Ângelo David Faustino, Maffia Francesco, Teschke Marcus, Sanz David, Galrito Marta, Cardoso Henrique, Marques Rute, Nabuco Carlos
Instituto Português da Face, 1050-227 Lisbon, Portugal.
Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal.
J Clin Med. 2023 Oct 19;12(20):6612. doi: 10.3390/jcm12206612.
Custom-made alloplastic temporomandibular joint replacement (ATMJR) is not validated in irradiated patients. However, in specific situations, after previous reconstructive surgical failures, the authors hypothesized the role of a customized ATMJR after radiotherapy.
A 65-year-old male patient was referred to Instituto Português da Face-Lisbon, Portugal-after failed attempts of mandibular reconstruction secondary to oral carcinoma resection and partial hemi-mandibulectomy plus radiotherapy of 60 total Grays. Primary reconstruction was performed with fibula free flap. Due to failure, secondary reconstructions were performed with osteosynthesis plate without success. The patient was unable to have adequate mastication and deglutition due to a severe crossbite. The authors treated the patient with an extended customized alloplastic temporomandibular joint replacement (F0M2).
With 3 years of follow-up, the patient showed an improvement in masticatory function, mandibular motion, pain levels, and overall quality of life. No complications were observed related to ATMJR.
The presented case described how ATMJR, although not a validated option after radiotherapy, can be considered to restore functionality in complex cases with bone and soft tissues problems.
定制的全塑料颞下颌关节置换术（ATMJR）在接受过放射治疗的患者中尚未得到验证。然而，在特定情况下，既往重建手术失败后，作者推测放射治疗后定制ATMJR的作用。
一名65岁男性患者被转诊至葡萄牙里斯本葡萄牙面部研究所，此前因口腔癌切除、部分半侧下颌骨切除术及总计60格雷的放射治疗后下颌骨重建失败。初次重建采用游离腓骨瓣。由于失败，二次重建采用接骨板但未成功。由于严重的反咬合，患者无法进行充分的咀嚼和吞咽。作者用定制的延长型全塑料颞下颌关节置换术（F0M2）治疗该患者。
经过3年随访，患者的咀嚼功能、下颌运动、疼痛程度和整体生活质量均有改善。未观察到与ATMJR相关的并发症。
本病例描述了尽管ATMJR在放射治疗后不是一个经过验证的选择，但在伴有骨和软组织问题的复杂病例中可考虑用于恢复功能。
