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Ultra-high molecular weight polyethylene fossa wear and incidence of

adverse effects

Article  in  Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons · August 2004
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Louis G Mercuri
Rush University Medical Center
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906
cial Surgery titled “Impacted Tooth in Mandibular Fracture
Line: Treatment With Closed Reduction” (J Oral Maxillofac
Surg 62:289-291, 2004).
In the article Dr Baykul states, “We believe that removal
of asymptomatic impacted teeth is additional trauma, allow-
ing displacement of fragments as well as increased infection
risk.” I would like to take exception to these comments.
It has been my experience in treating mandibular frac-
tures that third molars in the line of fracture should be
extracted. I say this for the following reasons:
1. These teeth are usually nonfunctional (as are the teeth
shown in figures 5 and 6 of the above article) and are
not worth the risk of an infection in this area by
leaving them in place.
2. Because the fracture is associated with the third mo-
lars, their extraction is usually made easier.
3. Extracting these teeth does not lead to further dis-
placement of the proximal and distal fragments if done
carefully.
4. By extracting third molars in the line of fracture the
infection rate is substantially decreased rather than in-
creased in my experience at a large municipal hospital.
I do agree with the author that closed reduction with
maxillomandibular fixation (wire) is the treatment of choice
for the majority of these fractures, with antibiotic coverage
for no more than 5 days.
RICHARD D. ZALLEN, DDS, MD
Denver, CO
doi:10.1016/j.joms.2004.04.010
In Reply:—I would like to thank to Dr Zallen for his letter
and his comments. In our case series, because most of the
teeth in the fracture line were fully impacted, bone removal
during surgery was necessary. Removal of the bone in the
fracture line may reduce the contacting bone surfaces be-
tween the fragments. This condition may increase the sec-
ondary healing surfaces and may lead to delayed healing.
We believe that the forces applied during the surgical re-
moval may cause displacement of the fragments although
they are applied carefully. Also, because of these forces, the
impacted teeth can displace to submandibular or parapha-
ryngeal spaces depending on the tooth position and the
direction of the fracture line. We support Wolujevicz’s
(reference 5 in our article) result that the impacted teeth in
the fracture line can stabilize the fragments. Our treatment
choice was closed reduction with maxillomandibular fixa-
tion, because we think that creating a new surgical site for
the removal of an impacted tooth may increase the infec-
tion risk in the related area. At the same time, in such
patients, surgery becomes harder because of the limited
mouth opening and edema under local anesthesia. In light
of the results of our study and the above-mentioned reasons,
we do not advocate removing an asymptomatic impacted
tooth from a fracture line if the jaw is immobilized with
closed reduction and intermaxillary fixation.
TIMUÇIN BAYKUL, DDS, PHD
Isparta, Turkey
doi:10.1016/j.joms.2004.04.011
LETTERS TO THE EDITOR
CONDYLAR POSITION IN DISC DISPLACEMENT
To the Editor:—We were impressed with the method of
quantifying condylar position within the glenoid fossa de-
scribed in the recent article by Gateno et al (J Oral Maxil-
lofac Surg 62:39-43, 2004).1 This paper confirms a common
observation that patients with anterior disc displacement of
the temporomandibular joint (TMJ) often have reduced
posterior joint space. We have recognized this pattern, and
have reported our use of the sagittal split osteotomy in a
series of patients to intentionally reposition the posteriorly
displaced condylar head.2 The paper by Gateno et al rein-
forces the concept that condylar position is equally as
important as disc position when evaluating patients with
TMJ internal derangements. Treatment of disc displace-
ment—whether nonsurgical or surgical—should address all
anatomic components of the derangement. In patients who
meet surgical criteria, our group has advocated condylar
repositioning surgery (with either vertical ramus osteotomy
or sagittal split ramus osteotomy) over disc repositioning
because of the high rate of failure after disc repositioning.3
Gateno et al’s approach of measuring the distance be-
tween the geometric centers of the glenoid fossa and con-
dyle appears to be superior to previously reported methods
of analyzing bony temporomandibular joint relationships.
Recruiting the assistance of a local radiologist who can
trace, measure, and calculate normalized values in a consis-
tent fashion, however, may be difficult to achieve in the
private practice setting.
JOHN W. PRUITT, DDS, MD
JOHN E. MOENNING, DDS, MSD
THOMAS A. LAPP, DDS, MS
DAVID A. BUSSARD, DDS, MS
Indianapolis, IN
References
1. Gateno J, Anderson PB, Xia JJ, et al: A comparative assessment of
mandibular condylar position in patients with anterior disc dis-
placement of the temporomandibular joint. J Oral Maxillofacial
Surg 62:39, 2004
2. Pruitt JW, Moenning JE, Lapp TH, et al: Treatment of painful
temporomandibular joint dysfunction with the sagittal split ra-
mus osteotomy. J Oral Maxillofacial Surg 60:996, 2002
3. Montgomery MT, Gordon SM, Van Sickles JE, et al: Changes in
signs and symptoms following temporomandibular joint disc
repositioning surgery. J Oral Maxillofac Surg 50:320, 1992
doi:10.1016/j.joms.2004.04.005
ULTRA-HIGH MOLECULAR WEIGHT POLYETHELENE
FOSSA WEAR AND INCIDENCE OF ADVERSE
EVENTS
To the Editor:—The US Food and Drug Administration’s
voluntary Manufacturers And User Facility Device Experi-
ence Database (MAUDE) provides health care institutions,
professionals, and consumers with data concerning re-
ported “adverse events” related to the use of medical de-
vices.
