Internal Maxillary Artery Preoperative Embolization Using n-Butyl Cyanoacrylate and Pushable Coils for Temporomandibular Joint Ankylosis Surgery.
BACKGROUND
Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery.


METHODS
Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery.


RESULTS
Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics.


CONCLUSIONS
Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss.
Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Division of Neurointerventional Surgery, Department of Neurology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA. Electronic address: yazanalderazi@yahoo.com.
Yazan J
YJ
Alderazi
Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
Darshan
D
Shastri
Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, New Jersey, USA.
John
J
Wessel
Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
Melvin
M
Mathew
Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Surgery, Rochester Regional Health System, Rochester, New York, USA.
Tareq
T
Kass-Hout
Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, New Jersey, USA.
Shahid R
SR
Aziz
Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
Charles J
CJ
Prestigiacomo
Division of Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
Chirag D
CD
Gandhi
D000328:Adult; D000844:Ankylosis / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008438:Maxillary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging / Q000628:therapy*
D004659:Enbucrilate
Embolization; Internal maxillary artery; Preoperative embolization; Temporomandibular joint ankylosis; Temporomandibular joint surgery