One-Stage Treatment of Giant Condylar Osteoma: Alloplastic Total Temporomandibular Joint Replacement Aided by Digital Templates

Surgical Guides and Prebent Titanium Improve the Planning for the Treatment of Dentofacial Deformities Secondary to Condylar Osteochondroma

PURPOSE

To investigate current Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technologies applied in the treatment of dentofacial deformities secondary to condylar osteochondroma and introduce a modified method with additional pre-bent titanium miniplates to improve the accuracy of operation.

METHODS

Literature review about the application of CAD/CAM in the treatment of condylar osteochondroma and secondary dentofacial deformities was conducted. And 8 patients with condylar osteochondroma and secondary dentofacial deformities were treated by the CAD/CAM cutting and drilling surgical guides as well as pre-bent titanium miniplates. Pre- and post-operative 3D-cephalometric measurement were recorded and the difference between virtual simulation and postoperative modeling images was measured. Follow-up and radiographic examinations were performed.

RESULTS

A total of 17 studies (including 216 patients) about the application of CAD/CAM in the treatment of dentofacial deformities secondary to condylar osteochondroma have been reported since 2010, including the 8 present patients. In our study, all patients were satisfied with the surgical outcome, without obvious relapse or evidence of temporomandibular joint disorder or other complications during follow-up; all patients avoided condylar reconstruction and sagittal split of ramus osteotomy on the ipsilateral mandible side. Comparison between simulated plans and actual postoperative outcomes showed surgical simulation plan was accurately transferred to the actual surgery.

CONCLUSIONS

The application of CAD/CAM cutting and drilling guides as well as pre-bent titanium plates could achieve more accurate and favorable outcomes, improving the clinical planning and surgical execution for patients with condylar osteochondroma and secondary dentofacial deformities.

Total Alloplastic Temporomandibular Joint Replacement

Purpose

End-stage temporomandibular joint (TMJ) disease are not uncommon and affects quality of life. Multiple surgical procedures have been mentioned in literature for management of TMJ disease which ranges from conservative management to aggressive resection of involved joint and replacement with alloplastic total joint prosthesis. The purpose of the present paper was to provide an overview of the role of alloplastic total joint prosthesis in TMJ replacement.

Methods and results

Alloplastic total joint prosthesis is nowadays considered as a standard of care in the adult patients who require TMJ replacement. The requirement of alloplastic total prosthesis has increased in present era with the improvement in design and material of implants, surgical skills and reported victorious outcome along with improved quality of life after its use. It provides restoration of form and functions, improvement in quality of life, reduction in pain and maintenance of ramal height. Additionally, in TMJ ankylosis it reduces chances of re-ankylosis and allows facial asymmetry correction. Currently, enough evidence is however not available for replacement in skeletally immature patient.

Conclusion

The authors conclude that the total joint replacement is a standard procedure for end-stage TMJ disease. Every maxillofacial surgeon should be well-acquainted with TMJ replacement.

Alloplastic total joint replacement in management of temporomandibular joint ankylosis

Both autogenous and alloplastic material have been used in management of temporomandibular joint (TMJ) ankylosis. Second surgical site, donor site morbidity, possibility of over/undergrowth, graft fracture or resorption and increased surgical time are the disadvantages of autogenous graft. Alloplastic total joint replacement (TJR) has become a promising technique in management of adult temporomandibular joint ankylosis (TMJA). This paper intends to present the role of alloplastic TJR in management of TMJA. There is significant current evidence of the role of alloplastic TJR in the management of TMJA. Results in TMJA are excellent with sustained improvement in pain free mouth opening, correction of facial asymmetry, reduction in recurrence and improved quality of life. TMJ TJR is becoming the gold standard of care in the management of TMJA, although costs can sometime preclude access to this mode of therapy.

Custom Alloplastic Temporomandibular Joint Reconstruction: Expanding Reconstructive Horizons

Custom alloplastic temporomandibular joint (TMJ) reconstruction has been well established for the management of end-stage TMJ disease. However, its use in congenital TMJ deformities is limited. Here, the authors present initial outcomes of skeletally mature patients who underwent custom alloplastic TMJ reconstruction and simultaneous orthognathic surgery.A retrospective case series of patients who underwent custom alloplastic TMJ reconstruction concurrent with orthognathic surgery between 2014 and 2019 was completed. Functional, aesthetic and orthodontic outcomes as well as complications were recorded.Seven TMJs in 5 skeletally mature patients (4 female, 1 male, ages 16-30) (2 bilateral, 3 unilateral) were replaced. All but 1 patient had previous attempts at reconstructive surgery with poor results. All cases were prepared using virtual surgical planning and underwent concomitant maxillomandibular orthognathic surgery. All patients demonstrated improved post-operative occlusions. Four of 5 patients achieved >30 millimeters of post-operative MIO. Complications included ear canal perforation and facial nerve dysfunction.There were no infections or other implant-related complications. Mean follow up was 2 years and 15 days. Alloplastic TMJ reconstruction at the time of skeletal maturity for patients with congenital mandibular TMJ defects is an alternative to existing management options. Further long-term prospective outcomes studies are ongoing.

The use of cutting/positioning devices for custom-fitted temporomandibular joint alloplastic reconstruction: current knowledge and development of a new system

Alloplastic replacement of the temporomandibular joint (TMJ) is the treatment of choice in cases of TMJ end-stage disease. Improvements in computer-aided design/computer-aided manufacturing (CAD/CAM) translated into the possibility ongf designi very precise TMJ prostheses based on the anatomy of each single patient. Custom-made TMJ prostheses are described in the most recent literature and provide facilitations in terms of ease of placement and accuracy. Although before the era of custom-made surgical guides, they did not play a prominent role in the field of TMJ surgery, their use has become mandatory when custom-made prostheses are used. Surgical guides, generally known also as cutting guides, allow the subcondylar bone cut to be performed according to the exact shape and size of the planned prostheses. Additionally, they allow the predrilling of fixation holes in the mandible to minimize errors in prostheses positioning. However, the design of surgical guides did not evolve over time as much as prostheses did. In this paper the authors critically analysed literature on this topic and described the improvements of surgical guides over time. Moreover, based on the findings of literature research, a new cutting guide system was developed and is proposed in this article.

Giant Osteomas: Optimizing Outcomes Through Virtual Planning; a Report of Two Cases and Review of the Literature

Osteomas are benign slow-growing tumors of compact or cancellous bone. They are often asymptomatic. However, a rare variety of "giant" osteomas exists, which can reach an impressive size, causing both functional and cosmetic concerns. The location and size of these lesions can make surgical intervention challenging. Here we present 2 cases of giant osteomas in which 3-dimensional planning was of great aid in optimizing functional and esthetic outcomes, and review the literature related to giant osteomas of the mandible.

Clinical guidelines for total temporomandibular joint replacement

Total joint replacement (TJR) of the temporomandibular joint (TMJ) is a promising surgical procedure and device for treating end-stage diseases of the TMJ. For the functional and aesthetic reconstruction of the oral and maxillofacial head and neck region, TMJ TJR significantly helps maintain the patient's quality of life in terms of a better diet, mastication, speech and social interaction. TMJ TJR was approved by regulatory authorities in 2019 in Japan, thus enabling the clinical application of the TJR system. However, the surgery demands particularly difficult and high-risk procedures, necessitating the prudent selection of indicated patients. The joint committee of the Japanese Society of Oral and Maxillofacial Surgeons and Japanese Society for Temporomandibular Joint is working together to develop an appropriate clinical guideline for TMJ TJR.