Background. Temporomandibular joint (TMJ) arthritis is a degenerative pathology that may cause pain and dysfunction. Nonsurgical therapy is the traditional treatment of TMJ diseases but if ineffective, TMJ surgery can be performed and may include arthroplasty with interposition of autograft. The encouraging results reported with the use of human amniotic membrane (HAM) in different surgical fields have highlighted its potential, but approaches providing the positioning of HAM within the intra-articular space of arthritic TMJs have never been investigated. Case Presentation. A 48-year-old woman was presented with limited mouth opening and pain with palpation at the left joint. A severe TMJ degeneration was diagnosed, and a surgical treatment was necessary. In the present case report, the authors describe the application of a cryopreserved HAM patch within the joint space as a disc-replacing film during major surgeries for discectomy and arthroplasty. Three months after the intervention, the patient reported an overall improvement in chewing efficiency as well as the absence of pain. Conclusions. According to the regenerative effects of HAM, the design of trials on the topic should be encouraged for its possible inclusion within the field of TMJ disease practice.
BackgroundThe 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.MethodsThe 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.ResultsTen 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.ConclusionsDespite
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.
Temporomandibular disorders (TMD) are a heterogeneous group of pathologies affecting the temporomandibular joint (TMJ) and/or the masticator muscles, characterized by a molteplicity of signs and symptoms, the most common of which are pain localized in the preauricular area and/or in the masticatory muscles; jaw motion abnormalities; articular sounds, such as click and/or crepitus, during mandibular movements (1). A specific etiolpathogenesis is detectable in a minority of cases, since the occurrence of TMD symptoms is often..
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