J Maxillofac Oral Surg 8(4):371 371 TECHNICAL NOTE

Sanjeev Kumar1  · Vishal Bansal2 · An effective intra-operative method to Rajat Agarwal3 control bleeding from vessels medial to 1 Professor & HOD 2 Associate Professor the temporomandibular joint 3 Senior Lecturer Dept. of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut Received: 24 July 2008 / Accepted: 23 November 2009 © Association of Oral and Maxillofacial Surgeons of India 2009

Abstract The control of hemorrhage from the medial aspect of the TMJ can be Address for correspondence: troublesome and time-cosuming during ankylosis surgery. There could be a number of vessels which could lead to this inadvertent though sometimes unavoidable Sanjeev Kumar B-10, Staff Quarters, Subhartipuram complication. We have found that simple compression against bone can be useful in NH-58 Delhi-Haridwar Bypass Road controlling hemorrhage from this difficult to approach site. This short paper Meerut-58, India describes the technique which we follow in our unit for such situations. Ph: 91-121-2439043,52 Fax: 91-121-2439067 Keywords TMJ surgery · Bleeding · Maxillary artery E-mail: [email protected]

Aggressive resection of the condyle and/ situ for 3 days, which is removed carefully technique to identify the source of the or coronoid in cases of ankylosis is often in installments over the next few days. This bleeding and ligate or cauterize the complicated by severe hemorrhage from may necessitate extended hospitalization of offending vessel under vision. vessels which lie in close proximity to the the patient. In rare cases, external carotid As far as we are aware, this technique medial aspect of the neck of the condyle. artery may need to be ligated. Iatrogenic of controlling intra-operative bleeding from Any of the several vessels in the pterygoid injury to both the middle meningeal and vessels medial to the condyle during TMJ fossa may be the cause of excessive superficial temporal arteries during TMJ surgery has not been described in the bleeding. These include the maxillary surgery has also been controlled by literature before. artery and its branches namely, middle embolization with a gelatin-based meningeal artery, mandibular artery and hemostatic agent [3]. In our department, a deep temporal artery [1,2]. The pterygoid simple technique of controlling hemorrhage References venous plexus is also a frequent source of by digital compression is being utilized troublesome bleeding in TMJ surgery. which has shown to significantly control 1. Norman JEdeB, Bramley P editors. A Suggested management to control intra-operative bleeding from vessels textbook and colour atlas of the hemorrhage has included uni and bipolar medial to the condyle. temporomandibular joint. London: electrocautery, laser ablation, local Wolfe Medical Publications Ltd.: anesthetics with vasoconstrictors, direct 1990:p. 169 pressure, embolization, and ligation [3]. Technique 2. Talebzadeh N, Rosenstein TP, Pogrel The briskness of the hemorrhage, M (1999) Anatomy of structures medial retraction of the bleeding vessel and the Firm pressure with the fore-finger applied to the temporomandibular joint. Oral limited access often preclude the intra-orally and directed posterolaterally in Surg Oral Med Oral Pathol Oral Radiol possibility of “catching” or ligating the the region of the maxillary tuberosity Endod 88(6): 674–678 bleeding vessel under vision. immediately controls bleeding from vessels 3. Cillo JE Jr , Sinn D, Truelson J (2005) Firm packing of the pterygoid fossa medial to the TMJ. This is so because the Management of Middle Meningeal and with oxidized cellulose and dry ribbon muscle bed which contains the bleeding Superficial Temporal Artery gauze is the usual method of controlling vessel is compressed effectively against Hemorrhage From Total such bleeding [1]. Often the pack has to be bone i.e. the pterygoid plates or the ramus Temporomandibular Joint Replacement repeated, which adds significantly to the of the mandible. Surgery With a Gelatin-Based operative time. At times, when bleeding is This pressure must be maintained as Hemostatic Agent. J Craniofac Surg tedious a BIPP/BPC ribbon pack is left in long as necessary. We have applied this 16(2): 309–312

Source of Support: Nil, Conflict of interest: None declared.

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