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Evaluation of Prosthetic TMJ Positioning Using Intraoperative C-Arm in Unilateral TMJ Replacement Surgery: A

Kiran Kumar Boyina1, Saubhik Dasukil2, Iswariya Ariyan3

  • 1Department of Trauma and Emergency (Oral and Maxillofacial Surgery), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.

Journal of Maxillofacial and Oral Surgery
|November 27, 2025
PubMed
Summary

Intraoperative C-arm imaging improves temporomandibular joint reconstruction (TMJR) accuracy for ankylosis. This technique helps surgeons precisely position alloplastic prostheses, ensuring better patient outcomes in complex cases.

Keywords:
C-armCondylar prosthesisStock TMJ prosthesisTMJ ankylosisTMJ replacement surgeryTemporomandibular joint reconstruction (TMJR)

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Temporomandibular joint reconstruction (TMJR) using alloplastic prostheses is effective for TMJ ankylosis, particularly recurrent cases.
  • Morphological changes in long-standing TMJ ankylosis complicate the adaptation of standard prostheses.

Purpose of the Study:

  • To address the challenges in accurately positioning stock TMJ prostheses due to mandibular morphological changes.
  • To overcome the difficulty in assessing mediolateral inclination of the mandibular component during unilateral TMJ replacement surgery.

Main Methods:

  • Utilized an intraoperative C-arm fluoroscope during unilateral total TMJ replacement.
  • Employed the C-arm to visualize, compare, and confirm the mediolateral and anteroposterior placement of the alloplastic prosthesis.
  • Explored various C-arm positions for optimal visualization.

Main Results:

  • The C-arm facilitated precise placement of the condylar unit in a near-ideal three-dimensional position within the fossa.
  • Reduced surgical ambiguity regarding prosthesis positioning.

Conclusions:

  • Intraoperative C-arm usage enhances the accuracy of TMJR by providing real-time visualization of prosthesis placement.
  • This technique helps resolve surgeon uncertainty about the three-dimensional positioning of the new condyle.