scholarly journals Tissue Engineered Vascularized Patient-Specific Temporomandibular Joint Reconstruction in a Yucatan Pig Model

2020 ◽  
Author(s):  
Shelly Abramowicz ◽  
Sarah Jo Crotts ◽  
Scott J. Hollister ◽  
Steve Goudy
Keyword(s):  
Temporomandibular Joint ◽  
Porcine Model ◽  
Superficial Temporal Artery ◽  
Mandibular Condyle ◽  
Temporal Artery ◽  
Patient Specific ◽  
Temporalis Muscle ◽  
Control Side ◽  
Titanium Screws ◽  
3D Printed

ABSTRACTPurposePediatric temporomandibular joint (TMJ) reconstruction occurs as a result of acquired, developmental, and/or congenital conditions. Current pediatric reconstruction options are limited. The aim of this project was to develop a proof of principle porcine model for a load bearing, customized 3-dimensional (3D) printed and BMP2-coated scaffold implanted in a pedicled (temporal) flap as a regenerative approach to pediatric TMJ mandibular condyle reconstruction.Materials and MethodsScaffolds were custom designed and 3D printed based on porcine computed tomography and absorbed with BMP2. Two operations occured: (1) implantation of scaffold in temporalis muscle to establish vascularity, and six weeks later, (2) unilateral condylectomy and rotation of the vascularized scaffold (with preservation of superficial temporal artery) onto mandibular ramus defect and secured with titanium screws. At 6 months post-implantation, the pigs were sacrified. The experimental side (muscle-scaffold) and the control side (unoperated condyle) were individually harvested at 6 months and evaluated by clinical, mechanical, radiographic, and qualitative/histologic methods.ResultsScaffolds maintained physical properties similar in appearance to unoperated condyles. The vascularized scaffolds had bone formation at edges and adjacent to scaffold-bone interface. New bone was visible in scaffold. Condyle height on the reconstructed side was 68% and 78% of the control side. Reconstructed condyle stiffness was between 20% and 45% of the control side.ConclusionIn our porcine model, customized 3D printed TMJ scaffolds impregnanted with BMP2 and implanted in and pedicled on temporalis muscle has the ability to (1) reconstruct a TMJ defect model, (2) maintain appropriate condylar height and upper airway diameter, and (3) generate new bone, without impacting functional outcomes.

scholarly journals Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits

2008 ◽  
Vol 41 (02) ◽  
pp. 110-115
Author(s):  
Mukund Jagannathan ◽  
Maksud Devale ◽  
Prashantha Kesari ◽  
Siddharth Karanth
Keyword(s):  
Temporomandibular Joint ◽  
Articular Surface ◽  
Superficial Temporal Artery ◽  
Mouth Opening ◽  
Temporal Artery ◽  
Long Term Results ◽  
Success Rates ◽  
Tmj Ankylosis ◽  
Potential Applicability ◽  
Bony Segment

ABSTRACT Context: Surgery for the release of temporomandibular joint (TMJ) ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw. Aims: We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint. Settings and Design: There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA), which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint. Materials and Methods: Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid. Results: The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained. Conclusions: The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.

Novel Myocutaneous Hemicraniectomy Flap: Technical Note and Cadaveric Dissection Using the “Feng-Huang Technique”

2021 ◽  
Author(s):  
Xiaochun Zhao ◽  
Dongxia Feng ◽  
Jason Huang ◽  
Yilu Zhang ◽  
Ian F. Dunn
Keyword(s):  
Present Note ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Middle Fossa ◽  
Temporalis Muscle ◽  
Novel Technique ◽  
Common Technique ◽  
Key Steps ◽  
Technical Illustration

