Autologous Fat Grafts Placed Around Temporomandibular Joint Total Joint Prostheses to Prevent Heterotopic Bone Formation

Abstract

This study evaluated 1) the efficacy of packing autologous fat grafts around temporomandibular joint (TMJ) total joint prosthetic reconstructions to prevent fibrosis and heterotopic bone formation and 2) the effects on postsurgical joint mobility and jaw function. One hundred fifteen patients (5 males and 110 females) underwent TMJ reconstruction with total joint prostheses and simultaneous fat grafts (88 bilateral and 27 unilateral) for a total of 203 joints. The abdominal fat grafts were packed around the articulating portion of the joint prostheses after the fossa and mandibular components were stabilized. Patients were divided into two groups: group 1 (n = 76 joints) received Christensen total joint prostheses, and group 2 (n = 127 joints) received TMJ Concepts total joint prostheses. Clinical and radiographic assessments were performed before surgery, immediately after surgery, and at long-term follow-up. In group 1, maximal incisal opening (MIO) increased 3.5 mm, lateral excursions (LE) decreased 0.2 mm, and jaw function improved 1.9 levels. In group 2, MIO increased 6.8 mm, LE decreased 1.4 mm, and jaw function improved 2.4 levels. The improvement for MIO and patient perception of jaw function in both groups was statistically significant; no significant difference was found for LE. There was no radiographic or clinical evidence of heterotopic calcifications or limitation of mobility secondary to fibrosis in either group. Twenty-five Christensen prostheses (33%) were removed because of device failure and/or metal hypersensitivity; no fibrosis or heterotopic bone formation was seen at surgical removal. Four TMJ Concepts prostheses (3%) were removed because of metal hypersensitivity. In all instances, removal of the prostheses was unrelated to the autologous fat grafting. Ten patients (8.7%) developed complications involving the fat donor site: two patients (1.8%) developed abdominal cysts requiring surgery, and eight patients (6.9%) developed seroma formation requiring aspiration. Autologous fat transplantation is a useful adjunct to prosthetic TMJ reconstruction to minimize the occurrence of excessive joint fibrosis and heterotopic calcification, consequently providing improved range of motion and jaw function.

Treatment of Temporomandibular Joint (TMJ) Reankylosis with Preservation of the TMJ Prosthesis and Use of Fat Graft: A Case Report and Review of the Literature

“…It has also been reported that replacement of the affected TMJ prosthesis with packing of autologous fat around the joint components reduces the risk of re-ankylosis by reducing dead-space available for hematoma formation and subsequent ossification [28] [29] [30]. Fat not only fills the dead space around the TMJR articulating components but also has a haemostatic effect on the surrounding tissues [20].…”

Efficacy of abdominal dermis fat graft as the interpositional material in the management of Temporomandibular joint ankylosis in children- an original study

“…Viable condition of fat tissues even after years at the joint region are studied and proved by many authors. [6,7,14,16,17] The surgeons who used the dermal fat graft as the interposition material for the management of TMJ ankylosis uniformly claimed the minimal fibrosis action and hetarotopic calcification prevention [8,14] as the advantages of using dermis fat graft. Some authors also practiced with the buccal pad fat [15,16] as the interposition material and uniformly claimed the material, buccal pad fat, was taking appreciable part in the prevention of reankylosis .…”

“…They have stated that the intermittent compressive forces of the joint may act as a negative influence on the growth and also explained the fat tissues are maintained within the joint space itself. Larry M Wolford et al in 2008, [8] in their study of fixing prosthesis in the joint space have not encountered any fibrosis or bone formation. Mehothra et al in 2008 [9] randomly divided 17 patients in to 2 groups, the first group was treated with dermis fat graft procured from the groin where as the controlled group treated with temporalis fascia.…”

Alloplastic or autogenous reconstruction of the TMJ

“…Wolford has described a reduction in frequency of recurrence when an alloplastic reconstruction is used in conjunction with abdominal free fat packed around the prosthesis. 20 Once recurrence has occurred with an autogenous reconstruction the host bed is so poorly vascularised that only a vascularised graft or alloplast should be used.…”