Page 32 - Demo

Chapter 230ResultsTMJ fossa-eminence prostheses and condylar prostheses used separatelyInterpositioning materials and fossa prosthesis John Carnochan(10) (H) was a pioneering neurosurgeon who first described the use of an interpositioning material in the 1840s as a treatment technique for the ankylosed TMJ. He carved a piece of wood for gap arthroplasty that was inserted between the glenoid fossa and condyle.(7,11,12) The literature then fell silent for decades until 1889, when Rosner introduced the use of gold as an interpositioning material after performing a condylectomy to prevent recurrent ankylosis.(6) This design was further altered by Orlow(13) (OCEBM LOE IV) in 1903, who made use of gold-coated aluminum plates that were fixed to the resected bone.(6) As relatively good results were seen in two of the three patients treated by Orlow(13), the use of interpositioning materials to prevent recurring ankylosis after TMJ resection gained traction. Consequently, several different materials were used as interpositioning material placed below the fossa, with the aim of reducing the foreign body reaction. These include ivory by Partsch(14) (H) in 1932, gold foil by Risdon(15) (H) in 1934, and a metallic plate by Risdon(6) (H) in 1934. Later, tantalum foil was used as an interpositioning prosthesis by Eggers(16) (H) in 1946 and Goodsell(17) (H) in 1947.(11,12,18–20) However, tantalum foil had a tendency to be displaced, which Goodsell(17) attempted to prevent by fixing the foil using two stainless steel wires that ran through the foil and several drill holes made in the fossa.(18) Despite the improved anchorage, the tendency of tantalum to fragment remained, which caused inflammation and further ankylosis; therefore, the material was abandoned. Although the use of interpositioning materials is a technique that is still relied upon, the early literature is mainly limited to sporadic case reports and letters of opinion. A notable step forward was made in the 1950s, which could be considered the dawn of customized TMJ biomaterials, Nikolas de Meurechy NW.indd 30 05-06-2024 10:14