One can assume that any manufacturer’s product(s) that
repeatedly appears in such a database deserves attention
and possible further scrutiny.
When one searches the topic “TMJ” on the MAUDE for
the years 2002 to 2003, one finds a total of 39 adverse event
reports, 21 (53.8%) involving either the TMJ, Inc (Golden,
 LETTERS TO THE EDITOR
CO) fossa/eminence device or a TMJ, Inc total joint replace-
ment device.
For the years 2000 to 2001, 46 (69.7%) of 66 TMJ device-
related reported adverse events involved the same devices.
Drs Curry and Alexander’s (J Oral Maxillofac Surg 62:261,
2004)1 and Dr Christensen’s (J Oral Maxillofac Surg 62:262-
263, 2004)2 letters in the February 2004 issue of the Jour-
nal raised concerns about ultra-high molecular weight poly-
ethylene (UHMWPE) fossa wear leading to premature
device failure. TMJ Concepts (Ventura, CA; nee, Tech-
medica) has been utilizing this orthopedic gold standard
geometry since 1990. No UHMWPE-related failures were
reported in a recent long-term TMJ Concepts follow-up
paper3 published in a refereed journal or in the MAUDE.
If UHMWPE wear were as big of a problem in the TMJ as
Curry, Alexander, and Christensen guessed, it certainly
would not only be reflected in the results of the TMJ
Concepts long-term study,3 but also in the MAUDE. For the
2002 to 2003 period, there was 1 (2.6%) TMJ Concepts
report unrelated to device failure. There were 3 (4.5%)
non-device failure TMJ Concepts reports filed.
LOUIS G. MERCURI, DDS, MS
Maywood, IL
References
1. Curry JT, Alexander R: Comparison of 2 temporomandibular
joint total joint prosthesis systems. J Oral Maxillofac Surg 62:
261, 2004 (letter)
2. Christensen RW: Further comparison of temporomandibular
joint prosthesis systems. J Oral Maxillofac Surg 62:262, 2004
(letter)
3. Mercuri LG, Wolford LM, Sanders B, et al: Long-term follow-up of
the CAD/CAM patient-fitted total temporomandibular joint re-
construction system. J Oral Maxillofac Surg 60:1440, 2002
doi:10.1016/j.joms.2004.04.006
A PLEA FOR PRECISE TERMINOLOGY
To the Editor:—I wish to appeal for the use of correct and
precise terminology in our scientific publications. When
teaching residents or speaking to our colleagues, we all use
View publication stats
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slang or imperfect descriptors. But when we publish, we
have the luxury of editing our manuscript and, with reflec-
tion, being distinct and accurate in our words.
In the following examples I wish to be clear that I am not
criticizing any of the authors or impugning their work or
the results of their article. It was chosen simply because it
was the first in my latest edition of the Journal and further
examples can be found in other reports. The article I am
referencing is “Status of the Internal Orbit After Reduction
of Zygomaticomaxillary Complex Fractures” by Ellis and
Reddy (J Oral Maxillofac Surg 62:275-283, 2004).
In the abstract heading the paper, orbital contents dis-
placed into the maxillary sinus are referred to as soft tissue
sagging. Sag is defined as to sink, especially in the middle,
from weight or pressure. In the body of the paper, the term
prolapse is used to describe the same phenomenon. Medi-
cal dictionaries define prolapse as the falling down, or
sinking, of a part or viscus. Neither of these terms correctly
describes the situation.
Herniation is the third term used in this paper. This is
defined as abnormal protrusion of an organ or other body
structure through a defect or natural opening in a covering
membrane, muscle, or bone. Here we have a winner.
In the third paragraph of the paper, the second sentence
reads “One of the unanswered questions about ZMC frac-
tures is whether an orbital floor defect that is deemed not
worthy of reconstruction preoperatively by using CT scans
will be larger and more significant after reduction of the
ZMC.” I don’t know how a fracture can have worth or value.
I assume what was meant was that the extent of the injury
did not warrant reconstruction of the orbit.
I am not trying to be pedantic but our literature is used to
report studies and thoughts to our colleagues, help educate
trainees, and becomes the basis for our textbooks and
qualifying examinations. It is also used in the courts of law.
Precision is important.
I have a request on a separate topic. Could we find some
terms to replace the overused “paradigm” and “gold stan-
dard”?
DAVID S. EVASKUS, DDS, MS
Chicago, IL
doi:10.1016/j.joms.2004.04.008