Minimally invasive intraoral proportional condylectomy with a three-dimensionally printed cutting guide

Facial Asymmetry-Demystifying the Entity

Introduction/Background

Perfect facial symmetry has always been considered a hallmark of beauty, but, is almost elusive in nature. However, clinically evident skeletal facial asymmetry on the other hand is quite common, which can result from congenital deformities, developmental abnormalities, secondary to maxillofacial trauma and it is an entity maxillofacial surgeons deal with on a regular basis. Surgical correction of facial asymmetry is challenging, as it not only involves the correction of the skeletal asymmetry for an aesthetic outcome, but, also the improvement of the soft tissue drape and dental occlusal harmony. This results in rehabilitation of functional components of orofacial complex like speech, deglutition and phonation.

Objective

With this paper, we intend to throw a light on this challenging aspect of maxillofacial surgery, along with giving the next generation of maxillofacial surgeons a direction to explore the topic further.

Conclusion

Meticulous evaluation and diagnosis of the patient's problems with latest diagnostic methods like 3-dimensional imaging and surgical treatment with orthognathic surgery, gap arthroplasty or distraction osteogenesis, utilizing cutting edge 3-D virtual planning will result in better outcomes.This review will collate the information available in the literature, along with the authors' recommendations for better planning and execution of this challenging puzzle of facial asymmetry.

Piezoelectric Condylectomy Through Transoral Endoscopic Approach: A Cadaveric Study

Surgical approaches in the treatment of TMJ pathologies are a much-debated topic in literature. We propose a new surgical approach performed by intraoral access and completed by endoscopic magnification and long-tip piezosurgery assistance. A piezosurgery (Piezosurgery Plus, Mectron s.p.a. 2014) with a long angled tip (MT5-10 L) was used to perform an endoscopically assisted condylectomy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03168-0.

The learning curve of transoral condylectomy; a retrospective analysis of 100 consecutive cases of unilateral condylar hyperplasia

In this study, 100 consecutive scheduled transoral condylectomies for unilateral condylar hyperplasia were included. The safety and surgical performances were assessed, using the operating time, conversion rate and complication rate. The conversion rate learning curve was evaluated with a learning curve cumulative summation (LC-CUSUM). The total conversion rate was 8.0%. The LC-CUSUM for conversion signaled at the 53th procedure, indicating sufficient evidence had accumulated that the surgeon had achieved competence. For procedures 54-100, the conversion rate was 4.0%. The operating time for the transoral condylectomy was 41.5 ± 15.3 min; when a conversion was necessary, the operating time was 101.4 ± 28.3 min (p < 0.05). The estimated operating time in the post-learning phase was 37 min, this was reached after approximately 47 procedures. There was 1 major complication of a permanent inferior alveolar nerve hypoesthesia. The complication rate was not significantly decreased after the learning curve. Within the limitations of the study, it seems that transoral condylectomy for UCH is a safe procedure with several advantages over the traditional preauricular approach. Surgeons starting this procedure should be aware of the potential complications and of the learning curve of approximately 53 procedures.

In-House, Fast FDM Prototyping of a Custom Cutting Guide for a Lower-Risk Pediatric Femoral Osteotomy

Three-dimensional printed custom cutting guides (CCGs) are becoming more and more investigated in medical literature, as a patient-specific approach is often desired and very much needed in today’s surgical practice. Three-dimensional printing applications and computer-aided surgical simulations (CASS) allow for meticulous preoperatory planning and substantial reductions of operating time and risk of human error. However, several limitations seem to slow the large-scale adoption of 3D printed CCGs. CAD designing and 3D printing skills are inevitably needed to develop workflow and address the study; therefore, hospitals are pushed to include third-party collaboration, from highly specialized medical centers to industrial engineering companies, thus increasing the time and cost of labor. The aim of this study was to move towards the feasibility of an in-house, low-cost CCG 3D printing methodology for pediatric orthopedic (PO) surgery. The prototype of a femoral cutting guide was developed for its application at the IOR—Rizzoli Orthopedic Institute of Bologna. The element was printed with an entry-level 3D printer with a high-temperature PLA fiber, whose thermomechanical properties can withstand common steam heat sterilization without bending or losing the original geometry. This methodology allowed for extensive preoperatory planning that would likewise reduce the overall surgery time, whilst reducing the risks related to the intervention.