85% of patients reported they were much (18%) and very much (67%) improved, 75% reported their pain was much (30%) and very much (45%) improved, and the majority (91%) reported their TMJ symptoms were much (24%) and very much (67%) improved. The vast majority (87%) reported a diet between soft/regular (46%) and regular (41%). The mean preoperative Characteristic Pain Intensity (CPI) score was 63 with improvement down to 24, the mean pain Interference Score was 52 with an improvement down to 9. The mean JFLS total decreased from 88.3 ± 34.2 (pre-op) to 25.5 ± 27.2. Oral health-related quality of life impact was minimal, with a mean OHIP-14 score of 11.46 ± 8.99. In PSS-4, 48% of patients reported low stress (48%) and moderate stress (35%). Almost all patients reported that they would recommend the surgery to family or friends (82%), and that they would do the surgery again if they were in the same circumstances as before (85%).

Outcomes Data: The vast majority of patients reported an improvement in several domains of human experience in terms of TMJ function, facial pain, diet, and disability days. There was a small subset of patients (n = 2) who reported adverse results specifically in ability to chew and facial pain.

Conclusion: Temporomandibular joint total joint replacement is associated with high patient satisfaction, substantial symptom improvement, and favorable patient-reported quality-of-life outcomes. Residual limitations are mild and task-specific, supporting TJR as an effective treatment option for appropriately selected patients with advanced TMJ disease.