Recurrent giant cell reaction to residual Proplast in the temporomandibular joint

Exuberant foreign-body inflammatory reaction to polytetrafluoroethylene implants of the temporomandibular joint, marketed as Proplast-Teflon implants, has been widely recognized. Presently, removal of these implants is generally advised. Extensive damage of the joint and surrounding structures has been reported, including severe bony degeneration, perforation into the middle cranial fossa, and cerebrospinal fluid leak. However, recurrent foreign-body giant cell reaction, presumably as a result of residual Proplast material, has not been reported. We review our experience with Proplast-Teflon implant removal from 112 joints in 71 patients over a 6-year period, including four joints with recurrent giant cell reaction at various times after removal. Emphasis is placed on the phenomenon of recurrence and on microsurgical techniques to facilitate implant removal.