Int. J. Oral Maxillofac. Surg. 2009; 38: 301–307 doi:10.1016/j.ijom.2008.12.

014, available online at http://www.sciencedirect.com

Review Paper TMJ Disorders

Historical development of alloplastic temporomandibular joint replacement before 1945
Oliver Driemel, Tobias Ach, Urs Dietmar Achim Muller-Richter, Michael Behr, ¨ Torsten Eugen Reichert, Martin Kunkel, Rudolf Reich: Historical development of alloplastic temporomandibular joint replacement before 1945. Int. J. Oral Maxillofac. Surg. 2009; 38: 301–307. # 2009 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons. Abstract. Resections of the temporomandibular joint (TMJ) have been carried out for about 150 years. This article reviews the beginning of TMJ surgery technique before 1945 by carrying out extensive inquiries in public and private libraries and collections. Before 1945 the technique of alloplastic reconstruction of the TMJ was mainly influenced by German and French surgeons. Reconstruction was limited to replacement of the condyle. The role of the TMJ within the orofacial system was not considered. Interposition of alloplastic implants, resection dressings and prostheses were the dominant technique. The main concerns were sterilisation, biocompatibility and implant fixation. No evidence-based data on outcomes are available from that time. By 1945 reconstruction of the TMJ involved the close cooperation of surgeons and dentists.

Oliver Driemel1, Tobias Ach1, ¨ Urs Dietmar Achim Muller-Richter2, Michael Behr3, Torsten Eugen Reichert1, Martin Kunkel4, Rudolf Reich5
1 Department of Oral and Maxillofacial Surgery, University of Regensburg, Germany; 2 Department of Oral and Maxillofacial Plastic ¨ Surgery, University of Wurzburg, Germany; 3 Department of Prosthetic Dentistry, University of Regensburg, Germany; 4 Department of Oral and Maxillofacial Surgery, University of Bochum, Germany; 5 Department of Oral and Maxillofacial Surgery, University of Bonn, Germany

Keywords: TMJ; condyle; alloplastic reconstruction; mandible; historical review. Accepted for publication 16 December 2008 Available online 23 February 2009

Resection surgery of the mandible can be traced back to the early 19th century. The first continuity resection of the mandible without exarticulation has been ascribed to Deadrik in 181041 and Dupuytren in 191251,58. The first hemimandibulectomy including exarticulation was carried out by Grafe in 182147 rather than in 1793 by the ¨ Austrian medical officer Fischer47 who had only removed bone fragments resulting from a gunshot injury51. Signorini performed the first total mandibulectomy with exarticulation in 184341 (Table 1). In view of their high mortality rates these extensive and complicated interven0901-5027/040301 + 07 $36.00/0

tions were performed by only a few surgeons24. Weber, for instance, reported a mortality rate of 30% (36 deaths in 153 exarticulations) in 186441. The range of indications for temporomandibular joint (TMJ) resection varied and included pathologies that have lost their significance (phosphorus necrosis) or where therapeutic management has undergone fundamental change (actinomycosis, tuberculosis, luxations) (Table 2). The grave functional and aesthetic consequences of mandible resection with exarticulation were recognized at an early ¨ stage. SCHRODER differentiated complica-

tions developing during the first three postoperative weeks (early sequelae) from those based on scar contraction and occurring from the fourth postoperative week onward (late sequelae)52 (Table 3). Attempts were made to control these complications by implanting alloplastic materials; in ankylosis patients several alloplastic implants were used to prevent recurrences35. In extensive bone resections defect reconstruction followed the concepts of the German School6,16 or the French School31. This historical overview represents the first part of two dealing with autogenous

# 2009 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons.

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Table 1. Chronology of mandibular resection surgery. Year of -surgery 1793 1810* 1812* 1821 1843 1854 Surgeon Fischer Deadrik Dupuytren Grafe ¨ Signorini Humphry Type of intervention Removal of bone fragments Continuity resection without exarticulation Continuity resection without exarticulation Hemimandibulectomy with exarticulation Total mandibulectomy with exarticulation Isolated resection of the condylar process Source Schlossmann (1905) [51] ¨ Perthes (1907) [41] Tilmann (1903) [58], Schlossmann (1905) [51], ¨ Sigron (1991) [55] Rothmund (1853) [47], Sigron (1991) [55] Perthes (1907) [41], Sigron (1991) [55] Humphry (1856) [20], Abbe (1880) [1], Orlow (1903) [35]

*

Reported in the literature.

