Considerations for the Use of Alloplastic Temporomandibular Joint Replacement in Irradiated Patients: Report of an Off-Label Indication

Author:

Ângelo David Faustino123,Maffia Francesco14ORCID,Teschke Marcus5,Sanz David1,Galrito Marta1,Cardoso Henrique1ORCID,Marques Rute1,Nabuco Carlos1

Affiliation:

1. Instituto Português da Face, 1050-227 Lisbon, Portugal

2. Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal

3. Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal

4. Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy

5. Independent Researcher, 28195 Bremen, Germany

Abstract

Background: 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. Methods: 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). Results: 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. Conclusions: 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.

Publisher

MDPI AG

Subject

General Medicine

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3. Mandibular reconstruction;Kakarala;Oral Oncol.,2018

4. Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap;Parise;Oral Maxillofac. Surg.,2018

5. Multiple Remediation of Soft Tissue Reconstruction in Osteoradionecrosis of the Mandible: A Case Report;Etezadi;J. Oral Maxillofac. Surg.,2013

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