Total Customized Alloplastic Reconstruction for Treatment of Severe Temporomandibular Joint Pathologic Conditions: A Case Series of Combined Intraoral and Extraoral Approach.

ABSTRACT: Temporomandibular joint (TMJ) reconstruction with customized alloplastic implants has become a safe and effective treatment option of TMJ end-stage pathology with excellent outcomes reported in the literature. The purpose of this study is to report 5 cases of severe TMJ pathology and customized alloplastic reconstruction using a combined intraoral approach and extraoral approach. Four patients with TMJ involved for benign tumor and one patient with severe TMJ resorption were enrolled. Compromised joints were replaced with customized prosthesis under general anesthesia using an association of intraoral approach/extraoral approach. An implant handpiece with adapted drills for bone drilling and the insertion of screws was used to fixate the mandibular component intraorally; the fossa component was inserted via preauricular approach. The hemimandibulectomies/codilectomy with safety margin were successfully performed and for 2 patients Orthognathic Surgery was also required. Follow-up period was from 15 to 28 months (average 22 months), with no history of surgical site infection or damage to the prostheses. Occlusal relationship and function, as well as facial symmetry were kept stable in all patients. The combination of an intraoral and extraoral approach for total TMJ replacement with customized prosthesis may be an alternative and reliable strategy for pathologic reconstruction, keeping function and reducing aesthetic damage.

Poly(L-lactic acid) membranes: absence of genotoxic hazard and potential for drug delivery.

The use of poly(L-lactic acid) (PLA) has been considered an important alternative for medical devices once this polyester presents biomechanical, optical and biodegradable properties. Moreover, the use of PLA results in less inflammatory reactions and more recently it has been proposed its application in drug delivery systems. Genotoxicological evaluations are considered part of the battery assays in toxicological analysis. Considering the wide applications of PLA, the present work evaluated the potential cytotoxic and genotoxic effects of PLA in CHO-K1 cells, as well as its physicochemical properties. No cytotoxic effects of PLA were detected by colorimetric tetrazolium assay (XTT) analysis, and the clonogenic survival assay showed that PLA did not disrupt the replicative cell homeostasis, neither exhibited genotoxic effects as evidenced by comet and micronucleus assays. Thermogravimetric properties of PLA were not altered after contact with cells and this film exhibited ability in absorb and release Europium(III) complex. All these data suggest genotoxicological safety of PLA for further applications in drug delivery systems.