Table 2. Overview of indications for TMJ resections as described until 1945. Indications for TMJ resection Ankyloses Acquired (posttraumatic) Number of cases 1 2 17 2 n. g. n. g. 2 27 3 5 n. g. n. g. n. g. 2 2 n. g. 1 1 1 1 1 1 1 1 2 1 1 1 3 3 3 1 1 n. g. 1 n. g. n. g. 12 n. g. n. g. n. g. 100 Source Helferich (1894) [19], Orlow (1903) [35], Blair (1914) [5], Murphy (1914) [33], Ridson (1934) [45], Dingman (1946) [8] Konig (1878) [23], ¨ Blair (1914) [5], Murphy (1914) [33], Orlow (1903) [35], Ridson (1934) [45], Dingman (1946) [8] Orlow (1903) [35], Blair (1914) [5], Murphy (1914) [33] Dingman (1946) [8] Berndt (1898) [3], Konig (1908) [25] ¨ Keller (1853) [21], ¨ BONNECKEN (1893) [6], BERNDT (1898) [3], TILMANN (1903) [58], ¨ KUHNS (1904) [28], ¨ SCHLOSSMANN (1905) [51], ¨ KONIG (1908) [25], KOHEN-BARANOWA (1908) [27], LEXER (1908) [30], RIEGNER (1911) [46], EISELSBERG and PICHLER (1923) [11] KELLER (1853) [21], WOOD (1856) [60], LANGENBECK VON (1878) [29], SCHLENKER 1883 [50] ¨ VORSCHUTZ (1912) [59] RIEGNER (1911) [46]
¨ BONNECKEN (1893) [6], HASHIMOTO (1908) [18], KLAPP (1917) [22] BONATESTA (2000) [7]

Acquired (postinflammatory)

and alloplastic TMJ replacement and aims to: outline the development of alloplastic TMJ replacement up to 1945; document the origin of the interposition of alloplastic material in the context of ankylosis treatment; pinpoint the differences between the German and the French Schools in their reconstruction concepts following jaw resection with exarticulation; and outline the problems of alloplastic TMJ replacement for their present relevance.
Material and methods

Congenital

Neoplasias Benign Malignant

The online database ‘Oldmedline’ goes back to 1950, therefore no information on alloplastic TMJ replacement before 1945 could be obtained from it. The literature was obtained from interlibrary lending or copies of contributions from various European libraries, museum archives and private collections. Further articles were found with the help of references in the literature retrieved and were integrated in this overview.
Interposition of alloplastic material

Inflammatory Changes Phosphorous Necrosis

Actinomycosis Tuberculosis Trauma War Injuries Occupational Injuries Luxations that cannot be repositioned Total (without n. g.) n. g. not given.

FINK (1910) [13], AXHAUSEN (1925) [2]

Rosner introduced the interposition of alloplastic material in 1898 after ankylosis-related resection of the TMJ condyle. He implanted a gold plate to prevent recurrence. This method was modified by Orlow who attached goldcoated aluminium plates to the exposed bone ends35,45. The favourable functional outcomes reported by Orlow (incisal jaw opening about 2.5 cm) for the first postoperative weeks35 led to the wide acceptance of this therapeutic concept, despite the fistulation that occurred in one patient and resulted in the removal of the interpositioned alloplastic material35. Early postoperative functional TMJ exercise9, today considered an essential therapeutic element, played no role in this treatment35. Modifications

TMJ Replacement before 1945
Table 3. Overview of the complications of mandibular resection including exarticulation. Complications of mandibular resection with exarticulation Early complications Chewing disorders Source
¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] HASHIMOTO (1908) [18] BILLING (1910) [4] ¨ NYSTROM (1912) [34] ¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] HASHIMOTO (1908) [18] BILLING (1910) [4] ¨ NYSTROM (1912) [34] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] ¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] HASHIMOTO (1908) [18] BILLING (1910) [4] ¨ NYSTROM (1912) [34] ¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] HASHIMOTO (1908) [18] BILLING (1910) [4] ¨ NYSTROM (1912) [34] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51]

