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Development of a patient-specific TMJ prosthesis2499Important to remark is that the reattachment of the lateral pterygoid muscle was not always achievable, nor favorable. In cases with too much osteogenic capacity (young, ankylotic joint) or in absence of the lateral pterygoid muscle altogether (hemifacial microsomia, Pruzansky type III), no reconstruction of the muscle enthesis was attempted. In 25% of the discussed joint replacements, an enthesis reconstruction could not be performed, otherwise, the lateral pterygoid reattachment was carried out as described in the work of Prof Mommaerts.(17)Post-operative maximal mouth opening increased from 25.9 (SD 4.3) mm to 32.5 (SD 1.3) mm. The preoperative average pain score of 8.1 (SD 1.2) dropped to 1.4 (SD 1.3), whilst the mean preoperative diet score of 1.7 (1= liquid, 2 = soft, 3 = solid; SD 0.4) increased to 2.8 (SD 0.3). The average follow-up period was 23.3 months.Case StudiesTo illustrate the functionality of the TMJ Parametro, unilateral and bilateral replacement cases are discussed. Case study #1: unilateral total joint replacement. In the early 1990s, a male patient was treated using intermaxillary fixation for 11 months (according to the patient, unverified) following a facial trauma. Since that time, the patient has experienced progressive worsening of joint function and increasing pain. This persistent pain became unbearable in 2017, forcing the patient to sleep upright. The majority of the pain was located on the right side, both at rest and while medicated. While speaking, the patient had to push the right ascending ramus into protrusion using his index finger. In 2018, a maximal mouth opening of 40 mm was measured, and laterotrusive motions of 10 mm and 5 mm to the left and right, respectively, were observed. Both at rest and during movement, capsulitis arthralgia was noticeable, which limited the patient’s diet to only liquid and very soft foods. A visual analogue scale (VAS) pain score of 10/10 was obtained, which led to an overall Wilkes Stage 5 classification(22) and a clinical dysfunction degree (Helkimo Index) of III.(20) CT scans showed bilateral, degenerative changes of both TMJs, narrowing of both joint spaces, and bilateral formation of Nikolas de Meurechy NW.indd 249 05-06-2024 10:14