Total Temporomandibular Joint Replacement with Customized Prosthesis in Craniofacial Malformations: A Scoping Review.

Background

Craniofacial malformations may affect maxillomandibular growth and TMJ function. Customized total TMJ replacement has been used for reconstruction in selected patients with severe congenital TMJ deficiencies.

Objectives

To map and characterize the evidence on indications, surgical and prosthetic characteristics, associated procedures, outcomes, complications, and knowledge gaps of customized total TMJ replacement in patients with craniofacial malformations.

Methods

This scoping review followed PRISMA-ScR guidelines. PubMed, Embase, Scopus, and Web of Science were searched from 1994 to 7 August 2026, with complementary searches in Google Scholar and OATD. Study selection and data extraction were independently performed by two reviewers, and findings were synthesized descriptively.

Results

Seven studies comprising 36 patients aged 9-59 years were included. Forty-three TMJ replacements were performed (29 unilateral and 7 bilateral), most commonly using customized TMJ Concepts prostheses. Twenty-five patients (69.4%) had undergone previous surgery. Orthognathic surgery was part of the treatment pathway in all studies. Reported outcomes included mouth opening, facial symmetry, occlusion, and mandibular function; however, outcome reporting was heterogeneous, limiting attribution of these outcomes specifically to TMJ replacement.

Conclusions

Evidence remains limited and heterogeneous, precluding conclusions regarding effectiveness, safety, predictability, or superiority. Prospective studies with standardized outcomes and long-term follow-up are needed.