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Total Temporomandibular Joint Replacement and Simultaneous Orthognathic Surgery Using Computer-Assisted Surgery.
Natalia Lucia Gomez1, Luis Alejandro Boccalatte1, Águeda Lopez Ruiz2
1Head and Neck Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, Peron 4190, 1181 Buenos Aires, Argentina.
Journal of Maxillofacial and Oral Surgery
|August 19, 2021
Summary
Computer-assisted surgery (CAS) enables single-stage orthognathic surgery combined with temporomandibular joint (TMJ) replacement. This approach offers predictable outcomes for complex facial reconstruction procedures.
Area of Science:
- Oral and Maxillofacial Surgery
- Biomedical Engineering
- Computer-Aided Surgery
Background:
- Temporomandibular joint (TMJ) disorders often accompany facial skeleton abnormalities, necessitating surgical correction.
- While traditionally requiring staged procedures, advancements like computer-assisted surgery (CAS) facilitate single-stage interventions.
- CAS enables complex procedures, including TMJ replacement alongside orthognathic surgery, for improved anatomical and functional outcomes.
Purpose of the Study:
- To present a protocol for orthognathic surgery integrated with unilateral and bilateral TMJ replacement using patient-fitted prostheses.
- To demonstrate the application of CAS in guiding these complex, combined surgical procedures.
Main Methods:
- The study illustrates the protocol through two patient cases.
- Utilized CAS for designing patient-fitted prostheses and intraoperative navigation.
Main Results:
- Achieved high accuracy in TMJ replacement, with minimal deviations between planned and actual surgical outcomes (e.g., < 2.6 mm).
- The second case showed slightly larger, yet clinically insignificant, differences due to anatomical variations.
Conclusions:
- Combined midface and mandible surgery with total TMJ replacement is a feasible and advantageous treatment option.
- CAS significantly enhances the planning, prosthesis design, and execution of these intricate surgical procedures, leading to beneficial patient outcomes.
