Abstract
BackgroundsThe purpose of this study is to discuss the total joint reconstruction surgery for a patient with recurrent ankylosis in bilateral temporomandibular joints (TMJs) using three-dimensional (3D) virtual surgical planning, computer-aided manufacturing (CAD/CAM)-fabricated surgical guides, and stock TMJ prostheses.Case presentationA 66-year-old female patient, who had a history of multiple TMJ surgeries, complained of severe difficulty in eating and trismus. The 3D virtual surgery was performed with a virtual surgery software (FACEGIDE, MegaGen implant, Daegu, South Korea). After confirmation of the location of the upper margin for resection of the root of the zygoma and the lower margin for resection of the ankylosed condyle, and the position of the fossa and condyle components of stock TMJ prosthesis (Biomet, Jacksonville, FL, USA), the surgical guides were fabricated with CAD/CAM technology. Under general anesthesia, osteotomy and placement of the stock TMJ prosthesis (Biomet) were carried out according to the surgical planning. At 2 months after the operation, the patient was able to open her mouth up to 30 mm without complication.ConclusionFor a patient who has recurrent ankylosis in bilateral TMJs, total joint reconstruction surgery using 3D virtual surgical planning, CAD/CAM-fabricated surgical guides, and stock TMJ prostheses may be an effective surgical treatment option.
Highlights
Ankylosis of the temporomandibular joint (TMJ) is a disabling condition in mastication, speech, facial expression, pain, and oral hygiene, resulting in compromise of patient’s quality of life [1, 2]
There are a variety of surgical options to manage the TMJ ankylosis including gap arthroplasty, interpositional arthroplasty, and total joint reconstruction [4]
When the total joint reconstruction surgery with alloplastic materials is planned, it would be necessary to combine the advantages of stock TMJ prosthesis and custom-made TMJ prosthesis: a single-stage approach, low-cost, more precise surgical outcome, and less operation timeconsuming
Summary
Ankylosis of the temporomandibular joint (TMJ) is a disabling condition in mastication, speech, facial expression, pain, and oral hygiene, resulting in compromise of patient’s quality of life [1, 2]. The objectives in the treatment of TMJ ankylosis are to restore the masticatory function, improve the facial esthetics and phonation, relieve the pain, and prevent the re-ankylosis [3]. There are a variety of surgical options to manage the TMJ ankylosis including gap arthroplasty, interpositional arthroplasty, and total joint reconstruction [4]. In case of recurrent bony ankylosis, gap arthroplasty or interpositional arthroplasty has limitations to be applied due to. The most frequently used alloplastic prosthetic device for total joint reconstruction is stock TMJ prosthesis and custom-made TMJ prosthesis [12]. The stock TMJ prosthesis system involves a two-stage protocol. During stage 1 surgery, the ankylotic bone is removed to create an adequate bony gap for placement of a spacer. After computed tomogram (CT) scan is taken, a stereolithographic model is fabricated to find the appropriate size
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