Lateral pterygoid muscle enthesis reconstruction in total temporomandibular joint replacement: An animal experiment with radiological correlation

Nikolas De Meurechy, Denis Verwilghen, Yannick De Brucker, Bert Van Thielen, Maurice Y Mommaerts

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

A novel total temporomandibular joint replacement (TMJR) was developed with CADskills BV (Ghent, Belgium), aiming to achieve reinsertion of the (LPM) onto a scaffold in the implant. In order to investigate the possibility of reinsertion of the LPM, an animal experiment was conducted. An in vivo sheep experiment was conducted, which involved implanting sheep with a TMJR. Clinical parameters were recorded regularly and computed tomography (CT) scan images of two randomly selected sheep per scan were made at 1, 3, and 6 months. After 9.5 months, the sheep were euthanized, and CT scans of all animals were performed in order to evaluate the LPM's enthesis. A total of 13 sheep were implanted with a TMJR. One sheep was used as a sham. Radiographs revealed four outcome types of enthesis reconstruction. In four sheep, there was no reconstruction between the implant and the LPM. In three sheep, there was a purely soft tissue connection of 0.5-0.9 mm (average 0.7 mm) between the ostectomized bony LPM insertion and the implant's lattice structure. A combination of partial bony and partial soft tissue enthesis attachment (0.3-0.5 mm, average 0.4 mm) was found in three sheep. A bony ingrowth of the enthesis into the scaffold occurred in two sheep. A secondary bony connection between the mandible and the insertion of the LPM was found in 10 of 13 sheep. Four fossa components were found to be displaced, yet TMJ function remained in these ewes. The heterotopic ossification that was seen may be a confounding factor in these results. This in vivo experiment showed promising results for improving the current approach to TMJR with the possibility of restoring the laterotrusive function. The fossa displacement was considered to be due to insufficient fixation and predominant laterotrusive force not allowing for proper osseointegration. Further optimization of the reattachment technique, scaffold position and surface area should be done, as well as trials in humans to evaluate the effect of proper revalidation.

Original languageEnglish
Pages (from-to)256-268
Number of pages13
JournalJournal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
Volume49
Issue number4
Early online date16 Feb 2021
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Keywords

  • Animal experiment
  • Arthroplasty
  • Computed tomography
  • Joint prosthesis
  • Pterygoid muscles
  • Temporomandibular joint

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