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Huang D, Zou L, Lu C, Zhao J, He D, Yang C. Simultaneous standard total joint prosthesis reconstruction with SSRO and Le Fort I osteotomy in the treatment of unilateral temporomandibular joint ankylosis with jaw deformity: a case cohort study. Clin Oral Investig 2024; 28:163. [PMID: 38383876 PMCID: PMC10881754 DOI: 10.1007/s00784-024-05543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Unilateral temporomandibular joint ankylosis with jaw deformity (UTMJAJD) may require simultaneous total joint prosthesis (TJP) reconstruction, sagittal split ramus (SSRO), and Le Fort I osteotomies. The purpose of this study was to evaluate outcomes in patients treated with these procedures. METHODS Patients diagnosed UTMJAJD between 2016 and 2018 were selected for the study. Mandible-first procedure was performed after ankylosis release with TJP on the ankylosed side and SSRO on the contralateral side. Le Fort I osteotomy with and without genioplasty was lastly performed. Maximal incisor opening (MIO), facial symmetry, and jaw and condyle stability were compared before, after operation, and during follow-ups. RESULTS Seven patients were included in the study. Their average chin deviation was 9.5 ± 4.2 mm, and maxillary cant was 5.1 ± 3.0°. After operation, jaw deformity significantly improved, with chin deviation corrected 7.6 ± 4.1 mm (p = 0.015) and advanced 5.9 ± 2.5 mm (p = 0.006). After an average follow-up of 26.6 ± 17.1 months, MIO significantly increased from 11.4 ± 9.3 to 35.7 ± 2.6 mm (p = 0.000). The occlusion was stable with no significant positional or rotational changes of the jaw (p > 0.05). There was no obvious condylar resorption during follow-ups. CONCLUSION Simultaneous TJP reconstruction, SSRO, and Le Fort I osteotomy are reliable and effective methods for the treatment of UTMJAJD.
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Affiliation(s)
- Dong Huang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Luxiang Zou
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Chuan Lu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Jieyun Zhao
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Dongmei He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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Amarista FJ, Perez DE. Concomitant Temporomandibular Joint Replacement and Orthognathic Surgery. Diagnostics (Basel) 2023; 13:2486. [PMID: 37568850 PMCID: PMC10416914 DOI: 10.3390/diagnostics13152486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The treatment of patients with severe temporomandibular joint (TMJ) disorders and associated skeletal discrepancies presents a complex challenge for oral and maxillofacial surgeons. It is widely recognized that TMDs can impact the stability and outcomes of surgical treatments for dentofacial deformities. Consequently, addressing TMDs prior to or in conjunction with orthodontic or surgical interventions may be necessary to achieve optimal and long-lasting results. Alloplastic temporomandibular joint replacement (TMJR) and orthognathic surgery have emerged as the standard approach due to their predictability, long-term stability and excellent outcomes when addressing end-stage TMJ disease in conjunction with DFDs as it provides a comprehensive solution to address both functional and aesthetic aspects of these patients' conditions. Understanding the appropriate utilization of TMJR in conjunction with orthognathic surgery can lead to improved treatment planning and successful outcomes for patients with complex TMJ disorders and associated dentofacial deformities. This review aims to discuss the indications, preoperative evaluation, staging, sequencing, and surgical considerations involved in utilizing alloplastic TMJ replacement in the presence of dentofacial deformities.
