Santillan Alejandro, Hee Sur Min, Schwarz Justin, Easthausen Imaani, Behrman David A, Patsalides Athos
Department of Neurological Surgery, Division of Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
Department of Oral and Maxillofacial Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
Interv Neuroradiol. 2020 Feb;26(1):99-104. doi: 10.1177/1591019919880426. Epub 2019 Oct 9.
This retrospective study evaluates the safety and effectiveness of preoperative endovascular embolization in patients who underwent temporomandibular joint (TMJ) replacement surgery.
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.
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.
Endovascular preoperative embolization of the IMAX is feasible, safe and likely effective in reducing blood volume loss in complex TMJ replacement surgery.
本回顾性研究评估术前血管内栓塞术在接受颞下颌关节（TMJ）置换手术患者中的安全性和有效性。
纳入2016年6月至2019年1月期间接受上颌内动脉（IMAX）术前栓塞治疗的所有患者。所有患者均由同一位外科医生采用标准手术方法和步骤进行治疗。报告围手术期不良事件、手术期间失血情况及临床随访结果。
14例患者（12例女性，中位年龄32.5岁）在TMJ置换手术（使用TMJ Concepts假体）前接受了21次IMAX栓塞（7例患者为双侧栓塞）。7例患者表现为TMJ强直/退行性关节病/创伤后畸形，4例患者患有特发性髁突吸收并导致下颌移位/发育不全，2例患者患有类风湿关节炎相关的髁突退变并导致下颌位置丧失，1例患者在假体关节感染治疗后进行再次重建。7例患者接受双侧假体关节置换。4例患者在治疗过程中接受了额外的面部骨骼手术。TMJ手术期间的平均失血量约为370 cc（范围100 - 800 cc）。未记录关节间隙特异性失血量，但据手术团队称，与未栓塞患者相比，失血量显著减少。术中无并发症。中位临床随访时间为3.5个月（范围1 - 24个月）。所有患者术前及最后一次临床随访时改良Rankin量表（mRS）均为0。TMJ手术后，3例患者报告三叉神经感觉异常可能与残留髁突切除有关，2例患者因手术暴露出现轻度面神经麻痹（颞支和/或下颌缘支）。
IMAX术前血管内栓塞术在复杂TMJ置换手术中减少失血量方面是可行、安全且可能有效的。
