Reasons for failure of total temporomandibular joint replacement: a systematic review and meta-analysis.

The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk of revision surgery with stock or custom-fitted prostheses (the two most current TMJR prosthesis types). A systematic review was performed, with a search of PubMed, Google Scholar, and the Cochrane Library in November 2020. Overall, 27 articles were included in this study, describing Biomet and TMJ Concepts prostheses and including postoperative data on complications requiring a return to the operating room. A total of 2247 prostheses were analysed: 1350 stock Biomet prostheses and 897 custom-fitted TMJ Concepts and custom-fitted Biomet prostheses. The global revision rate was 1.19 per 100 prosthesis-years. The most common reason for revision was heterotopic bone formation. Stock prostheses appeared to have a lower risk of revision compared to custom prostheses: rate ratio 0.52 (95% confidence interval 0.33-0.81, P-value 0.003). Regarding causes of revision, the only significant difference between the types of devices was a higher rate of heterotopic bone formation for custom-made prostheses (P = 0.001). The results of this study revealed a low revision rate post TMJR revision, with stock devices even less prone to such risk. Nevertheless, these results can be explained by the fact that custom-made prostheses are more likely to be used for cases in which the anatomy is significantly abnormal or there is a history of multiple joint surgeries, which carry a greater risk of complications and heterotopic bone formation.

Association of surgical excision and brachytherapy for the management of keloids.

Many techniques have been described to prevent the appearance and relapse of keloids but most of them have an efficacy lower than 50%. Our objective is to describe our standardized management of keloids by associated surgery and brachytherapy. Surgery-brachytherapy is usually given only when less invasive treatments failed. Both a surgeon and a radiotherapist are involved. Forty-eight hours of hospitalization in a surgery unit are required. The extra-lesional excision is performed and a brachytherapy sheath is placed in the dermis plane. An iridium source with an initial activity of 300 GBq is used to deliver high dose rate brachytherapy. The brachytherapy sessions are held in a lead-shielded room in a radiotherapy unit: the first session at 6 h after surgical excision, while the second and third on the following day. The total dose administered is 18 Gy. A surgical workup is scheduled at 10 days. The patient is followed-up closely by the radiotherapist for an 18-month period. The recurrence rate after 2 years is 8 to 12%. The main complaints are dyschromia, telangiectasia and skin atrophy.