Protocol for the treatment of heterotopic bone formation in the temporomandibular joint

The increase in patients with multiply operated temporomandibular joints (TMJs) has led to an increase in associated complications that respond unfavorably to additional attempts at correction. These can present as ankylosis and/or heterotopic bone formation. This has been recognized in other joint reconstruction, to a much more significant degree, and related to decreased vascularity, increased fibrosis and scarring, and decreased cellularity of the tissue in the joint space following multiple surgical procedures. Attempted correction of this problem can often lead to an increase in the etiology and to recurrence of the bone formation in spite of its debridement. Correction in other joints has evolved to include the use of thorough debridement of the heterotopic bone, alloplastic joint reconstruction, autologous fat grafting, and use of NSAIDs and low-dose radiatíon to decreaserecurrence.