303

Dysphagia

Insufficient fixation of the tongue causing it to sink back Speech disorders

tion of tantalum foil for the prevention of relapses after ankylosis-related resection of the TMJ condyle in children 10 (Table 4). Dingman abandoned all lining of the joint socket and favoured the idea of inducing a large blood clot on account of its connective tissue structure8. The literature is confined largely to individual case reports with short follow-ups. Functional outcomes after interposition of alloplastic material obtained at that time cannot be assessed reliably. Interpositional arthroplasty, introduced more than 100 years ago in surgical ankylosis management, is still recommended for the prevention of reankylosation, in major and medially located disc perforation, in rheumatoid arthritis and in the context of painful chronic synovitis associated with treatment refractory chronic rheumatoid arthritis43,44.
Resection dressing

Increased flow of saliva from the corners of the mouth (oral continence compromised)

Mild aesthetic impairment Late Complications Opening of the mouth severely restricted High-grade dislocation of mandible

Pain in the residual TMJ Impaction of the tongue Ulcers of the palate and gingival Maxillary deformation Severe aesthetic impairment

HASHIMOTO (1908) [18] ¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] PECKERT (1905) [40] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] HASHIMOTO (1908) [18] ¨ NYSTROM (1912) [34] ¨ NYSTROM (1912) [34] ¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] HASHIMOTO (1908) [18] ¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] PERTHES (1907) [41] ¨ BONNECKEN (1893) [6] ¨ SCHRODER (1901) [52] ¨ SCHLOSSMANN (1905) [51] PERTHES (1907) [41] HASHIMOTO (1908) [18] ¨ NYSTROM (1912) [34]

of the implant material (magnesium45, gutta-percha5, ivory38) as well as body tissues such as myofascial flaps obtained from the temporal muscle33,38 and fatty tissue33 were used to minimize potential

foreign body reactions (Table 4). Apart from the material used, the volume of the inserted alloplastic implant became an issue in the middle of the 20th century. Eggers recommended the interposi-

Resection dressings were introduced in the late 19th century by the German or Berlin ¨ School and were mainly affected by BON27 NECKEN, HAHL and SAUER . These dressings should counter scar contraction following partial jaw resection and fix the remaining jaw in its physiological position. After successful wound healing the resection dressing was replaced or supplemented by a definite prosthesis6,48. In many cases this did not include the restoration of the ascending mandibular ramus32 to prevent any contact of fresh wounds with an immediately implanted foreign body32. In 1883 Sauer combined resection dressings with a metal plate at an inclined plane (Fig. 1a), which was fixed to the teeth of the residual jaw17. This inclined plane would slide along the maxillary teeth during occlusion movements guiding the residual jaw into its anatomically correct position16 (Table 4). In an edentulous jaw, the inclined plane was anchored in the bone itself6,17. Trying to preserve the periosteum, if possible31, the bony mandibular defect was regularly packed with iodoform gauze over a period of several months. The wire splint allowed regular wound hygiene, but was unable to support soft tissues41,54. HAHL replaced the wire splint of SAUER’s resection dressing by natural rubber in which the remaining teeth were embedded in a perfect fit for retentive anchoring and which conveyed the outer shape of the alveolar process (Fig. 1b). The free-ending cupped rubber base was designed to provide support to the cheeks

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and preclude direct contact between the alloplastic material and the wound. The teeth of the resected mandible were moulded from white natural rubber17,24,32. Cooperation between surgeons and dentists for optimal rehabilitation41 could be so problematic that it was sometimes avoided. Garre introduced a piano wire ´ loop, the bent section of which rested in the fossa while its two ends were attached to the resected mandible; it was designed to allow surgeons to work independently from dentists27.

