Oral and Maxillofacial Surgery Unit/ Clinical Hospital of Porto Alegre (HCPA), School of Dentistry/Federal University of Rio Grande Do Sul (UFRGS), Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
Head Face Med. 2022 Jul 29;18(1):27. doi: 10.1186/s13005-022-00331-4.
There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up.
In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components.
The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis.
颞下颌关节（TMJ）的部分或全部置换有多种适应证，包括肿瘤和严重的骨质吸收。在这方面，已经提出了几种技术来提高这些假体的功能和寿命。本病例报告描述了使用 Puricelli 双凸面关节成形术（ABiP）技术治疗 TMJ 强直患者的情况，并进行了长期随访。
1978 年，一名 33 岁的男性多发创伤患者出现右侧耳前区域疼痛症状，并伴有同侧 TMJ 运动受限。由于髁突下骨折，应用了弹性上下颌骨固定器（EMMI）。随后，当确认患者的最大开口度（10mm）受限和存在触诊时加重的自发性疼痛时，将其转来治疗。影像学检查证实了骨折，存在前内侧移位和关节的骨性强直。建议切除受损组织并用 ABiP 置换。该方法采用保守入路（即耳前切口），对强直块进行部分切除，并使用两个聚甲基丙烯酸甲酯（PMMA）组件进行组织置换，凸面之间的接触最小且稳定。手术结束时，测试了关节稳定性和牙齿咬合。患者在术后 6 个月的随访中表现出显著改善，无疼痛且开口度增加（30mm）。在 43 年的随访中，未报告关节弹响、疼痛或运动受限（开口度 36mm）。影像学检查未显示组织退化，并显示了假体组件的完整性。
本病例报告表明，ABiP 能够使 TMJ 运动，在超过 40 年的随访中缓解症状和体征。这些数据表明，对于成人强直患者，如果需要 TMJ 重建，该技术是一种简单有效的替代方法。
