Dysregulated healing response participates in the pathophysiology of temporomandibular joint ankylosis

Córdova, Luis A.; Reyes, María Isabel Pávez; Galaz, Rubén Soto; Hernández, Marcela; Cortés, J.

doi:10.1016/j.jcms.2021.02.014

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…Trauma-induced TMJ ankylosis is similar to fracture healing [23,24]. Histologically, ankylosis presents a remodelling bone callus [25] with a progressive fusion between the temporal bone and the mandibular condyle [26][27][28]. Since the bony mass is not a neoplasm, its excision can be programmed and limited [29].…”

Section: Discussionmentioning

confidence: 99%

Puricelli biconvex arthroplasty as an alternative for temporomandibular joint reconstruction: description of the technique and long-term case report

Puricelli

2022

Head Face Med

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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. Case presentation 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.

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Section: Discussionmentioning

confidence: 99%

Puricelli biconvex arthroplasty as an alternative for temporomandibular joint reconstruction: description of the technique and long-term case report

Puricelli

2022

Head Face Med

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“…Additionally, it has been shown that CD34+ endotheliocytes are present along the cartilage-bone junction and accelerate the calcification and formation of bony TMJA [10]. Another study also reported the presence of aberrant cartilage that was characterized by hypertrophic chondrocyte-like cells at the bone/cartilage interface [13].…”

Section: Discussionmentioning

confidence: 99%

“…However, the limited availability of tissue material, the rarity of the condition itself, and late diagnosis and surgical intervention (usually when patient has long-standing or end-stage disease) has restricted the possibilities to conduct extensive research in human subjects. In the literature, only a handful of human tissue-based histopathological studies have been reported [10][11][12][13][14]. In these studies, apart from general morphological appearance, processes related to neoangiogenesis [10], collagenization [11], cellular stress [12], bone resorption [13], and tissue growth [14] have been described immunohistochemically.…”

Section: Introductionmentioning

confidence: 99%

“…In the literature, only a handful of human tissue-based histopathological studies have been reported [10][11][12][13][14]. In these studies, apart from general morphological appearance, processes related to neoangiogenesis [10], collagenization [11], cellular stress [12], bone resorption [13], and tissue growth [14] have been described immunohistochemically. Hence, in our present case report study, we furthered our understanding of various related processes by immunohistochemical investigation of the processes related to tissue remodeling, growth, inflammation, antimicrobial activity, and transcriptional regulation in two separate tissue samples obtained from the same patient six years apart.…”

Section: Introductionmentioning

confidence: 99%

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Temporomandibular Joint Ankylosis in a Girl Child: Immunochemical Evaluation of Tissue Material Obtained from Repeated Arthroplasty Surgeries

et al. 2023

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Temporomandibular joint ankylosis (TMJA) is a rare, but debilitating, condition that leads to TMJ joint hypomobility. Surgery is the mainstay for treatment, which is accompanied by rehabilitative and psychological support. Despite the advances in surgical techniques, the recurrence of TMJA post-surgery has been reported as a common complication. Therefore, it becomes essential to investigate and understand the histo-morpho-pathological processes governing these ankylotic changes. Given the lack of such studies in the literature, herein we present a case of a girl child who underwent primary surgery at the age of six years, followed by a second surgery at the age of twelve years. Ankylotic tissue samples collected during both surgeries were studied using various immunohistochemical markers for tissue remodeling, inflammation, antimicrobial activity, and transcriptional regulation. The expression of MMP-2 and -9 was downregulated in repeated surgery materials, whilst MMP-13 was rarely detected in both tissues. Strong MMP-8, TIMP-2, and TIMP-4 expressions were noted in both tissues, showing their anti-inflammatory and protective roles. Moderately strong expression of bFGF, FGFR-1, IL-1α, and TNF-α could indicate sustained tissue growth in the background of inflammation (wound healing). Interestingly, the expression of β-defensin-2 was found to be constant in both tissues, thereby indicating possible ECM remodeling and collagen breakdown. Finally, a moderate expression of RUNX-2, coupled with a low expression of WNT-1 and -3a, could indicate a slow and delayed bone regeneration process. Our results showcase the complex myriad of pathways that could be involved in the progression of TMJA and post-surgery healing processes. Immunopathological studies could aid in improving the diagnosis, treatment, and prognosis for patients affected with TMJA.

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Dysregulated healing response participates in the pathophysiology of temporomandibular joint ankylosis

Cited by 2 publications

References 25 publications

Puricelli biconvex arthroplasty as an alternative for temporomandibular joint reconstruction: description of the technique and long-term case report

Puricelli biconvex arthroplasty as an alternative for temporomandibular joint reconstruction: description of the technique and long-term case report

Temporomandibular Joint Ankylosis in a Girl Child: Immunochemical Evaluation of Tissue Material Obtained from Repeated Arthroplasty Surgeries

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