Table 4. Overview of alloplastic implants following TMJ resection. Implantation of foreign material after TMJ resection Interposition of foreign material Metal plate Gold-coated metal plate Magnesium Gutta-percha Ivory plate Tantalum foil Resection dressings Resection dressing after Sauer Number of cases n. 3 n. n. n. 1 2 1 n. n. n. 1 n. n. n. 3 n. n. n. n. n. n. 1 n. n. n. g. g. g. g. Source RIDSON (1934) [45] ORLOW (1903) [35] RIDSON (1934) [45] BLAIR (1914) [5] PARTSCH (1932) [38] EGGERS (1946) [10]
¨ BONNECKEN (1893) [6] ¨ KORNER (1894) [26] SCHLATTER (1895) [49] HAHL (1897) [16] FRITZSCHE (1901) [14] HAHL (1901) [17] ¨ SCHLOSSMANN (1905) [51] ¨ KONIG (1907) [24] PERTHES (1907) [41] KOHEN-BARANOWA (1908) [27] ¨ MOHRING (1915) [32] PARTSCH (1917) [37] ¨ SCHRODER (1921) [54] HAHL (1901) [17] ¨ KONIG (1907) [24] KOHEN-BARANOWA (1908) [27] ¨ MOHRING (1915) [32] ¨ SCHRODER (1921) [54] ¨ KONIG (1907) [24] KOHEN-BARANOWA (1908) [27] PARTSCH (1917) [37]

g. g. g. g. g. g. g. g. g. g. g. g. g. g. g.

Prostheses for the reconstruction of the mandible including the condyle

Resection dressing after Hahl

Piano wiring after Garre ´

n. g.

Prostheses for mandibular reconstruction including the condyle ¨ Prosthesis after Martin n. g. BONNECKEN (1893) [6] 1 MARTIN (1893) [31] n. g. SCHLATTER (1895) [49] n. g. PARTSCH (1897) [36] n. g. FRITZSCHE (1901) [14] ¨ n. g. SCHRODER (1901) [52] ¨ n. g. SCHLOSSMANN (1905) [51] ¨ n. g. KONIG (1907) [24] n. g. PERTHES (1907) [41] 2 KOHEN-BARANOWA (1908) [27] ¨ n. g. MOHRING (1915) [32] n. g. PARTSCH (1917) [37] ¨ n. g. SCHRODER (1921) [54] Prosthesis after Schroder ¨ n. g. PECKERT (1905) [40] ¨ n. g. SCHRODER (1905) [53] ¨ 1 KONIG (1907) [24] ¨ 2 KONIG (1908) [25] n. g. KOHEN-BARANOWA (1908) [27] 2 RIEGNER (1911) [46] ¨ 3 MOHRING (1915) [32] n. g. PARTSCH (1917) [37] ¨ n. g. SCHRODER (1921) [54] Prosthesis after Stoppany 1 FRITZSCHE (1901) [14] n. g. PECKERT (1905) [40] ¨ n. g. SCHLOSSMANN (1905) [51] ¨ n. g. KONIG (1907) [24] n. g. PERTHES (1907) [41] 1 KOHEN-BARANOWA (1908) [27] ¨ n. g. MOHRING (1915) [32] n. g. PARTSCH (1917) [37] ¨ n. g. SCHRODER (1921) [54]

Towards the end of the 19th century and at the turn of the century, the French School or ‘Lyon School’ founded by Martin was considered to be (together with the German School) the world leader in alloplastic TMJ replacement. Its protagonists favoured primary reconstruction with prostheses made from natural rubber, which were fitted by dentists on a patient-by-patient basis, and were attached to the teeth using clips or were screwed to the resection stump16,27,31,32 (Fig. 2a). This so-called immediate prosthesis, first implanted by Martin in 187814, was designed to support the adjacent soft tissue immediately on resection and counter postoperative scar contraction and deformation of the wound area32. Cleansing of wound surfaces was achieved by an integrated tube system that was flushed with antiseptic irrigation solutions at 1–2-hour intervals51. ¨ In Germany, SCHRODER was considered the pioneer of immediate prostheses12. Natural rubber turns porous when subjected to sterilisation, so he used hard rubber for the immediate prosthesis he designed and reduced its weight by making it hollow54 (Fig. 2b and c). In view of the frequently observed granulating inflammation in the joint fossa region, Partsch substituted the hard rubber con¨ dyle of SCHRODER’s immediate prosthesis with a glass body37. The immediate prosthesis, according to Stoppany, initially served as a replacement for the body of the mandible. It consisted of an aluminium splint that only reconstructed the vestibular part of the resected jaw and was packed lingually with iodoform gauze56. Additional reconstruction of the TMJ condyle became pos¨ sible when SCHRODER succeeded in soldering a tin condyle to the aluminium splint32.

