Yazan J Alderazi1, Darshan Shastri2, John Wessel3, Melvin Mathew2, Tareq Kass-Hout4, Shahid R Aziz3, Charles J Prestigiacomo2, Chirag D Gandhi2. 1. Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Division of Neurointerventional Surgery, Department of Neurology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA. Electronic address: yazanalderazi@yahoo.com. 2. Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA. 3. Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, New Jersey, USA. 4. Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Surgery, Rochester Regional Health System, Rochester, New York, USA.
Abstract
BACKGROUND: Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery. METHODS: Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery. RESULTS: Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics. CONCLUSIONS: Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss.
BACKGROUND:Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery. METHODS: Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery. RESULTS: Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics. CONCLUSIONS: Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss.