Immobilizing the jaw during stereotactic radiosurgery for lesions extending beyond temporomandibular joint: An avant-garde approach for a quick, reversible, non-invasive, radiolucent and reliable fixation
Manjul Tripathi, Rajkumar Verma, Adesh Shrivastava, Sachin K Rai, Reena Sharma, Renu Madan, Chirag K Ahuja, Rupinder Kaur and Sandeep Mohindra
The first essential prerequisite for safe Gamma knife radiosurgery (GKRS) is target definition and strict immobilization of the target in relation to the cartesian system. Lesions extending beyond the traditional limits into the extracranial locations remain challenging(1,2). The extracranial pathologies such as lesions near the craniocervical junction and temporomandibular joint (TMJ) are prone to movement both during image acquisition and radiation delivery. Jaw immobilization is required for patients undergoing GKRS for extracranial lesions involving potentially mobile regions such as the temporomandibular joints (TMJ). Literature reports intermaxillary fixation with titanium screws in the maxilla and mandible to immobilize TMJ. But the invasive nature of the procedure and the metal artifacts are often a deterrent. The use of the routine metal arch bar and conventional metal braces with intermaxillary elastic is not feasible in these patients as metal interferes in the MRI imaging process. A surgical plan with titanium plates/screw is also an invasive procedure and expensive for the required purpose(3). In a similar case, the authors performed intermaxillary fixation with intermaxillary elastics mounted on non-metallic aesthetics braces. With this technical report, authors wish to highlight a completely non-invasive method for jaw immobilization. This method helped extend the reach of GKRS for lesions in the subtemporal area and upper cervical spine.
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