{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:16:46Z","timestamp":1783012606302,"version":"3.54.6"},"reference-count":24,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Custom-made alloplastic temporomandibular joint replacement (ATMJR) is not validated in irradiated patients. However, in specific situations, after previous reconstructive surgical failures, the authors hypothesized the role of a customized ATMJR after radiotherapy. Methods: A 65-year-old male patient was referred to Instituto Portugu\u00eas da Face\u2014Lisbon, Portugal\u2014after failed attempts of mandibular reconstruction secondary to oral carcinoma resection and partial hemi-mandibulectomy plus radiotherapy of 60 total Grays. Primary reconstruction was performed with fibula free flap. Due to failure, secondary reconstructions were performed with osteosynthesis plate without success. The patient was unable to have adequate mastication and deglutition due to a severe crossbite. The authors treated the patient with an extended customized alloplastic temporomandibular joint replacement (F0M2). Results: With 3 years of follow-up, the patient showed an improvement in masticatory function, mandibular motion, pain levels, and overall quality of life. No complications were observed related to ATMJR. Conclusions: The presented case described how ATMJR, although not a validated option after radiotherapy, can be considered to restore functionality in complex cases with bone and soft tissues problems.<\/jats:p>","DOI":"10.3390\/jcm12206612","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T05:43:28Z","timestamp":1697694208000},"page":"6612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Considerations for the Use of Alloplastic Temporomandibular Joint Replacement in Irradiated Patients: Report of an Off-Label Indication"],"prefix":"10.3390","volume":"12","author":[{"given":"David Faustino","family":"\u00c2ngelo","sequence":"first","affiliation":[{"name":"Instituto Portugu\u00eas da Face, 1050-227 Lisbon, Portugal"},{"name":"Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal"},{"name":"Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-2107","authenticated-orcid":false,"given":"Francesco","family":"Maffia","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas da Face, 1050-227 Lisbon, Portugal"},{"name":"Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Teschke","sequence":"additional","affiliation":[{"name":"Independent Researcher, 28195 Bremen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sanz","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas da Face, 1050-227 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Galrito","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas da Face, 1050-227 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5750-2875","authenticated-orcid":false,"given":"Henrique","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas da Face, 1050-227 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rute","family":"Marques","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas da Face, 1050-227 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Nabuco","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas da Face, 1050-227 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.oraloncology.2008.05.017","article-title":"Current concepts in management of oral cancer\u2014Surgery","volume":"45","author":"Shah","year":"2009","journal-title":"Oral Oncol."},{"key":"ref_2","first-page":"E345","article-title":"Timing for implant placement in patients treated with radiotherapy of head and neck","volume":"170","author":"Ciolfi","year":"2019","journal-title":"Clin. Ter."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.oraloncology.2017.12.020","article-title":"Mandibular reconstruction","volume":"77","author":"Kakarala","year":"2018","journal-title":"Oral Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s10006-018-0701-2","article-title":"Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap","volume":"22","author":"Parise","year":"2018","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.joms.2012.09.011","article-title":"Multiple Remediation of Soft Tissue Reconstruction in Osteoradionecrosis of the Mandible: A Case Report","volume":"71","author":"Etezadi","year":"2013","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s10006-020-00889-w","article-title":"Reconstruction of mandible using a computer-designed 3D-printed patient-specific titanium implant: A case report","volume":"25","author":"Darwich","year":"2021","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.coms.2011.04.011","article-title":"Osteoradionecrosis","volume":"23","author":"Sinha","year":"2011","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1055\/s-2007-981505","article-title":"Microsurgical Reconstruction for Radiation Necrosis: An Evolving Disease","volume":"23","author":"Sandel","year":"2007","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Raccampo, L., Sembronio, S., Tel, A., and Robiony, M. (2023). Extended Complex Temporomandibular Joint Reconstructions Exploiting Virtual Surgical Planning, Navigation Assistance, and Custom-Made Prosthesis: A Comprehensive Protocol and Workflow. J. Pers. Med., 13.","DOI":"10.3390\/jpm13060931"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.bjoms.2020.10.020","article-title":"Validation of an extended total joint replacement (eTJR) classification system for the temporomandibular joint (TMJ)","volume":"59","author":"Elledge","year":"2021","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.bjoms.2022.03.011","article-title":"Modification of an extended total temporomandibular joint replacement (eTMJR) classification system","volume":"60","author":"Higginson","year":"2022","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3390\/oral3020017","article-title":"Postoperative Recovery after TMJ Arthroscopy: Masticatory Improvement and Postoperative Diet","volume":"3","author":"Prior","year":"2023","journal-title":"Oral"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1002\/jso.24976","article-title":"Early and late complications in the reconstructed mandible with free fibula flaps","volume":"117","author":"Abbink","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"630123","DOI":"10.3389\/fonc.2021.630123","article-title":"A Novel Treatment Concept for Advanced Stage Mandibular Osteoradionecrosis Combining Isodose Curve Visualization and Nerve Preservation: A Prospective Pilot Study","volume":"11","author":"Leeuwrik","year":"2021","journal-title":"Front. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1002\/hed.21537","article-title":"Free flap reconstruction of osteoradionecrosis of the mandible: A 10-year review and defect classification","volume":"33","author":"Baumann","year":"2011","journal-title":"Head Neck"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s12663-015-0762-9","article-title":"Osteoradionecrosis of the Jaws: Clinico-Therapeutic Management: A Literature Review and Update","volume":"14","author":"Nadella","year":"2015","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105073","DOI":"10.1016\/j.oraloncology.2020.105073","article-title":"Safety of boneless reconstruction of the mandible with a CAD\/CAM designed titanium device: The replica cohort study","volume":"112","author":"Bedogni","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.bjoms.2006.12.001","article-title":"Guidelines for the replacement of temporomandibular joints in the United Kingdom","volume":"46","author":"Sidebottom","year":"2008","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jdsr.2020.03.001","article-title":"Clinical guidelines for total temporomandibular joint replacement","volume":"56","author":"Yoda","year":"2020","journal-title":"Jpn. Dent. Sci. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gonzalez-Perez, L.-M., Montes-Carmona, J.-F., Torres-Carranza, E., and Infante-Cossio, P. (2023). Total Joint Replacement for Immediate Reconstruction following Ablative Surgery for Primary Tumors of the Temporo-Mandibular Joint. J. Pers. Med., 13.","DOI":"10.3390\/jpm13071021"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.ijom.2012.05.032","article-title":"Alloplastic temporomandibular joint replacement: Rationale for the use of custom devices","volume":"41","author":"Mercuri","year":"2012","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/j.jcms.2021.05.002","article-title":"Digitally designed, personalized bone cement spacer for staged TMJ and mandibular reconstruction\u2014Introduction of a new technique","volume":"49","author":"Teschke","year":"2021","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.otohns.2009.12.008","article-title":"Disease relapse after segmental resection and free flap reconstruction for mandibular osteoradionecrosis","volume":"142","author":"Suh","year":"2010","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijom.2016.11.002","article-title":"Patient-centered quality of life measures after alloplastic temporomandibular joint replacement surgery","volume":"46","author":"Alakailly","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:09:36Z","timestamp":1760130576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,19]]},"references-count":24,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12206612"],"URL":"https:\/\/doi.org\/10.3390\/jcm12206612","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,19]]}}}