TMJ Replacement before 1945
Table 4 (Continued ) Implantation of foreign material after TMJ resection Tin splinting after Fritzsche Number of cases n. 1 2 n. n. n. n. 4 n. n. n. n. n. n. 1 1 n. n. 34 g. g. g. g. g. g g. g. g. g. g. g. g.

305

Source FRITZSCHE (1901) [14] ¨ KUHNS (1904) [28] ¨ SCHLOSSMANN (1905) [51] ¨ KONIG (1907) [24] PERTHES (1907) [41] KOHEN-BARANOWA (1908) [27] PARTSCH (1917) [37] BERNDT (1898) [3] FRITZSCHE (1901) [14] ¨ SCHLOSSMANN (1905) [51] ¨ KONIG (1907) [24] PERTHES (1907) [41] ¨ MOHRING (1915) [32] PARTSCH (1917) [37] ¨ KONIG (1908) [25] SUDECK (1909) [57] ¨ MOHRING (1915) [32] PARTSCH (1917) [37]

Celluloid prosthesis after Berndt

Ivory prosthesis

Total number (without n. g.)

Fig. 1. Resection dressings. (a) Resection dressing, after Sauer, made from metal with inclined plane. (b) Resection dressing, after Hahl, made from natural rubber in two colours, with inclined plane.

The difficult wound and relapse control that was criticized by advocates of resection dressings6 inspired FRITZSCHE to develop a removable immediate prosthesis. Prior to surgery, the surgeon defined on a model jaw the mandibular section to be resected and a dentist cast this section in tin. The immediate prosthesis was fixed to the residual jaw with splint support that permitted removal of the immediate prosthesis for wound cleansing14,15 (Fig. 2d). All immediate prostheses were intended to be replaced by a definite prosthesis after wound healing14,39. These prostheses took into consideration intraoral aesthetic aspects and could be inserted or removed by the patient41. Unlike immediate prostheses, the rarely used implant prostheses provided immediate definite reconstruction of the mandible including the condyle and no subsequent replacement by a definite prostheses was required41. BERNDT was an early supporter of implant prostheses. Because of its good sterilisation properties, its light weight and easy handling in the restoration of bony defects he implanted a celluloid ring after exarticulation3. The main criticisms of it were the absence of fixation to the residual jaw25,41 and foreign body reactions involving fis¨ tulation32,41,51. These points led KONIG and ROLOFF to design an implant prosthesis made from ivory, which was anchored in the spongy bone of the mandibular stump with a spike (Fig. 2e). Despite the good initial stability of this junction of bone and ivory spike25, stability was lost later on and the prostheses were removed frequently42.

Fig. 2. Immediate prostheses for the primary reconstruction of the mandible including the condyle. (a) Immediate prosthesis, after Martin, made from natural rubber with integrated tube system for postoperative irrigation of wound surfaces. (b) Immediate hard rubber prosthesis, after Schroder, for ¨ surgical management after hemimandibulectomy. (c) Fluted immediate prosthesis, after Schroder, made from hard rubber for prosthetic care after total ¨ mandibulectomy. (d) Tin splinting, after Fritzsche, with splint support alowing the removal of the immediate prosthesis for wound cleansing. (e) Ivory implant prosthesis, after Konig and Roloff, with a spike to allow the prosthesis to be anchored in the spongy bone of the residual mandible. ¨

