Location
Philadelphia, PA
Start Date
9-5-2018 1:00 PM
Description
Introduction: Temporomandibular joint (TMJ) ankylosis is an often-disfiguring pathology causing significant reduction in mandibular mobility leading to disability in mastication, digestion, speech, and oral hygiene. Caused by trauma, radiation, infection, and iatrogenic injury, TMJ ankylosis requires complete excision of the ankylosing mass following by arthroplasty. Substantial hemorrhage during this procedure, up to 3.7L, resulting from injury to the internal maxillary artery (IMA) as it courses around the ankylosing mass may occur. There are few data to recommend pre-operative IMA embolization, though a case series describing two patients who underwent the procedure describes significant decrease in intra-operative blood loss. Our aim is to interrogate the efficacy and safety of pre-operative bilateral IMAX embolization in TMJ replacement.
Methods: Two patients from October 2016 to April 2017 underwent cerebral angiogram with pre-operative selective embolization of bilateral internal maxillary arteries immediately deep to the ankylosing mass with platinum micro-coils. After embolization, both patients were taken for bilateral temporomandibular joint replacements with arthroplasty of the temporomandibular joints, glenoid fossa and zygomatic arches. Blood loss during each procedure was documented and compared to blood loss from the same surgeon’s previous similar procedures. Patients 1 and 2 were followed up for 6 months and 1 year, respectively and outcomes compared to similar patients who did not undergo embolization.
Results: Bilateral selective internal maxillary artery embolization was successful in decreasing intraoperative blood loss in both patients. Each patient sustained 200cc of estimated blood loss during subsequent temporomandibular joint reconstruction compared to patients not undergoing embolization. At 6 months and 1 year, patients had significant improvement in their maximal incisural opening and functional status with no evidence of necrosis or wound break down.
Conclusions: In our cases, after embolization, both patients had successful TMJ reconstruction with 200cc blood loss, compared to the reported possibility of hemorrhage resulting in up to 3.7L of estimated blood loss. Upon follow up at 6 months and 1 year, neither patient had evidence of tissue necrosis or wound break down. Based on these observations, pre-operative embolization has shown to be a safe and effective procedure for minimizing hemorrhage during TMJ reconstruction.
Embargo Period
5-31-2018
A Case Series: Pre-Operative Internal Maxillary Artery Embolization Before Temporomandibular Joint Reconstruction
Philadelphia, PA
Introduction: Temporomandibular joint (TMJ) ankylosis is an often-disfiguring pathology causing significant reduction in mandibular mobility leading to disability in mastication, digestion, speech, and oral hygiene. Caused by trauma, radiation, infection, and iatrogenic injury, TMJ ankylosis requires complete excision of the ankylosing mass following by arthroplasty. Substantial hemorrhage during this procedure, up to 3.7L, resulting from injury to the internal maxillary artery (IMA) as it courses around the ankylosing mass may occur. There are few data to recommend pre-operative IMA embolization, though a case series describing two patients who underwent the procedure describes significant decrease in intra-operative blood loss. Our aim is to interrogate the efficacy and safety of pre-operative bilateral IMAX embolization in TMJ replacement.
Methods: Two patients from October 2016 to April 2017 underwent cerebral angiogram with pre-operative selective embolization of bilateral internal maxillary arteries immediately deep to the ankylosing mass with platinum micro-coils. After embolization, both patients were taken for bilateral temporomandibular joint replacements with arthroplasty of the temporomandibular joints, glenoid fossa and zygomatic arches. Blood loss during each procedure was documented and compared to blood loss from the same surgeon’s previous similar procedures. Patients 1 and 2 were followed up for 6 months and 1 year, respectively and outcomes compared to similar patients who did not undergo embolization.
Results: Bilateral selective internal maxillary artery embolization was successful in decreasing intraoperative blood loss in both patients. Each patient sustained 200cc of estimated blood loss during subsequent temporomandibular joint reconstruction compared to patients not undergoing embolization. At 6 months and 1 year, patients had significant improvement in their maximal incisural opening and functional status with no evidence of necrosis or wound break down.
Conclusions: In our cases, after embolization, both patients had successful TMJ reconstruction with 200cc blood loss, compared to the reported possibility of hemorrhage resulting in up to 3.7L of estimated blood loss. Upon follow up at 6 months and 1 year, neither patient had evidence of tissue necrosis or wound break down. Based on these observations, pre-operative embolization has shown to be a safe and effective procedure for minimizing hemorrhage during TMJ reconstruction.