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Affiliation(s)
- Felix Jose Amarista
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, 8210 Floyd Curl Drive, Mail Code 8124, San Antonio, TX 78229, USA;
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Total Temporomandibular Joint Replacement and Simultaneous Orthognathic Surgery Using Computer-Assisted Surgery. J Maxillofac Oral Surg 2021; 20:394-403. [PMID: 34408366 DOI: 10.1007/s12663-020-01422-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
Abstract
Background Disorders of the temporomandibular joint (TMJ) are frequent and are usually associated with other disorders of the facial skeleton. Surgery might be needed to correct TMJ anatomy and function and, in cases where pathologies coexist, a two-stage corrective surgery might be needed. However, the current fashion of single-stage procedures is feasible with the aid of new technologies such as computer-assisted surgery (CAS). This is a step forward toward performing complex procedures such as a TMJ replacement with simultaneous orthognathic surgery. CAS allows designing patient-fitted prosthesis and more predictable and accurate surgeries. Moreover, intraoperative development can be controlled in real time with intraoperative navigation, and postoperative results can be measured and compared afterwards. Aims The primary purpose of this article is to present the protocol used in our institution for orthognathic surgery associated with unilateral and bilateral TMJ replacement with patient-fitted prostheses guided with CAS. Materials and methods We present two cases to illustrate our protocol and its results. Results In the first case, the difference in millimeters between planning and surgical outcomes was 1.72 mm for the glenoid component and 2.16 mm for the condylar prosthesis; for the second case, differences in the right side were 2.59 mm for the glenoid component and 2.06 mm for the ramus, and in the left side, due to the anatomy the difference was a little greater, without clinical significance. Conclusion Combined surgery of the midface and mandible with total TMJ replacement is feasible and beneficial for the patient. CAS facilitates the planning and design of custom-fit prosthesis and execution of these procedures.
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Luo E, He Z. [Treatment of dentofacial deformities secondary to condylar resorption]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:1-5. [PMID: 32037758 PMCID: PMC7184297 DOI: 10.7518/hxkq.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/02/2019] [Indexed: 02/05/2023]
Abstract
Treating dentofacial deformities secondary to condylar resorption is a remarkable clinical challenge. Combined orthodontic treatment and orthognathic surgery is currently the main treatment scheme and is often integrated with temporomandibular joint surgery or conservative treatment according to the severity of condylar resorption. This paper discussed the etiology, clinical features, imaging features, treatment options, and prophylaxis of condylar resorption.
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Affiliation(s)
- En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ze He
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Idiopathic condylar resorption. Br J Oral Maxillofac Surg 2018; 56:249-255. [DOI: 10.1016/j.bjoms.2018.02.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/28/2018] [Indexed: 11/23/2022]
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Kim YK. Complications associated with orthognathic surgery. J Korean Assoc Oral Maxillofac Surg 2017; 43:3-15. [PMID: 28280704 PMCID: PMC5342970 DOI: 10.5125/jkaoms.2017.43.1.3] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022] Open
Abstract
While most patients undergo orthognathic surgery for aesthetic purposes, aesthetic improvements are most often followed by postoperative functional complications. Therefore, patients must carefully decide whether their purpose of undergoing orthognathic surgery lies on the aesthetic side or the functional side. There is a wide variety of complications associated with orthognathic surgery. There should be a clear distinction between malpractice and complications. Complications can be resolved without any serious problems if the cause is detected early and adequate treatment provided. Oral and maxillofacial surgeons must have a full understanding of the types, causes, and treatment of complications, and should deliver this information to patients who develop these complications.
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Affiliation(s)
- Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
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Raberin M. [Orthognathic surgery: the incisor decompensation and its effect on articulation]. Orthod Fr 2016; 87:411-425. [PMID: 27938654 DOI: 10.1051/orthodfr/2016044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The surgical protocols are based on arches preparation before or immediately after the surgical phase. Incisor guides normalization is achieved by incisor decompensation in three dimensions. Place and extend of surgical movements depend on the incisor position obtained at the end of orthodontic preparation. Extraction versus non extraction depends on incisor position planning. Orthognathic surgery induces muscular and temporo-mandibular joint stress which can cause temporo mandibular dysfunction (TMD). OBJECTIVES This article studies relations between incisor decompensation amplitude, orthognathic surgical procedures and risk to create or to increase TMD. CONCLUSIONS Sagittal, vertical and transversal incisor decompensation impact to place and amplitude of surgical movements. Incisor decompensation does not seem to induce TMD during orthodontic preparation even if occlusal guide controls are lost. Temporo mandibular dysfunction degrees define surgical movements area, moderate specially mandibular surgical movements and incisor decompensation objectives.