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5. Blair VP. Operative treatment of ankylosis of the mandible. Surgery gynecology and obstetrics 1914: 19: 436–451. ¨ 6. Bonnecken H. Ueber Unterkiefer-Prothese. Verhandlung der deutschen odontologischen Gesellschaft 1893: 4: 21–99. 7. Bonatesta G. Die Entwicklung der Knochenplastik im Unterkiefer zwischen 1919 und 1939 in Deutschland. Zuricher ¨ Medizingeschichtliche Abhandlungen 2000: 285: 3–73. 8. Dingman RO. Ankylosis of the temporomandibular joint. American journal of orthodontics and oral surgery 1946: 32: 120–125. 9. Driemel O. Metallische Halbendoprothesen zum Ersatz des Kiefergelenkkopfes. Vergleich funktioneller und asthetischer Langzeitergebnisse mit und ¨ ohne Rekonstruktion. Mund- Kiefer- und Gesichtschirurgie 2005: 9: 71–79. 10. Eggers GWN. Arthroplasty of the temporomandibular joint in children with interposition of tantalum foil. The journal of bone and joint surgery 1946: 28: 603– 606. ¨ 11. Eiselsberg A, Pichler H. Uber den Ersatz von Kiefer- und Kinnhautdefekten. Archiv fur klinische Chirurgie 1923: ¨ 337–369. 12. Ernst F. Kieferresektion, -prothese und – plastik. Die Fortschritte der Zahnheilkunde nebst Literaturarchiv 1926: 2: 973– 1012. 13. Fink F. Ueber die blutige Reposition veralteter Kiefergelenksluxationen. Archiv fur klinische Chirurgie 1910: ¨ 93: 1037–1040. 14. Fritzsche C. Ueber Unterkieferprothesen und uber einen neuen kunstlichen ¨ ¨ Unterkiefer. Deutsche Monatszeitschrift fur Zahnheilkunde 1901: 1: 262–276. ¨ 15. Fritzsche C. Ein neues Verfahren fur die ¨ Herstellung kunstlicher Unterkiefer. ¨ Deutsche Monatsschrift fur Zahnheilk¨ unde 1902: 1: 262–276. 16. Hahl G. Die Prothesen nach Unterkieferresectionen. Archiv fur klinische Chir¨ urgie 1897: 54: 695–735. 17. Hahl G. Erfahrungen in den Resectionsprothesen des Unterkiefers. Deutsche Monatsschrift fur Zahnheilkunde 1901: ¨ 6: 249–256. 18. Hashimoto VT. Ueber die prothetische Nachbehandlung der Unterkieferschussverletzungen. Deutsche Gesellschaft fur ¨ Chirurgie 1908: 88: 191–217. 19. Helferich H. Ein neues Operationsverfahren zur Heilung der knochernen Kie¨ fergelenksankylose. Arch Klin Chir 1894: 48: 864–870. 20. Humphry GM. Excision of the condyle of the lower jaw. Association medical journal 1856: 169: 61–62. 21. KELLER A. Ueber die Resection des ganzen Unterkiefers. Inaugural paper (Thesis), Erlangen 1853. 22. KLAPP R. Gelenkplastik bei Defekten des aufsteigenden Astes. In: Klapp R, Schro¨ der H (Hrsg) Die Unterkieferschußbruche ¨ und Behandlung. Meusser, Berlin, 1917: 191–235. ¨ Konig F. Die Kieferklemme in Folge von entzundlichen Processen im Kiefergelenk ¨ und deren Heilung durch Gelenkresection. Deutsche Zeitschrift fur Chirurgie ¨ 1878: 10: 26–36. ¨ ¨ Konig F. Uber die Prothesen bei Exartikulation und Resektion des Unterkiefers. Deutsche Zeitschrift fur Chirurgie 1907: ¨ 88: 1–20. ¨ Konig F. Weitere Erfahrungen uber Kie¨ ferersatz bei Exartikulationen des Unterkiefers. Deutsche Zeitschrift fur ¨ Chirurgie 1908: 93: 237–251. ¨ Korner H. Kieferprothese. Deutsche Monatsschrift fur Zahnheilkunde 1894: ¨ 12: 79–80. Kohen-Baranowa C. Ueber die Prothesenbehandlung nach Resektion und Exartikulation des Unterkiefers. Beitrage zur ¨ klinischen Chirurgie 1908: 3: 727–751. ¨ Kuhns C. Immediatprothese nach Unterkieferresektion. Deutsche Monatsschrift fur Zahnheilkunde 1904: 175–180. ¨ Langenbeck von B. Ueber Knochenbildung nach Unterkieferresectionen. Archiv fur klinische Chirurgie 1878: ¨ 22: 469–499. Lexer E. Die Verwendung der freien Knochenplastik nebst Versuche uber ¨ Gelenkversteifung und Gelenktransplantation. Archiv fur klinische Chirurgie ¨ 1908: 86: 939–954. MARTIN C. Des resultants eloignes de la ´ ´ prothese immediate dans les resections du ` maxillaire inferieur, 1893. ´ ¨ MOHRING B. Zur Indikation und Technik der Unterkiefer-Resektionsprothese. Thesis paper, Friedrich-Wilhelms-Universitat Berlin, 1915. ¨ Murphy JB. Arthroplasty for intraarticular bony and fibrous ankylosis of temporomandibular articulation. The Journal of the American Medical Association 1914: 62: 1783–1784. ¨ Nystrom G. Klinische Beitrage zu dem ¨ osteoplastischen Ersatz der Unterkieferdefecte. Archiv fur klinische Chirurgie ¨ 1912: 98: 1001–1021. Orlow LW. Ankylosis mandibulae verae. Deutsche Zeitschrift fur Chirurgie ¨ 1903: 66: 399–508. Partsch C. Ersatz des Unterkiefers nach Resection. Archiv fur klinische Chirurgie ¨ 1897: 55: 746–763. PARTSCH C. Die chirurgischen Erkrankungen der Mundhohle, der Zahne und Kie¨ ¨ fer. In: Partsch C, Bruhn C, Kantorowicz A (Hrsg) Handbuch der Zahnheilkunde. Bergmann, Wiesbaden, 1917: 230–387. PARTSCH C. Die chirurgischen Erkrankungen der Mundhohle, der Zahne und Kiefer ¨ ¨ In: Partsch C, Bruhn C, Kantorowicz A (Hrsg) Handbuch der Zahnheilkunde. Bergmann, Munchen, 1932: 359–361. ¨ ¨ Payr E. Uber osteoplastischen Ersatz nach Kieferresektion (Kieferdefekten) durch Rippenstucke mittels gestielter ¨ Brustwandlappen oder freier Transplan-

