Luke reconstructs all types of jaw defects and carried out the first total jaw replacement with a titanium implant in the UK.
Mr Luke Cascarini is a specialist in problems that affect the temporomandibular joint (TMJ), the joint that allows the jaw to move.
TMJ replacement surgery, or total temporomandibular joint replacement is a relatively new surgical procedure that involves replacing the joints between the lower jaw and the base of the skull with custom-made prosthetic joints.
Luke is one of the UK’s leading surgeons able to offer jaw joint replacement to patients whose jaw problems fail to respond to other treatments. He carries out the majority of these operations performed in the South of England.
Who is a TMJ replacement suitable for?
Most patients who need TMJ replacement have either had their jaw smashed in an accident or the joint and part of the jaw bone has been removed due to a cancerous tumour, a deep-seated bone infection or because of a destructive joint disease such as rheumatoid arthritis or psoriatic arthritis. Patients who have a seriously damaged TMJ experience limited movement and pain that can be debilitating.
Still’s disease, a rare form of arthritis that affects teenagers and young adults, can also damage the TMJ.
With severe TMJ disorder the patient usually can’t talk or swallow their own saliva without severe pain. A TMJ replacement can be a huge benefit to these patients.
When did TMJ replacements become available?
This operation has become mainstream only in the last 10 years or so. In the early days many of the replacement joints just didn’t work so there was quite a high failure rate. This also happened when surgeons first started doing hip replacements but because the number of patients who need a TMJ replacement is far lower, it has taken some time to perfect the jaw prostheses. We now have about 15 years of research that provides evidence that 2 models on the market really do work. These are both made from titanium, which is very long-lasting and well tolerated.
In January 2019, Luke became the first surgeon in the UK to perform a jawbone (TMJ) replacement using a 3D-printed mandible incorporating a titanium frame. Only five such procedures have been carried out globally to date.
How is a TMJ replacement performed?
The planning and custom manufacture for joint replacement is complex and takes approximately 3 months. This stage begins with the patient undertaking a special very fine slice CT scan which is then used to create draft designs by the implant manufacturer. These designs will be discussed and amended until Luke is completely happy that they are perfect. Following this, a date will be booked at the hospital, and once funding is agreed between the hospital and the insurance company (in the case of insured patients), the 6-week process of the building of the joint can begin.
The surgery itself takes approximately 1.5 hours per side. The patient usually remains in hospital as an inpatient for one week and will require some recovery time before returning to work. The patient will be regularly reviewed and patients with chronic pain may require longer admissions.
What are the risks of the procedure?
As with any joint replacement procedure, one of the main risks is of infection. Other risks are an allergic reaction to implant components.
Risks specific to TMJ replacement include: facial swelling and facial nerve weakness; heterotopic bone formation (bone found in an abnormal place); neuroma formation (abnormal growth of nerve tissue); ear problems; dislocation; replacement of one joint can cause detrimental effects to the opposite joint.
Misalignment of the teeth after surgery is also possible.
Patients with long term pain prior to surgery may continue to experience pain. In this case, the patient will be referred to a chronic pain specialist.
Luke recently treated a female patient in her 30s who has psoriasis and related psoriatic arthritis that has destroyed her jaw joints. She could have benefited from TMJ replacement 2-3 years ago; if we could have seen her earlier, she would have been spared a lot of pain, but she was only referred quite recently.
Bilateral TMJ replacement
The following pictures show the scars on a bilateral TMJ replacement patient after one year.
Although the surgery is quite involved, I found the whole process (including the surgical recovery) much more straightforward than I had anticipated. This really didn’t feel like a ‘car crash’ surgery: but rather a highly controlled, and relatively pain free one. I attribute this to Mr Cascarini’s skill and gentle approach. I would recommend that anyone suffering from similar jaw problems seek advice and trust Mr Cascarini’s informed opinion: he is conservative in approach and I trust that he would not recommend surgery lightly.