BRITISH ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS


British Association of TMJ Surgeons (B.A.T.S.)

National Case Registration of Temporomandibular Joint Replacement

Revalidation Report based on baseline data as of 13 January 2012: 255 cases

The total replacement of the temporomandibular joint (TMJ) registration project was set up at the request of BAOMS Council in 2010. The surgeons performing this operation formed the B.A.T.S group and from this came the agreement on a minimal dataset for patients having TMJ replacement. Data points are baseline (pre-op), 6 weeks, 1 year and then annually up to 10 years. The data includes process, objective and patient derived elements. Data entry is via SNAP and commenced in the summer of 2011. All new patients will be entered as will retrospective data from 1994. The intention is to produce an annual output suitable for revalidation which in future will summarise both baseline and follow-up data. At present there are 12 consultants nominated to submit data of which 6 have done so. There have been some difficulties entering data by a few surgeons and this will be rectified so that their full participation in the project is acknowledged in future and included in the next revalidation report scheduled for January 2013.

This first report is based on baseline data only and is a summary of a selection of fields suitable for revalidation. It includes the overall picture from the 6 consultants and does not include comparison between consultants. Each individual consultant submitting data has received their output compared to the whole group for purposes of reflection and revalidation. There will be more in-depth analyses and it expected that the B.A.T.S group will present this data at national and international meetings and via peer review journal publication.

Report lead:

Professor Simon N Rogers (Chairman of the BAOMS Clinical Effectiveness Subcommittee)

Data Analysis:

Professor Derek Lowe (Medical Statistician)

Table 1: Baseline data as at 13 January 2012

Consultant / Total
A / B / C / D / E / F / Not Known
YEAR / 1994 / 0 / 0 / 3 / 0 / 22 / 0 / 0 / 25
1995 / 0 / 0 / 0 / 0 / 23 / 0 / 0 / 23
1996 / 0 / 0 / 2 / 0 / 1 / 0 / 0 / 3
1997 / 0 / 0 / 3 / 0 / 0 / 0 / 0 / 3
1998 / 0 / 0 / 2 / 0 / 0 / 0 / 0 / 2
1999 / 0 / 0 / 4 / 0 / 0 / 0 / 0 / 4
2000 / 0 / 0 / 2 / 0 / 0 / 0 / 0 / 2
2001 / 0 / 0 / 2 / 0 / 0 / 1 / 0 / 3
2002 / 0 / 0 / 4 / 0 / 0 / 0 / 0 / 4
2003 / 0 / 0 / 5 / 0 / 0 / 1 / 0 / 6
2004 / 0 / 4 / 4 / 0 / 0 / 0 / 1 / 9
2005 / 0 / 5 / 9 / 0 / 0 / 4 / 0 / 18
2006 / 0 / 6 / 11 / 1 / 0 / 7 / 0 / 25
2007 / 0 / 4 / 8 / 2 / 0 / 6 / 0 / 20
2008 / 2 / 0 / 3 / 3 / 0 / 19 / 0 / 27
2009 / 1 / 0 / 7 / 3 / 0 / 12 / 0 / 23
2010 / 4 / 11 / 9 / 3 / 0 / 8 / 0 / 35
2011 / 0 / 12 / 2 / 1 / 0 / 5 / 0 / 20
NK / 0 / 0 / 3 / 0 / 0 / 0 / 0 / 5
Total / 7 / 42 / 83 / 13 / 46 / 63 / 1 / 255

Table 2: Age and sex

All Baseline data
Mean (SD) Age / 43 (13), n=252
Median (IQR) Age / 44 (33-51), n=252
Females / 79% (201)
Males / 21% (54)

Table 3: Case location

All Baseline data
Local hospital catchment / 37% (95)
Other hospital within your region / 24% (62)
Other UK hospital outside your region / 34% (86)
Other country / 2% (6)
Not Known / 2% (6)

Table 4: Written information on the procedure and any possible complications has been given to the patient (or carer/guardian if patient incapacitated)

All Baseline data
Yes / 85% (217)
No / 0.4% (1)
Not Known / 15% (37)

Table 5: Diagnosis

All Baseline data
Ankylosis / 19% (49)
Rheumatoid Arthritis / 6% (16)
Seronegative Arthritis / 13% (33)
Osteoarthritis / 45% (114)
Septic Arthritis / 0% (0)
Traumatic / 8% (21)
Congential/craniofacial / 1% (2)
Orthognathic condylar resorption / <1% (1)
Oncology / <1% (1)
Previous failed surgery / 17% (43)
Revision prosthesis / 9% (22)
Other* / 15% (39)

*Others comprised: internal derangement (15), Arthrogryposis multiplex (1), CHRONIC BRUXIST (1), closed lock (1), condylar tumour (1), Costochondral graft (1), Data incomplete, assume s-n a (1), degen changes (1), Ehlers Danlos (1), Failed Christensen (1), failed TJR from elsewhere (1), failed type I Christensen TJR from elsewhere (1), Fibromyalgia (1), infected prosthesis, pseudomonas (1), Massive bilateral ankylosis after RTA and bilateral condylar fractures (1), Metal allergy (1), Post condylectomy some years previous, infected prosthesis 6 months previously (1) ,post-fractured mandible (1), Previous Kent-Vitek now failed (1) ,PROGRESSIVE CONDYLAR RESORPTION (1), Psoriasis (1), PSORIATIC ARTHROPATHY (1) , TMJD 4 (1), Torn meniscus (1), BLANK (1).

Table 6: Side having TMJ replacement

All Baseline data
Left / 28% (71)
Right / 28% (71)
Bilateral / 44% (112)
NK / <1% (1)

Table 7: During the past week did you experience difficulty with chewing?

All Baseline data
Data Recorded / 38% (97)
If recorded: During the past week did you experience difficulty with chewing?
Always / 70% (68)
Often / 23% (22)
Sometimes / 7% (7)
Never / 0% (0)

Table 8: During the past week did you have pain when you chew?

All Baseline data
Data Recorded / 34% (87)
If recorded: During the past week did you have pain when you chew?
Always / 70% (61)
Often / 15% (13)
Sometimes / 13% (11)
Never / 2% (2)

Table 9: Number of previous open procedures

All Baseline data
1 or more / 30% (76)
None / 55% (141)
Not Known / 15% (38)

Table 11: Joint replacement system

All baseline data
Unilateral / Bilateral -both sides / Bilateral -1 side only
Custom prosthesis / 47% (67/142) / 41% (45/109) / 1% (1/109)
Stock prothesis / 30% (43/142) / 14% (15/109) / 1% (1/109)
Concepts / 43% (61/142) / 56% (61/109) / 0% (0/109)
Biomet / 1% (1/142) / 1% (1/109) / 2% (2/109)
Christensen / 55% (78/142) / 40% (44/109) / 1% (1/109)
Co-Cr joint / 49% (69/142) / 38% (41/109) / 2% (2/109)
Titanium joint / 5% (7/142) / 6% (6/109) / 0% (0/109)

Table 12: Facial nerve weakness

All Baseline data
Unilateral Left (N=71) / 17% (11/66)
Unilateral Right (N=71) / 13% (8/60)
Bilateral Left (N=112) / 12% (13/107)
Bilateral Right (N=112) / 9% (9/105)

Table 13: Length of stay

All Baseline data
≤ 3 days / 60% (154)
>3 days / 25% (64)
NK / 15% (37)
Mean LOS / 3.2 days
Median LOS / 3 days