Long Term Outcome of A Tmj Discectomy. Pseudo- Disc Formation after Silastic Implant. Case Report and Short Literature Review.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2016, Vol 1, Issue 4
Abstract
Temporomandibular joint disorders (TMJ) are a widespread cause of facial pain, headaches, joint noises and limited mouth opening. TMJ disc displacement is the most common disorder whereas benign tumors involving the TMJ, such as osteomas, are quite rare. Osteoma is a benign lesion that occurs in the bones of the craniofacial complex. It is a slow- growing, asymptomatic and usually solitary lesion which affects mainly young adults. Osteomas occurring in either the condyle or condylar process may result in morphologic and functional disturbances including TMJ dysfunction. Silastic is a flexible and inert silicone rubber (polydimethylsiloxane) with resilient properties, easily carved, readily adaptable to the TMJ, and it does not allow tissue ingrowth. Silastic implants can have 1 to 2 mm thickness and be reinforced with Dacron (or polyethylene terephthalate) fibers. Silastic has been used since the 1960s for joint replacements of the small bones of the hands and feet and the first reported use in the temporomandibular joint (TMJ) was in 1969. Researchers demonstrated that different forms of Silastic implants became surrounded by a fibrous capsule. It was thought that solid silicone fulfilled many of the requirements of an ideal implant material even though occasional intracellular particles of silicone elastomer were observed inside tissue macrophages. In 1981, silicone rubber replacement after TMJ discectomy became popular. However, reports published after 1982, demonstrated long-term instability of this material in the TMJ, FBGCR around fragmented silicone particles, peri-implant lymph nodes containing silicone particles, and a severe reactive synovitis, sometimes resulting in destructive arthritis of the condyle. These implants were subsequently removed from the market in January 1993. The rationale of silicon sheets seems to be avoiding adhesions between the fossa and the condyle thus possibly improving the mechanical conditions for joint functioning. Its use has been limited to surgically treated TMJ for advanced stages of disc displacement, extensive manifestation of destructive and irreversible inflammatory disorders. Since any material which is inserted into the TMJ is subject to considerable loading, these observation seem to be of interest to evaluate the long- term behavior of alloplastic implants and its effect on clinical function. This appears to be valid either for the clinician or the researcher.
Authors and Affiliations
Francesco Paparo
Keywords
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