Please cite this article in press as: Hossameldin RH, et al. Prophylactic embolisation of the internal maxillary artery in patients with ankylosis of the temporomandibular joint. Br J Oral Maxillofac Surg (2017), http://dx.doi.org/10.1016/j.bjoms.2017.03.001 ARTICLE IN PRESS YBJOM-5133; No. of Pages 5 British Journal of Oral and Maxillofacial Surgery xxx (2017) xxx–xxx Available online at www.sciencedirect.com ScienceDirect Prophylactic embolisation of the internal maxillary artery in patients with ankylosis of the temporomandibular joint R.H. Hossameldin a,* , J.P. McCain b,c,d , G. Dabus e,f a Lecturer of Oral & Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt b Private Practice of Oral and Maxillofacial Surgery, 8940 North Kendall Drive, Suite 604E, Miami, FL 33176, USA c Chief of Oral and Maxillofacial Surgery, Baptist Health Systems d Chief of OMS Subdivision in General Surgery Dep., Herbert Wertheim College of Medicine FIU, Miami, FL e Director of Neurointerventional Surgery Fellowships Miami Cardiac and Vascular Institute f Clinical Associate Professor Herbert Wertheim College of Medicine Florida International University Accepted 5 March 2017 Abstract The aim of the present study was to assess the efficacy of using prophylactic embolisation of the internal maxillary artery to minimise the risk of bleeding during gap arthroplasty. We studied a prospective series of 14 patients with ankylosis of the temporomandibular joint (TMJ) between January 2011 and February 2016, who were under the care of one surgeon. They were all treated by embolisation of the internal maxillary artery 24hours before gap arthroplasty. The main outcome variable was estimated blood loss, and others included the need to extend the gap arthroplasty, and the risk of reankylosis. We studied nine women and five men, mean (SD) age 51 (18) years, seven with unilateral and seven with bilateral ankylosis. Their mean (SD) estimated blood loss was 136 (77) ml, which we considered to be minimal. Patients were followed-up at six-monthly intervals, during which time there was no reankylosis or limitation of mouth opening. No patient lost more than 250 ml blood in total. Prophylactic embolisation of the internal maxillary artery seems to be beneficial and safe in the management of selected cases of ankylosis of the TMJ. © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: embolisation; temporomandibular joint; ankylosis; computed tomographic angiography; bleeding; internal maxillary artery Introduction Wide gap arthroplasty used in the treatment of ankylo- sis of the temporomandibular joint (TMJ) carries a risk of serious haemorrhage if the internal maxillary artery is injured. 1–4 This risk of massive bleeding is a life-threatening * Corresponding author at: MiamiOMS, 8490 North Kendal Drive, Suite 604E, Miami, FL, USA. Tel.: +1 305 301 1887; fax: +1 305 595 2219. E-mail addresses: reemhamdy@hotmail.com (R.H. Hossameldin), jmccain@miamioms.com (J.P. McCain), gdabus@gmail.com (G. Dabus). complication that can affect the surgeon’s ability to resect the bony callus adequately and provide an adequate gap in which to place the prosthesis and prevent reankylosis. 5,6 There have been many reports on the management of massive bleeding from the internal maxillary artery using conventional haemostatic measures. 7–11 Suggested tech- niques include tamponade with gauze sponges soaked in warm normal saline, firm pressure packs, the use of different haemostatic agents applied to the area, or a combination. In certain cases it becomes necessary to control the bleeding by dissection and ligation of the external carotid artery. The use http://dx.doi.org/10.1016/j.bjoms.2017.03.001 0266-4356/© 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.