Hassan Samir, Mercuri Louis G, Miloro Michael
Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL.
Visiting Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and Clinical Consultant, TMJ Concepts, Ventura, CA.
J Oral Maxillofac Surg. 2020 Jun;78(6):908-915. doi: 10.1016/j.joms.2020.01.020. Epub 2020 Jan 28.
Although concerns regarding implant-related metal hypersensitivity exist, no guidelines have been accepted for screening or treatment of patients with metal sensitivity before temporomandibular joint replacement (TMJR). The present study aimed to determine the trends in TMJR metal sensitivity screening and the effect of positive test results on patient treatment.
A questionnaire was distributed to members of the American Society of Temporomandibular Joint Surgeons and the European Society of Temporomandibular Joint Surgeons using a web-based data collection and analysis tool. The questions aimed to establish the screening methods used to establish a diagnosis of metal hypersensitivity and any changes in management when metal hypersensitivity had been documented.
A total of 72 responses (32.43%) were collected through the survey, with respondents primarily practicing in the United States (47.22%). Of the participants, 75% believed that metal hypersensitivity occurs with TMJR and only 2.77% did not. Most agreed that patients should be questioned about any metal sensitivities before consideration for TMJR (91.66%), and 80.55% routinely asked their patients if they had a previous sensitivity to any metals. Nickel was the most commonly encountered metal allergen (64.28%). If a metal allergy were reported, 44.28% of surgeons would refer the patient to determine the specific metal allergen. The diagnosis for metal allergy was based primarily on patient signs and symptoms (52.85%) and an allergist or dermatologist consultation (44.28%). The lymphocyte transformation test was the test most used by respondents to confirm the diagnosis. Of the surgeons, 41.42% would choose to observe/monitor as their first choice for patients testing positive for metal hypersensitivity. In the case of a "mild" reaction to metal hypersensitivity testing, 54.28% would alter their implant choice to a nonreactive metal component. For "severe" reactions to preoperative metal hypersensitivity testing, 62.85% would alter their implant choice to a nonreactive metal component, and 22.85% would choose not to perform TMJR.
The results from the present study have demonstrated that respondent TMJ surgeons agree that metal hypersensitivity occurs with TMJR. However, their approaches to screening and managing metal hypersensitivity vary. Further research of this topic is required to eventually develop specific management pre- and postoperative guidelines for the treatment of patients with metal sensitivities.
尽管存在与植入物相关的金属超敏反应问题，但对于颞下颌关节置换术（TMJR）前金属敏感性患者的筛查或治疗，尚无被认可的指南。本研究旨在确定TMJR金属敏感性筛查的趋势以及阳性检测结果对患者治疗的影响。
使用基于网络的数据收集和分析工具，向美国颞下颌关节外科医师协会和欧洲颞下颌关节外科医师协会的成员发放问卷。问题旨在确定用于诊断金属超敏反应的筛查方法以及记录到金属超敏反应时管理上的任何变化。
通过调查共收集到72份回复（32.43%），受访者主要在美国执业（47.22%）。在参与者中，75%认为TMJR会发生金属超敏反应，只有2.77%不这么认为。大多数人同意在考虑TMJR之前应询问患者是否有任何金属敏感性（91.66%），80.55%的人会常规询问患者是否曾对任何金属过敏。镍是最常遇到的金属过敏原（64.28%）。如果报告有金属过敏，44.28%的外科医生会将患者转诊以确定具体的金属过敏原。金属过敏的诊断主要基于患者的体征和症状（52.85%）以及过敏专科医生或皮肤科医生的会诊（44.28%）。淋巴细胞转化试验是受访者最常用来确诊的检测方法。在外科医生中，41.42%会选择观察/监测作为对金属超敏反应检测呈阳性患者的首选处理方式。对于金属超敏反应检测出现“轻度”反应的情况，54.28%会将植入物选择改为无反应性的金属部件。对于术前金属超敏反应检测出现“重度”反应的情况，62.85%会将植入物选择改为无反应性的金属部件，22.85%会选择不进行TMJR。
本研究结果表明，参与调查的颞下颌关节外科医生一致认为TMJR会发生金属超敏反应。然而，他们筛查和管理金属超敏反应的方法各不相同。需要对该主题进行进一步研究，以最终制定针对金属敏感性患者治疗的术前和术后具体管理指南。
