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Keywords

heterotopic bone, TMJ, complication of TM joint replacement

Abstract

Background: Heterotrophic ossification (HO) is defined as the formation of lamellar bone in soft tissues where normally bone does not exist. It is a rehabilitative disease which can be associated with any joint in the body; however, its pathogenesis and management in the temporomandibular joint (TMJ) is infrequently mentioned in the literature.

Types of studies reviewed: The authors searched various articles which included systematic reviews, meta-analyses, randomized clinical trials, Cohort studies, case reports and literature review on heterotopic bone formation and treatment in PubMed, Google Scholar and Scopus.

Results: Identification of patients who are classified as high risk for the development of HO is vital for its prevention and management. Postoperative range of motion exercises, prophylactic medication with indomethacin and etidronate could reduce the incidence of HO. Similarly, the role of external beam radiation in the prevention of HO is well documented. Additionally, several studies mentioned the inhibitory role of novel medication such as Rapamycin (RAPA), Palovarotene and Imatinib mesylate. Furthermore, clinical trials are underway to test the efficacy of Saracainib, Garetosmab and IPN60130.

Practical implications: HO is most frequently diagnosed in patients who undergo total hip and knee replacement surgeries; however, its mention in the temporomandibular joint is rarely found in literature. The risk factors for HO in TMJ include trauma, infections, ankylosis, recurrent ankylosis, intra-articular corticosteroid injections, recurrent inflammatory conditions and total TMJ replacement with alloplastic or autogenous grafts. Its formation is unpredictable and hence patients with identifiable risk factors should be explained about the risks and benefits of surgery and encouraged to strictly follow the postoperative regimen. Surgery is the final treatment of choice; however, fat graft in the surgical site has shown promising results to prevent HO at the surgical site.

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