Abstract：
BACKGROUND: There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up.
METHODS: In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components.
CONCLUSIONS: The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis.
METHODS: In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components.
CONCLUSIONS: The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis.
摘要：
背景：有几种适应症可以部分或全部替换颞下颌关节（TMJ），包括肿瘤和严重的骨吸收。在这方面,已经提出了几种技术来增加这些假体装置的功能和寿命。此病例报告描述了使用Puricelli双凸关节成形术（ABiP）技术治疗TMJ强直患者的方法，长期随访。
方法：1978年，一名33岁的男性多外伤患者在右耳前区出现疼痛症状，与同侧TMJ的运动受限有关。由于髁下骨折,应用弹性上颌下颌固定术（EMMI）。随后，当患者的切口间开口(10mm)的局限性和触诊时增加的自发性疼痛的存在被证实时,患者被转诊接受治疗.影像学检查证实骨折，伴有前内侧移位和关节骨性强直。指出了受损组织的排泄物及其通过ABiP的替代。该方法使用保守访问(即，耳前切口)，部分切除强直肿块，使用两种聚（甲基丙烯酸甲酯）成分进行组织置换，与最小和稳定的凸表面之间的接触。在程序结束时,关节稳定性和牙齿咬合进行了测试。患者在术后6个月随访时表现出明显的改善，没有疼痛和增加张口范围（30毫米）。在43年的随访中，没有关节噪音，报告疼痛或活动受限(张口36mm).影像学检查未显示组织变性，并显示假体组件的完整性。
结论：本病例报告表明，ABiP可以使TMJ关节运动，允许在超过40年的随访中缓解体征和症状。这些数据表明，当成年强直患者有TMJ重建指征时，该技术是一种简单有效的替代方法。
方法：1978年，一名33岁的男性多外伤患者在右耳前区出现疼痛症状，与同侧TMJ的运动受限有关。由于髁下骨折,应用弹性上颌下颌固定术（EMMI）。随后，当患者的切口间开口(10mm)的局限性和触诊时增加的自发性疼痛的存在被证实时,患者被转诊接受治疗.影像学检查证实骨折，伴有前内侧移位和关节骨性强直。指出了受损组织的排泄物及其通过ABiP的替代。该方法使用保守访问(即，耳前切口)，部分切除强直肿块，使用两种聚（甲基丙烯酸甲酯）成分进行组织置换，与最小和稳定的凸表面之间的接触。在程序结束时,关节稳定性和牙齿咬合进行了测试。患者在术后6个月随访时表现出明显的改善，没有疼痛和增加张口范围（30毫米）。在43年的随访中，没有关节噪音，报告疼痛或活动受限(张口36mm).影像学检查未显示组织变性，并显示假体组件的完整性。
结论：本病例报告表明，ABiP可以使TMJ关节运动，允许在超过40年的随访中缓解体征和症状。这些数据表明，当成年强直患者有TMJ重建指征时，该技术是一种简单有效的替代方法。
