Ultrasonic Resorbable Fixation (Sonic Weld) in Augmentation Eminoplasty With Calvarial Grafts for Recurrent TMJ Dislocation

Abstract

To assess long-term efficacy and performance of SonicWeld ultrasonic resorbable fixation (KLS Martin, Germany) system in augmentation eminoplasty (Dautrey's procedure) with calvarial block grafts for recurrent condylar dislocations. 5 female patients with mean age of 48 years were operated under nasotracheal general anesthesia. Preoperative 3-D reconstruction CT images were obtained and resorptions of articular eminences were assessed by Mimics software (Materialise, Belgium). Mean vertical height of articular eminences was 6 mm vertically. Hemicoronal flaps were raised accordingly to skeletonize the temporo-parietal calvarium and the articular eminence of zygomatic bone. One patient underwent bilateral augmentation while others had unilateral operations. A standard Dautrey's approach was performed with a sagital saw (NSK, Japan) and the eminences were fractured transversely. The calvarial grafts were harvested according to planned augmentation of articular eminences and tapped into osteotomy sites. SonicWeld pin 13-mm in length was used to fix the inferior osteotomized segment with a harvested calvarial graft to the superior stump. Dietary restriction and soft diet (Regime I) was prescribed to all patients for 4 weeks. Objective analysis with patient follow-up using CT scans and mouth opening (12 months). All inferior bone stumps and interpositional calvarial grafts were fixed satisfactorily with a SonicWeld pin. Acute positive response from operations was obtained immediately at the early post-op period. None of the patients experienced an episode of dislocation in the following 12 months of post-op period. Mean mouth opening was 31 mm. All patients had transient trismus for 2 weeks immediately after surgeries. Two patients had transient facial nerve neuropraxia for 5 weeks. The mean vertical height of the augmented articular eminences was 1.6 cm. TheSonicWeldpins resorbed completely at the 1st year follow-up CT scans. Fixation of cortical calvarial grafts in augmentation eminoplasty with SonicWeld system offers few advantages such as complete resorption of screws at augmented region in particular period and adequate fixation of osteotomy stumps and interpositional grafts avoiding intermaxillary fixation.