Abstract
BackgroundDigitally designed surgical templates for minimally invasive temporomandibular joint (TMJ) surgery (MITMJS) are a promising tool for improving the safety of these procedures. Given the TMJ anatomy, the template fitting and intraoperative overview are the most important issues for a safe surgery. This article is a technical advance article that aims to describe an endaural surgical template based on the Moses approach as a possible solution in TMJ surgery.MethodsThree patients with internal derangement were treated with the guidance of a MITMJS template based on cone beam computed tomography (CBCT) and a surface imprint of the periauricular region. None of the patients needed an additional open surgical procedure. Fitting of the templates was judged in terms of position and rotational stability. Surgical side effects and complications were recorded for each patient.ResultsThe template design and clinical use were satisfactory for MITMJS. The templates showed satisfying fit and good visibility. In the study cohort, no bleeding, facial nerve injury, or other complications occurred after the procedure, and no visible scars were noted postoperatively.ConclusionOur feasibility report on template-guided MITMJS shows a promising new application of templates. It points to improved access in arthroscopy or arthrocentesis of TMJ surgery through endaural access with an increased level of safety during surgery.
Highlights
Designed surgical templates for minimally invasive temporomandibular joint (TMJ) surgery (MITMJS) are a promising tool for improving the safety of these procedures
To simplify and standardize the approach, we described the use of a computer-aided designed and computer-aided manufactured (CAD-CAM) template for TMJ surgery in 2019, yet several modifications have been proposed to this promising technology
Given the TMJ anatomy, the fitting and unique placement of the template is of utmost importance to safely conduct the surgery
Summary
Designed surgical templates for minimally invasive temporomandibular joint (TMJ) surgery (MITMJS) are a promising tool for improving the safety of these procedures. Dental fixation of the template may lead to increased exposure to bacteria of the oral cavity Another drawback in the currently described templates is that they are designed to be utilized only through the preauricular approach. Visualization and instrumentation of the lateral and medial joint landmarks might be difficult to handle due to anatomical limitations This is a known surgical problem in arthroscopic TMJ surgery, which was addressed by Moses and Poker in 1989 [5]. They described an enaural approach to the TMJ leading to an increased field view and allowing for improved surgical handling
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