Total alloplastik temporomandibular eklem protezi etrafında gelişen heterotopik ossifikasyonun tedavisi: olgu bildirimi
Tanıtım: Temporomandibular eklem (TME) ankilozu durumlarında uygulanan total eklem protezi replasmanı erken dönemde fonksiyonu geliştirir ve reankiloz olasılığı oldukça azdır. Ancak nadiren TME protezi etrafında gelişen heterotopik kemik formasyonuna bağlı reankiloz meydana gelebilir. Bu durumda kemik kitlesi rezeke edilir ve protez yeniden uygun pozisyonda yerleştirilir. Ankiloz cerrahisi sonrasında artiküler yüzeylere yağ grefti uygulanmasının fonksiyonu geliştirdiği ve reankiloz olasılığını azalttığı belirtilmektedir.Olgu Bildirimi: Daha önce sol TME ankilozu nedeniyle total alloplastik TME protezi uygulanan hasta, ağız açıklığında kısıtlılık ve ağrı şikayetiyle kliniğimize başvurdu. Yapılan klinik ve radyolojik değerlendirme neticesinde TME protezi etrafında heterotopik kemik formasyonu geliştiği gözlendi. Genel anestezi altında preaurikular yaklaşım ile TME protezi açığa çıkarıldı. Temporomandibular eklem protezi atravmatik olarak uzaklaştırıldı ve heteretopik kemik kitlesi rezeke edildi. Ardından TME protezi uygun pozisyonda yerleştirildi ve artiküler yüzeylere otojen yağ grefti uygulandı. İki yıllık takipte herhangi bir reankiloz bulgusuna rastlanmadı. Sonuç: Reankiloz gelişen vakalarda kemik kitlesinin rezeksiyonunun ardından uygulanan interpozisyonel otojen yağ grefti rekürrens olasılığını azaltır ve çene fonksiyonlarını geliştirir.
Anahtar Kelimeler:
Ankiloz, heterotopik ossifikasyon, temporomandibular eklem
Treatment of heterotopic ossification developing around total alloplastic temporomandibular joint prosthesis: case report
Introduction: Total joint replacement applied in temporomandibular joint (TMJ) ankylosis improves function in the early period and significantly reduces the likelihood of reankylosis. However, reankylosis may rarely occur due to heterotopic bone formation around the TMJ prosthesis. In this situation, the bone mass is resected and the prosthesis is repositioned in the proper position. It has been reported in previous studies that the application of fat graft to the articular surfaces after the ankylosis surgery improves functionality and reduces the likelihood of reankylosis. Case Report: A patient with total alloplastic TMJ prosthesis that had been applied due to ankylosis of the left TMJ was admitted to our clinic with complaints of pain and limitation in mouth opening. Heterotopic bone formation around the TMJ prosthesis was observed through clinical and radiological examinations. Under general anesthesia, the TMJ prosthesis was exposed via preauricular approach. The TMJ prosthesis was removed atraumatically and the heterotopic bone mass was resected. The TMJ prosthesis was then placed in the appropriate position and autogenous fat graft was applied to the articular surfaces. No signs of reankylosis were observed during a two-year follow-up. Conclusion: Autologous interpositional fat graft applied after the resection of the bone mass in cases which develop reankylosis reduces the likelihood of recurrence, and improves jaw functions.
Keywords:
Ankylosis, heterotopic ossification, temporomandibular joint,
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- Yayın Aralığı: Yılda 3 Sayı
- Başlangıç: 1984
- Yayıncı: Gazi Üniversitesi Diş Hekimliği Fakültesi Dergisi