A Modified Novel Technique for Condylar Positioning in Mandibular Bilateral Sagittal Split Osteotomy Using Computer-Assisted Designed and Computer-Assisted Manufactured Surgical Guides

Cortese, Antonio; Chandran, Ravi; Borri, Antonio; Cataldo, Emilio

doi:10.1016/j.joms.2019.01.014

Cited by 15 publications

(18 citation statements)

References 14 publications

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“…However, one of the major difficulties related to this surgical method is the repositioning of the residual condylar stump [30]. Repositioning of neocondyle on the proximal segment after condylar OC resection and orthognathic surgery is a critical factor influencing the maintenance of facial symmetry, stable occlusal relationship, and TMJ function [31]. Postoperative changes in the neocondyle position with respect to the glenoid fossa could lead to multiple undesirable effects, including internal derangement of the TMJ, loss of mandible contour, neocondyle absorption, and loss or reduction in occlusion and mastication [32].…”

Section: Discussionmentioning

confidence: 99%

A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma

Cao

et al. 2021

Orphanet J Rare Dis

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Background Mandibular condylar osteochondroma (OC) could lead to facial morphologic and functional disturbances, such as facial asymmetry, malocclusion, and temporomandibular joint dysfunction. However, after condylar OC resection, the inaccurate reposition of the neocondyle still needs to be solved. The purpose of this study was to explore the feasibility of the condylar osteotomy and repositioning guide to reposition the neocondyle in the treatment of patients with severe deformity secondary to condylar OC. Results Three patients with severe deformity secondary to OC of the mandibular condyle were enrolled in this study. With the aid of condylar osteotomy and repositioning guide, condylar OC resection and repositioning were carried out, and the accuracy and stability of these guides were evaluated. All patients healed uneventfully, and no facial nerve injury and condylar ankylosis occurred. Compared with the computerized tomography scans in centric relation before surgery and 3 days after surgery, the results showed that the facial symmetry was greatly improved in all the patients. Also, after the superimposition of the condylar segments before surgery and 3 days after surgery, the postoperative reconstructed condyles had a high degree of similarity to the reconstruction of the virtual surgical planning. Observed from the sagittal and coronal directions, the measurements of condylar positions were very close to those of virtual surgical planning. Moreover, it also showed stable results after a 1-year follow-up. Conclusions For patients with severe deformity secondary to condylar OC, condylar osteotomy, and repositioning guide was expected to provide a new option for the improvement of facial symmetry and occlusal relationship.

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Section: Discussionmentioning

confidence: 99%

A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma

Cao

et al. 2021

Orphanet J Rare Dis

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“…For the TMJ disc, previous FEA predicted mechanical stress distribution, fluid pressurization, and disc lubrication using elastic, nonlinear viscoelastic models [22][23][24] or poroelastic or biphasic mixture models [25,26]. In patients with chronic unilateral mastication and relapse, FEA for postoperative treatment strategy such as occlusal splint would also help to predict complications after the treatment [27]. However, the impact of joint loading on the TMJ disc in patients with TMD remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Finite elements analysis of the temporomandibular joint disc in patients with intra-articular disorders

et al. 2020

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Background: Intra-articular disorders (ID) or anterior and/or medial displacement of the temporomandibular joint disorder (TMJ) disc are the most common form of TMJ dysfunction (TMD). TMD causes changes in the friction coefficient during TMJ movement. Herein, we provided a three-dimensional (3D) finite-elements model (FEM) including the maxilla, disc, and mandible and evaluated the stress distribution with different friction coefficient. Methods: Fourteen volunteers without TMD and 20 patients with MRI-diagnosed TMD were selected. CT and MRI data were collected to build the 3D FEA model of the mandible and TMJ disc. Stress distribution with different friction coefficient was measured. Result: In the normal model, stress distribution on the TMJ disc was 2.07 ± 0.17, 1.49 ± 0.14, and 1.41 ± 0.14 MPa with 0.001, 0.3, and 0.4 friction coefficient, respectively. In the TMD model, stress distribution was 3.87 ± 0.15, 7.23 ± 0.22, and 7.77 ± 0.19 MPa respectively. Conclusion: When the friction coefficient of the side with anterior displacement increased, stress on the disc, condyle and mandible of the opposite side increased. Simultaneously, stress values of the disc, condyle and mandible were higher than those of the normal lateral joint.

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“…A possible evolution of the technique will consist of digital planning of the operation through also using custom made fixation plates, reducing in this way the incidence of fragment malposition [15].…”

Section: Discussionmentioning

confidence: 99%

Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases

et al. 2020

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Condylar neck and sub-condylar fractures of the mandible are a frequent occurrence in maxillofacial surgery. The indication for surgical treatment of these fractures has changed over time, and several techniques have been developed with different results in the attempt to avoid the most worrisome adverse event, i.e., facial nerve injury. In this study, we present a new technique that combines an intraoral and a cutaneous pre-auricular access, which allows for easy and safe access to the surgical site, preventing facial nerve injury and avoiding surgical scars in high-impact aesthetic areas of the neck. Five consecutive patients affected by condylar neck or sub-condylar fractures were treated at a single institution using a combined intraoral and pre-auricular access. Results were evaluated after three months from surgery in terms of mandibular mobility, occurrence of complications, and patient’s satisfaction. All five patients had good outcome, with complete healing of the fracture and no occurrence of complications, including no facial nerve palsy. A key point of the technique is the safe reduction of the two mandibular fragments realized by a combined intraoral and a cutaneous pre-auricular surgical access. The periosteal plan of the ramus can be widely and safely elevated with the intraoral approach and connected to the condylar bone plane by the pre-auricular cutaneous approach without any need for soft tissue dissection at the fracture rim, thereby avoiding facial nerve injuries. Wide ramus periosteum elevation creates an “optical space”, allowing fragment reduction and fixation under direct oblique view without any endoscopic need. Our results strongly suggest that with our technique it is possible to treat sub-condylar and condylar neck fractures safely, avoiding facial nerve injury, which is an unacceptable complication due to its heavy impact on a patient’s life.

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A Modified Novel Technique for Condylar Positioning in Mandibular Bilateral Sagittal Split Osteotomy Using Computer-Assisted Designed and Computer-Assisted Manufactured Surgical Guides

Cited by 15 publications

References 14 publications

A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma

A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma

Finite elements analysis of the temporomandibular joint disc in patients with intra-articular disorders

Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases

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