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Long-Term Symptoms Onset and Heterotopic Bone Formation around a Total Temporomandibular Joint Prosthesis: a Case Report.

Guarda-Nardini L, Manfredini D, Olivo M, Ferronato G - J Oral Maxillofac Res (2014)

Bottom Line: The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function.Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening.Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Maxillofacial Surgery, University of Padova Italy.

ABSTRACT

Background: The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, some adverse events, such as heterotopic bone formation around the implanted prosthesis, may occur. In consideration of that, the present manuscript describes a case of heterotopic bone formation around a total temporomandibular joint prosthesis, which occurred several years after the implant.

Methods: The present manuscript describes a case of heterotopic bone formation around a total TMJ prosthesis, which occurred several years after the implant in patients, who previously underwent multiple failed TMJ surgeries.

Results: Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening. A computerized tomography showed evidence of marked heterotopic bone formation in the medial aspects of the joint, where a new-born ankylotic block occupied most part of the gap created by resecting the coronoid process at the time of the TMJ prosthesis insertion.

Conclusions: Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement. It can be suggested that an accurate assessment of pre-operative risk factors for re-ankylosis (e.g., patients with multiple failed temporomandibular joint surgeries) and within-intervention prevention (e.g., strategies to keep the bone interfaces around the implant separated) should be better standardized and define in future studies.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph showing aggressive excision of the fibrous and/or bony mass.
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fig2: Intraoperative photograph showing aggressive excision of the fibrous and/or bony mass.

Mentions: Two surgical phases characterized the intervention, viz., the removal of the ankylotic block and the positioning of the TMJ prosthesis. Thus, both preauricular access to the TMJ and temporal bone and a posteroinferior submandibular incision for access to the mandibular ramus were required. The superior incision has a 45o release into the temporal hairline, and the dissection is kept as posterior as possible to avoid the facial nerve. The inferior incision was almost vertical, viz., perpendicular to the lower two-thirds of the posterior border of the ramus). Once access to the TMJ was gained through the preauricular incision, the release of the ankylosis was performed (Figure 2). A 5 - 10 mm gap between the recountoured glenoid fossa and the mandible was created by removing the fibrous scar and heterotopic osseus tissue with surgical burs and chisels. Remodeling of the glenoid fossa and a full excision of the coronoid process were performed to fit and fix the fossa component of the prosthesis and to reduce the risk for re-ankylosis. The patient was then placed in the post-operatory intermaxillary relationship, which was secured with temporary wire fixation; condylectomy was then performed and the mandibular component of the prosthesis was placed and fixed.


Long-Term Symptoms Onset and Heterotopic Bone Formation around a Total Temporomandibular Joint Prosthesis: a Case Report.

Guarda-Nardini L, Manfredini D, Olivo M, Ferronato G - J Oral Maxillofac Res (2014)

Intraoperative photograph showing aggressive excision of the fibrous and/or bony mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4007372&req=5

fig2: Intraoperative photograph showing aggressive excision of the fibrous and/or bony mass.
Mentions: Two surgical phases characterized the intervention, viz., the removal of the ankylotic block and the positioning of the TMJ prosthesis. Thus, both preauricular access to the TMJ and temporal bone and a posteroinferior submandibular incision for access to the mandibular ramus were required. The superior incision has a 45o release into the temporal hairline, and the dissection is kept as posterior as possible to avoid the facial nerve. The inferior incision was almost vertical, viz., perpendicular to the lower two-thirds of the posterior border of the ramus). Once access to the TMJ was gained through the preauricular incision, the release of the ankylosis was performed (Figure 2). A 5 - 10 mm gap between the recountoured glenoid fossa and the mandible was created by removing the fibrous scar and heterotopic osseus tissue with surgical burs and chisels. Remodeling of the glenoid fossa and a full excision of the coronoid process were performed to fit and fix the fossa component of the prosthesis and to reduce the risk for re-ankylosis. The patient was then placed in the post-operatory intermaxillary relationship, which was secured with temporary wire fixation; condylectomy was then performed and the mandibular component of the prosthesis was placed and fixed.

Bottom Line: The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function.Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening.Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Maxillofacial Surgery, University of Padova Italy.

ABSTRACT

Background: The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, some adverse events, such as heterotopic bone formation around the implanted prosthesis, may occur. In consideration of that, the present manuscript describes a case of heterotopic bone formation around a total temporomandibular joint prosthesis, which occurred several years after the implant.

Methods: The present manuscript describes a case of heterotopic bone formation around a total TMJ prosthesis, which occurred several years after the implant in patients, who previously underwent multiple failed TMJ surgeries.

Results: Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening. A computerized tomography showed evidence of marked heterotopic bone formation in the medial aspects of the joint, where a new-born ankylotic block occupied most part of the gap created by resecting the coronoid process at the time of the TMJ prosthesis insertion.

Conclusions: Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement. It can be suggested that an accurate assessment of pre-operative risk factors for re-ankylosis (e.g., patients with multiple failed temporomandibular joint surgeries) and within-intervention prevention (e.g., strategies to keep the bone interfaces around the implant separated) should be better standardized and define in future studies.

No MeSH data available.


Related in: MedlinePlus