Abstract Background: The hemicraniectomy is a common technique used in a variety of pathologies including some traumatic brain injury and malignant stroke. A novel technique of performing hemicraniectomies using a retro-auricular incision can avoid transgressing the temporalis muscle and superficial temporal artery while providing adequate hemicranial exposure. Method: This technique was reproduced in a skull base lab using a cadaveric head. The key steps of this approach were illustrated in step-by-step fashion. A post-approach CT scan of the cadaver was performed to evaluate the decompression exposure. Results: This approach is able to provide sufficient middle fossa decompression and area of exposure, while preserving the temporalis along with the superficial temporal artery. Conclusions: The altered retro-auricular flap (the “Feng-Huang” flap) is a novel technique for hemicraniectomy which can provide sufficient middle fossa decompression and exposure while sparing the temporalis muscle and superficial temporal artery during the approach. A step-by-step technical illustration is demonstrated in the present note.

scholarly journals Superficial Temporal Artery Fistula Secondary to Temporomandibular Joint Arthroscopy

2021 ◽  
Vol 6 ◽  
pp. 247275122110131
Author(s):  
Jose Saucedo ◽  
Mougnyan Cox ◽  
Eric Granquist ◽  
Bryan Pukenas ◽  
Robert Hurst ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Arteriovenous Fistula ◽  
Temporomandibular Joint ◽  
Coil Embolization ◽  
Superficial Temporal Artery ◽  
Invasive Procedure ◽  
Temporal Artery ◽  
Fistula Formation ◽  
Minimally Invasive Procedure

Temporomandibular joint (TMJ) arthroscopy is considered a safe, minimally invasive procedure for the treatment of certain TMJ derangements. However, as TMJ arthroscopy is being popularized, more complications are being reported. Though exceedingly rare, arteriovenous fistula (AVF) can occur. We describe a case of superficial temporal artery (STA) fistula formation successfully treated with coil embolization.

scholarly journals Temporomandibular Joint (TMJ) Ankylosis Resection to Total Joint replacement – 30 Years Journey

2021 ◽  
Vol 33 (2) ◽  
Keyword(s):  
Temporomandibular Joint ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Articular Surface ◽  
Mandibular Condyle ◽  
Mouth Opening ◽  
Patient Specific ◽  
Mandibular Fractures ◽  
Tmj Ankylosis ◽  
Condyle Fracture

Temporomandibular joint (TMJ) ankylosis is an intracapsular union of the disc–condyle complex to the temporal articular surface that confines the mandibular drive, including the fibrous adhesions/ bony fusion between condyle, disc, glenoid fossa, and eminence. It is a severe and incapacitating ailment that can cause mastication, digestion, speech, appearance, and hygiene concerns. This is an unusual case of a 42-year-old adult patient, who suffered from bilateral recurrent TMJ ankylosis and reported following trauma to the face. The patient had a history of mandibular condyle fracture at ten years of age. Excision of existing ankylotic mass followed by reconstruction with patient-specific total joint replacement (TJR) was carried out. Postoperative physiotherapy exercises in the presented case improved patient’s mouth opening, and mandibular movement. Patient-specific TJR procedures and postoperative physiotherapy will be helpful in cases with TMJ ankylosis. Keywords: Genioplasty; Mandibular Condyle; Mandibular fractures; Temporomandibular Ankylosis; Temporomandibular Joint

scholarly journals Ankylosis of the temporomandibular joint—impression free CAD/CAM based joint replacement using patient-specific implants

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
D G E Thiem ◽  
B Al-Nawas ◽  
P W Kämmerer
Keyword(s):  
Temporomandibular Joint ◽  
Computer Aided Design ◽  
Mouth Opening ◽  
Patient Specific ◽  
Patient Specific Implants ◽  
Computer Aided ◽  
Cad Cam ◽  
3D Printed ◽  
Aided Design

Abstract In recent years, alloplastic temporomandibular joint (TMJ) replacement has become a permissible procedure for the reconstruction of severely destroyed TMJs. The use of computer-aided design/computer-aided manufacturing (CAD/CAM) has extended the range of applications to complex anatomical situations. The aim of the treatment is to improve the usually restricted mouth opening and thus oral hygiene and nutrition, which leads to a regular improvement in the general quality of life. The following case report describes the bilateral replacement of ankylotically destroyed TMJs using patient-specific endoprostheses with simultaneous displacement of the maxilla. Innovative in the case described is the impression-free CAD/CAM planning, whereby the upper and lower prostheses were produced on the basis of 3D printed patient models.

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