Internal maxillary artery preoperative embolization using nBCA and pushable coils for temporomandibular joint ankylosis surgery: technical note

• Published in: World neurosurgery
• Main Authors: Alderazi, Yazan J., MB BCh, Shastri, Darshan, MA, Wessel, John, DMD, MD, Mathew, Melvin, Kass-Hout, Tareq, MD, Aziz, Shahid R., MD, Prestigiacomo, Charles J, Gandhi, Chirag D., MD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Neurosurgery; CT; Computed tomography; Preoperative embolization; Embolization; Internal maxillary artery; IMAX; Oral and Maxillofacial Surgery; TMJ Temporomandibular joint; Temporomandibular joint surgery; OMFS; nBCA n-butyl-cyanoacrylate; Temporomandibular joint ankylosis
• DOI: 10.1016/j.wneu.2017.01.086
• ISSN: 1878-8750

Abstract Introduction 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 three liters, if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult due to 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 review of two patients who underwent preoperative embolization prior to TMJ ankylosis surgery. Results Both patients were women, aged 28 and 51 years old, and had severely restricted mouth opening. Embolization was carried out under 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 (nBCA, TRUFILL®, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurological examinations. TMJ surgery occurred with minimal operative blood loss; ≤300ml for each surgery. Maximum post-operative mouth opening was 35 and 34 respectively. One patient had a post-operative TMJ wound infection that was managed with antibiotics. Conclusions Preoperative IMAX embolization prior to TMJ anklyosis 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.