Conclusions 

Up to 1945 improvement of alloplastic TMJ reconstruction was mainly achieved by scientific curiosity and the creativity of several German and French physicians  The different regimes concentrated on condyle replacement only  The replaced condyle countered the functional and aesthetic impairments the patients experienced due to scar contraction. The functional role of the TMJ in the orofacial system was neglected  Sterilisation, biocompatibility and fixation of the implants were the main issues in alloplastic replacement  Interpositioning of alloplastic implants was introduced more than 100 years ago for the treatment and prevention of recurrent ankylosis, and is still advocated for this reason.  Surgical resection dressings and immediate, implant or definite prostheses were used in ablative tumour surgery, for the management of war and occupational diseases, and in the pre-antibiotic age after extensive resection of the mandible due to acute inflammatory changes  Alloplastic TMJ replacement was described mainly in individual case reports. Follow-ups were short and did not include standardized parameters for functional and aesthetic results. Actual outcomes of reconstruction at that time can only be presumed  Close cooperation between surgeons and dentists in TMJ reconstruction was preferred and underlines the importance of oromaxillofacial surgery as a link between those disciplines

23.

24.

25.

26. 27.

28. 29.

30.

31. 32.

33.

34.

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35. 36. 37.

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TMJ Replacement before 1945
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Corresponding author. Address: Oliver Driemel ¨ Klinik und Poliklinik fur MundKiefer- und Gesichtschirurgie ¨ Klinikum der Universitat Regensburg Franz-Josef-Strauß-Allee 11 D-93053 Regensburg Germany Tel. +49 941 9446337 Fax: +49 941 9446302 E-mail: oliver.driemel@klinik.uni-regensburg.de

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