Concomitant Custom-Fitted Temporomandibular Joint Reconstruction and Orthognathic Surgery
This chapter presents the diagnostic criteria, treatment planning, and surgical protocols for the application of computer-assisted surgical simulation (CASS) for patients requiring TMJ total joint replacement and orthognathic surgery (C-TJR-OS). The CASS
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Rishi Jay Gupta, Steven A. Schendel, and Larry Wolford
Abstract
This chapter presents the diagnostic criteria, treatment planning, and surgical protocols for the application of computer-assisted surgical simulation (CASS) for patients requiring TMJ total joint replacement and orthognathic surgery (C-TJR-OS). The CASS protocol decreases the preoperative workup time and increases the accuracy of model preparation and subsequent surgery.
10.1 Introduction Patients with temporomandibular joint (TMJ) pathology and coexisting dentofacial deformities can be corrected with concomitant TMJ and orthognathic surgery (C-TMJ-OS). Systematic TMJ and craniofacial analysis utilizing radiographic and clinical findings are critical in the decision-making on whether to proceed with isolated orthognathic surgery or in combination with total joint replacement (TJR). Surgical alterations utilizing C-TMJ-OS can help restore facial esthetics, improve R. J. Gupta (*) Department of Oral and Maxillofacial Surgery, San Francisco Veteran’s Affairs Health System, University of California San Francisco, San Francisco, CA, USA e-mail: [email protected] S. A. Schendel Stanford University, Stanford, CA, USA California Sleep Institute, East Palo Alto, CA, USA e-mail: [email protected] L. Wolford Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University College of Dentistry, Dallas, TX, USA e-mail: [email protected] © Springer Nature Switzerland AG 2019 S. T. Connelly et al. (eds.), Contemporary Management of Temporomandibular Disorders, https://doi.org/10.1007/978-3-319-99909-8_10
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airway and mastication function, provide a stable occlusion, and eliminate pain. C-TMJ-OS can be completed in one surgical stage or separated into two surgical stages. The two-stage approach requires the patient to undergo two separate operations (one surgery to correct the TMJ pathology and a second operation to perform the orthognathic surgery) and two general anesthetics, significantly lengthening the overall treatment time and increasing possible risks. Performing C-TMJ-OS in a single operation decreases treatment time, provides better clinical outcomes, but requires careful treatment planning and surgical proficiency in the two surgical areas. This chapter presents the diagnostic criteria, treatment planning, and surgical protocols for the application of computer-assisted surgical simulation (CASS) for patients requiring TMJ total joint replacement and orthognathic surgery (C-TJR-OS). The CASS protocol decreases the preoperative workup time and increases the accuracy of model preparation and subsequent surgery.
10.2 Indications for C-TJR-OS Temporomandibular joint (TMJ) disorders or pathology and dentofacial deformities commonly coexist. The TMJ pathology may be the causative factor of the jaw deformity or develop as a result of the jaw deformity, or the two entities may develop independent of each other. The most common TMJ pathologies that can adversely affect jaw position, occlusion,
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