Human Amniotic Membrane Positioning in the Surgical Treatment of Temporomandibular Joint Degenerative Disorder

Abstract

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.

Human amniotic membrane: an improvement in the treatment of Medication-related osteonecrosis of the jaw (MRONJ)? A case–control study

“…(Kesting et al 2014) This feature makes HAM suitable in oral and maxillofacial surgery, where it has been used since 1969 for the management of mucous defects after resection of malignant or precancerous lesions, due to the closure of oro-antral communication, for guided bone regeneration, post-traumatic orbital surgery and temporomandibular joint surgery. (Guarda-Nardini et al 2019;Kesting et al 2014) The present work carries on what had already been proposed in a case report (Ragazzo et al 2018) of the Authors of this paper. Because the main pharmacologic effect of BP is inhibition of osteoclasts and of bone vascularization, HAM was expected to stimulate both soft tissue healing and bone remodeling, thus contributing to the successful treatment of MRONJ.…”

Temporomandibular Joint Discectomy Followed by Disc Replacement Using Viable Osteochondral and Umbilical Cord Allografts Results in Improved Patient Outcomes

“…44 The most recent case report described the implantation of a cryopreserved amniotic patch as a disc-replacing graft after TMJ discectomy in a 48-year-old woman with TMJ DD. 15 At 3 months postoperatively, she had reported no pain and overall improvement. The investigators concluded that the results were encouraging and that the use of the placental tissue should be considered in the treatment of TMJ disease.…”

“…The investigators concluded that the results were encouraging and that the use of the placental tissue should be considered in the treatment of TMJ disease. 15 Overall, the number of studies using interpositional tissue grafts for TMJ reconstructive procedures has been low. The high heterogenicity in patient populations, types of grafts used, and surgical techniques have made it difficult to draw comparisons among the reported studies.…”

“…8,9 Human placental tissue, in particular, the amniotic membrane, has been used in surgical procedures, including for treatment of the TMJ. [10][11][12][13][14][15] The low immunogenicity and anti-inflammatory, antifibrotic, and antibacterial properties of placental tissue have made it an attractive choice for biological grafts. [16][17][18][19][20] An analysis of the structure and properties of the various allografts currently available on the market resulted in the identification of a cryopreserved viable osteochondral allograft (CVOCA) and a viable cryopreserved umbilical cord tissue (vCUT) allograft as optimal candidates to use as interpositional grafts.…”

Histopathology of the temporomandibular joint disc: Findings in 30 samples from joints with degenerative disease

“…Human amniotic membrane (HAM) was positioned between the bone surfaces to replace the extracted disc. 26 , 27 , 28 The discs were stored in formalin (4% formaldehyde) and sent to the pathological anatomy department for histological analysis. The samples were cut into 3 micron‐thick sections from the formalin‐preserved, paraffin‐embedded tissues.…”