Total Temporomandibular Joint Replacement with Customized Prosthesis in Craniofacial Malformations: A Scoping Review.

Background: Craniofacial malformations may affect maxillomandibular growth and TMJ function. Customized total TMJ replacement has been used for reconstruction in selected patients with severe congenital TMJ deficiencies. Objectives: To map and characterize the evidence on indications, surgical and prosthetic characteristics, associated procedures, outcomes, complications, and knowledge gaps of customized total TMJ replacement in patients with craniofacial malformations. Methods: This scoping review followed PRISMA-ScR guidelines. PubMed, Embase, Scopus, and Web of Science were searched from 1994 to 7 August 2026, with complementary searches in Google Scholar and OATD. Study selection and data extraction were independently performed by two reviewers, and findings were synthesized descriptively. Results: Seven studies comprising 36 patients aged 9-59 years were included. Forty-three TMJ replacements were performed (29 unilateral and 7 bilateral), most commonly using customized TMJ Concepts prostheses. Twenty-five patients (69.4%) had undergone previous surgery. Orthognathic surgery was part of the treatment pathway in all studies. Reported outcomes included mouth opening, facial symmetry, occlusion, and mandibular function; however, outcome reporting was heterogeneous, limiting attribution of these outcomes specifically to TMJ replacement. Conclusions: Evidence remains limited and heterogeneous, precluding conclusions regarding effectiveness, safety, predictability, or superiority. Prospective studies with standardized outcomes and long-term follow-up are needed.