Concurrent Bilateral Total Temporomandibular Joint Replacement Surgery and Conventional Maxillary Osteotomy Utilizing Virtual Surgical Planning Web-Based Technology

Abstract

We describe the case of a 31-year-old lady who presented in 1999 with significant temporomandibular joint (TMJ) dysfunction following a previous vertical subsigmoid osteotomy. The previous surgery had displaced both condyles from their glenoid fossae, and a persistent malocclusion resulted. Despite initial conservative management, both condyles remained out of their fossae and she re-presented 10 years later. On presentation, she had significant progressive right TMJ dysfunction with severe pain. A class III malocclusion was apparent with a 5-mm anterior open bite and jaw deviation to the right on mouth opening. Her maximal interincisal opening was 32 mm. The case was prepared using conventional orthodontic treatment, with surgery being remotely planned by a design facility using a web-based virtual planning and design process. The definitive surgery consisted of bilateral condylectomy, coronoidectomy, and bespoke TMJ replacement prostheses. A simultaneous Le Fort I osteotomy was performed with a 4-mm maxillary advancement. A class I occlusion was achieved with full range of movement, and good functional and aesthetic outcomes. This case documents one of the first reported cases of bilateral total TMJ replacement surgery performed with a concurrent maxillary osteotomy. It demonstrates the potential of virtual surgical planning and the viability of simultaneous procedures.