Endovascular preoperative embolization for temporomandibular joint replacement surgery

Abstract

<jats:sec><jats:title>Background and purpose</jats:title><jats:p> This retrospective study evaluates the safety and effectiveness of preoperative endovascular embolization in patients who underwent temporomandibular joint (TMJ) replacement surgery. </jats:p></jats:sec><jats:sec><jats:title>Material and methods</jats:title><jats:p> We included all patients treated with preoperative embolization of the internal maxillary artery (IMAX) between June 2016 and January 2019. All patients were treated by the same surgeon using standard surgical approaches and procedures. Periprocedural adverse events, blood loss during surgery and clinical follow-up are reported. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Fourteen patients (12 females, median age 32.5) were treated with 21 embolizations of the IMAX (bilateral embolizations in seven patients) prior to TMJ replacement surgery with prosthetic joints (TMJ Concepts prostheses). Seven patients presented with TMJ ankylosis/degenerative joint disease/post-trauma deformity, four patients with Idiopathic Condylar Resorption and resultant mandibular displacement/hypoplasia, two patients with rheumatoid arthritis-associated condylar degeneration and resultant loss of mandibular position, and 1 patient being re-reconstructed following management of a prosthetic joint infection. Seven patients underwent bilateral prosthetic joint replacement. Four patients underwent additional facial skeletal surgery as part of their treatment. The mean blood volume loss during TMJ surgery was approximately 370 cc (range 100–800 cc). Joint space-specific blood loss was not recorded, but, as per the surgical team, was significantly decreased when compared to non-embolized patients. There were no intra-procedural complications. The median clinical follow-up was 3.5 months (range 1–24 months). The modified Rankin scale (mRS) was 0 before the procedure and at last clinical follow-up in all patients. After TMJ surgery, three patients reported paresthesia of the trigeminal nerve likely related to the residual condyle resection and two patients had mild facial nerve weakness (Temporal and/or Marginal Mandibular branch) related to the surgical exposures. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Endovascular preoperative embolization of the IMAX is feasible, safe and likely effective in reducing blood volume loss in complex TMJ replacement surgery. </jats:p></jats:sec>

Preoperative Arterial Coil Embolization for Temporomandibular Joint (TMJ) Surgery in Children with TMJ Ankylosis

“…Prophylactic embolization to reduce the risk and degree of hemorrhage related to TMJ ankylosis surgical repair has been reported mostly in adults utilizing liquid agents or coil embolization. 16–18 TMJ ankylosis may require repeated surgical interventions, so the permanent nature of occluding the IMAX trunk by packed coils can be beneficial, as evidenced in our study where 3 patients (50%) underwent repeat surgical procedures without the need for blood product replacement.…”

“…Having a higher risk of non-target embolization to the orbit or brain by reflux or through collaterals. 18…”

“…Having a higher risk of non-target embolization to the orbit or brain by reflux or through collaterals. 18 Pediatric patients with craniofacial deformities are oftentimes significantly micrognathic, necessitating the need for mandibular DO. Mandibular DO can damage the glenoid fossa and disc which can lead to bony ankylosis and scarring.…”

Extended Complex Temporomandibular Joint Reconstructions Exploiting Virtual Surgical Planning, Navigation Assistance, and Custom-Made Prosthesis: A Comprehensive Protocol and Workflow

“…Moreover, patients that undergo TMJR are susceptible to potentially life-threatening vascular injury, most commonly of the IMAX. It is well established that preoperative embolization can reduce the risk of blood loss from inadvertent vascular injury and from surgical approach/dissection [ 11 ]. Cillo et al reported that in addition to IMAX, the MMA also may be injured during TMJR which involves extensive dissection, as in an eTMJR case [ 12 ].…”

Role of Magnetic Resonance Imaging in Temporomandibular Joint Ankylosis - An Evaluative Study

“…Autogenous tissues such as ear cartilage, temporalis muscle flap, dermis, fat, and bone, have been used after gap arthroplasty. [ 18 19 ]…”