Jennifer, A Caughey, DMD
| Jennifer, A Caughey, DMD |
Jennifer A Caughey, Eric Granquist
Oral and Maxillofacial Surgery, University of Pennsylvania Dental Medicine
Introduction
Maxillofacial surgery has been revolutionized by the introduction of virtual surgical planning (VSP), custom printed hardware, and custom cutting guides. Adoption of these newer technologies in temporomandibular surgery has included the use of VSP to allow for the design and manufacturing of customized TMJ prostheses, as well as custom surgical guides. While custom guides have the potential to increase precision in osteotomies and device placement, they also have been shown to lead to operative errors due to factors such as lacking well-defined borders for bony resections, or interference from the soft-tissue envelope [2]. Real-time intraoperative navigation has additionally been employed for increased precision in device placement; however, this type of navigation cannot track a mobile mandible, limiting its use in ankylosis resection once the mandible is freed from the skull base. The use of intraoperative CT (ICT) has not been widely reported for use in TMJ surgery. The small sample size of studies that have investigated ICT for TMJ surgery have primarily focused on its utilization for accurate bone removal during the treatment of ankylosis and verification of the positioning of implants and screws in TMJ replacement [1]. The purpose of this case series is to further explore the utility and efficacy of ICT in TMJ surgery.
Methods
A retrospective, observational case series was conducted on patients who had ICT performed intraoperatively during TMJ surgery.
Results
Outcomes are descriptive and include changes of device positioning during surgery, difference between pre- and postoperative positioning, gap between the bone and fossa, gap between the metal and skull base, etc.
Conclusion
The use of ICT in TMJ surgery should continue to be further explored, as its utilization may improve surgical outcomes and minimize the need for repeat operations. The increased use of custom hardware calls for increased intraoperative precision, as any changes in device positioning are amplified when using custom devices, which are inherently dependent on the correct placement of one another. Additionally, TMJ surgery poses a particular challenge in the fact that real-time intraoperative management is tasked with the tracking of a mobile mandible throughout the duration of the procedure.