title: Role of computed tomographic angiography in treatment of patients with temporomandibular joint ankylosis.
abstract: OBJECTIVE
  To evaluate the use of preoperative computed tomographic angiography (CTA) and selective embolization as an ancillary tool for the treatment of patients with temporomandibular joint (TMJ) ankylosis.
  
  
  METHODS
  The present study was a case series of subjects with bilateral TMJ ankylosis who had undergone preoperative CTA and surgical release with immediate reconstruction. The indications for CTA were either an intimate association between the vessels and the ankylotic mass on the facial computed tomography (CT) scan or a history of multiple previous TMJ operations. In cases in which intimate anatomic association was present between the branches of the maxillary artery and the ankylotic masses, preoperative selective embolization was performed. All subjects underwent a standard approach to ankylosis release with immediate reconstruction and were followed up for up to 6 months postoperatively. The demographic and operative variables were recorded for each subject.
  
  
  RESULTS
  Five subjects (mean age, 36.4 years; 3 females) with bilateral TMJ ankylosis underwent release and had undergone preoperative CTA for vascular assessment. Three subjects underwent preoperative embolization. The total operating time ranged from 5.9 to 10.3 hours. The intraoperative blood loss ranged from 150 to 3,750 mL. One patient who had undergone unilateral embolization required an intraoperative transfusion because of bleeding on the nonembolized side. No adverse cardiac, renal, or neurologic events developed secondary to the blood loss. In all 5 subjects, the preoperative maximal incisor opening was less than 15 mm, increased to more than 35 mm intraoperatively, and was 30 mm or more at 6 months or longer of follow-up.
  
  
  CONCLUSIONS
  In select cases, CTA can be a useful adjunct in the treatment of patients with TMJ ankylosis.
authors.affiliation: Currently, Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD; Formerly, Chief Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: ssusarl1@jhmi.edu.
authors.forename: Srinivas M
authors.initials: SM
authors.lastname: Susarla
authors.affiliation: Assistant Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Attending Oral and Maxillofacial Surgeon, Massachusetts General Hospital, Boston, MA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Peacock
authors.affiliation: Maxillofacial Surgeon, Department of Plastic Surgery, Santa Clara Medical Center, Santa Clara, CA.
authors.forename: W Bradford
authors.initials: WB
authors.lastname: Williams
authors.affiliation: Associate Professor of Radiology, Harvard Medical School, and Attending Radiologist, Department of Radiology, Division of Interventional Neuroradiology, Boston, MA.
authors.forename: James D
authors.initials: JD
authors.lastname: Rabinov
authors.affiliation: Clinical Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Attending Oral and Maxillofacial Surgeon, Massachusetts General Hospital, Boston, MA.
authors.forename: David A
authors.initials: DA
authors.lastname: Keith
authors.affiliation: Walter C. Guralnick Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Chairman, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Kaban
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods*; D000844:Ankylosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008335:Mandibular Condyle / Q000601:surgery; D008438:Maxillary Artery / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011300:Preoperative Care; D013704:Temporomandibular Joint / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed