The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on total prosthetic replacement of the temporomandibular joint in August 2014.
This document replaces the previous guidance on total prosthetic replacement of the temporomandibular joint (NICE interventional procedure guidance 329, March 2009).
Causes of disorders of the temporomandibular joint include inflammatory and degenerative arthritis, trauma, infection and complications of surgery. Symptoms include pain and difficulty opening the mouth, and an inability to eat a normal diet.
Conservative treatments for disorders of the temporomandibular joint include rest, non-steroidal anti-inflammatory drugs, bite splints and physiotherapy. Surgical options include arthroscopic surgery, remodelling of the joint surface, removal of the intra-articular disc and replacement of components of the joint such as the disc, the fossa (socket) or the mandibular condyle.
V20.1 Total prosthetic replacement of temporomandibular joint
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.