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Donovan TE, Marzola R, Murphy KR, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: Report of the committee on scientific investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2016; 116:663-740. [PMID: 28236412 DOI: 10.1016/j.prosdent.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 02/07/2023]
Abstract
STATEMENT OF PROBLEM It is clear the contemporary dentist is confronted with a blizzard of information regarding materials and techniques from journal articles, advertisements, newsletters, the internet, and continuing education events. While some of that information is sound and helpful, much of it is misleading at best. PURPOSE This review identifies and discusses the most important scientific findings regarding outcomes of dental treatment to assist the practitioner in making evidence-based choices. This review was conducted to assist the busy dentist in keeping abreast of the latest scientific information regarding the clinical practice of dentistry. MATERIAL AND METHODS Each of the authors, who are considered experts in their disciplines, was asked to peruse the scientific literature published in 2015 in their discipline and review the articles for important information that may have an impact on treatment decisions. Comments on experimental methodology, statistical evaluation, and overall validity of the conclusions are included in many of the reviews. RESULTS The reviews are not meant to stand alone but are intended to inform the interested reader about what has been discovered in the past year. The readers are then invited to go to the source if they wish more detail. CONCLUSIONS Analysis of the scientific literature published in 2015 is divided into 7 sections, dental materials, periodontics, prosthodontics, occlusion and temporomandibular disorders, sleep-disordered breathing, cariology, and implant dentistry.
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Affiliation(s)
- Terence E Donovan
- Professor, Biomaterials, University of North Carolina School of Dentistry, Chapel Hill, N.C.
| | | | | | - David R Cagna
- Professor, Advanced Prosthodontics University of Tennessee Health Sciences Center, Memphis, Tenn
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Mehra P, Nadershah M, Chigurupati R. Is Alloplastic Temporomandibular Joint Reconstruction a Viable Option in the Surgical Management of Adult Patients With Idiopathic Condylar Resorption? J Oral Maxillofac Surg 2016; 74:2044-54. [PMID: 27186870 DOI: 10.1016/j.joms.2016.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR. PATIENTS AND METHODS A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse. RESULTS Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was -10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions. CONCLUSIONS Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.
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Affiliation(s)
- Pushkar Mehra
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston; Chief, Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA.
| | - Mohammed Nadershah
- Former Resident, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine and Boston Medical Center, Boston, MA; Assistant Professor, Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Radhika Chigurupati
- Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA
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Kuhlefelt M, Laine P, Thorén H. Bilateral sagittal split surgery is not a predictable treatment for temporomandibular dysfunction in patients with retrognathia. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:595-601. [PMID: 26948019 DOI: 10.1016/j.oooo.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/11/2015] [Accepted: 12/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A prospective study to clarify the impact of forward bilateral sagittal split osteotomy (BSSO) on temporomandibular dysfunction (TMD). STUDY DESIGN We examined and interviewed patients with BSSO before and at 1 year after surgery to evaluate the changes in TMD symptoms. A well-known TMD index, which incorporated two complementary subindices-the objective functional Helkimo dysfunction index (Di) and the subjective symptomatic anamnestic index (Ai)-was used. Patients with a forward movement of the mandible and osteosynthesis with titanic miniplates were included. RESULTS Forty patients (26 females and 14 males, mean age of study population 36.9 years) retrognathia completed the study. There was no change in TMD symptoms in 24 patients (60%), as measured by the Di, and 26 (65%), as measured by the Ai. Twelve patients improved (30%), according to the Di scores and 10 (25%) according to the Ai scores. Four patients had more TMD symptoms at follow-up (10%), as measured by both Di and Ai. CONCLUSIONS Surgery for orthognathia is a predictable treatment for improving aesthetics and occlusion but less predictable for alleviating TMD symptoms in patients with retrognathia. TMD symptoms should therefore be treated independently.
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Affiliation(s)
- Marina Kuhlefelt
- Consultant (Oral and Maxillofacial Surgery), Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
| | - Pekka Laine
- Professor, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Thorén
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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