Endovascular preoperative embolization for temporomandibular joint replacement surgery

Area of Science:

• Interventional Radiology
• Oral and Maxillofacial Surgery
• Orthopedic Surgery

Background:

• Temporomandibular joint (TMJ) replacement surgery can involve significant blood loss, particularly in complex cases.
• Preoperative embolization is a technique used to reduce vascularity before surgical procedures.

Purpose of the Study:

• To evaluate the safety and effectiveness of preoperative endovascular embolization of the internal maxillary artery (IMAX).
• To assess the impact of embolization on blood loss during TMJ replacement surgery.

Main Methods:

• Retrospective study of patients undergoing TMJ replacement surgery with preoperative IMAX embolization (June 2016 - January 2019).
• Data collected on periprocedural adverse events, surgical blood loss, and clinical follow-up.
• Standardized surgical approaches and prosthetic joints (TMJ Concepts) were used.

Main Results:

• Fourteen patients received 21 embolizations of the IMAX prior to TMJ replacement.
• Mean blood loss during surgery was approximately 370 cc, reported as significantly decreased compared to non-embolized patients.
• No intra-procedural complications; three patients experienced trigeminal nerve paresthesia and two had mild facial nerve weakness post-surgery.

Conclusions:

• Preoperative endovascular embolization of the IMAX is a feasible and safe adjunct for complex TMJ replacement.
• The procedure is likely effective in reducing intraoperative blood loss, potentially improving surgical management.