Surgical Guides and Prebent Titanium Improve the Planning for the Treatment of Dentofacial Deformities Secondary to Condylar Osteochondroma

Abstract

Purpose: To investigate current Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technologies applied in the treatment of dentofacial deformities secondary to condylar osteochondroma and introduce a modified method with additional pre-bent titanium miniplates to improve the accuracy of operation. Methods: Literature review about the application of CAD/ CAM in the treatment of condylar osteochondroma and secondary dentofacial deformities was conducted. And 8 patients with condylar osteochondroma and secondary dentofacial deformities were treated by the CAD/CAM cutting and drilling surgical guides as well as pre-bent titanium miniplates. Pre-and post-operative 3D-cephalometric measurement were recorded and the difference between virtual simulation and postoperative modeling images was measured. Follow-up and radiographic examinations were performed. Results: A total of 17 studies (including 216 patients) about the application of CAD/CAM in the treatment of dentofacial deformities secondary to condylar osteochondroma have been reported since 2010, including the 8 present patients. In our study, all patients were satisfied with the surgical outcome, without obvious relapse or evidence of temporomandibular joint disorder or other complications during follow-up; all patients avoided condylar reconstruction and sagittal split of ramus osteotomy on the ipsilateral mandible side. Comparison between simulated plans and actual postoperative outcomes showed surgical simulation plan was accurately transferred to the actual surgery. Conclusions: The application of CAD/CAM cutting and drilling guides as well as pre-bent titanium plates could achieve more accurate and favorable outcomes, improving the clinical planning and surgical execution for patients with condylar osteochondroma and secondary dentofacial deformities.

Total Joint Replacement for Immediate Reconstruction following Ablative Surgery for Primary Tumors of the Temporo-Mandibular Joint

“…In our cases, osteochondroma was suspected given the clinical characteristics of the lesion. The changes in occlusion with unilateral posterior open bite and contralateral crossbite were related to the anatomical location of the tumor and were due to the alteration of the vertical dimension [4][5][6][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

“…There is little literature available on their characteristics and outcomes; thus, experience in the treatment of tumors and tumoral lesions in this anatomical area is limited. There are several types of tumors that can affect the TMJ, as any other joint, including benign tumors, such as osteochondroma (Figures 1-3), osteoma, osteoblastoma, chondroma, chondroblastoma, non-ossifying fibroma, hemangioma or lipoma, as well as malignant tumors such as synovial sarcoma, osteosarcoma, Ewing sarcoma or chondrosarcoma (Figure 4) [1,2,5,9,11,[21][22][23][24][25][26][27][28][29][30][31]. The wide variety of primary tumors of the TMJ indicates the great range of possible treatments, with most of them based on surgical intervention (Table 2).…”

Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma

“…In recent years, computer-aided surgery (CAS) in the field of oral and maxillofacial treatment and the virtual planning of craniofacial surgical procedures are becoming increasingly popular [ 1 , 2 , 3 ]. Individualized 3D-printed templates and models, as an important computer-assisted surgery technology, is often applied for preoperative simulation, osteotomy, and occlusal reconstruction [ 2 , 4 ].…”