Template-based temporomandibular joint puncturing and access in minimally invasive TMJ surgery (MITMJS) – a technical note and first clinical results

Abstract

Background Minimally invasive temporomandibular joint surgery (MITMJS) is an option for patients suffering from severe internal derangement or adhesions. To improve TMJ access, a workflow to create surgical templates is introduced. Methods A workflow to generate a dividable patient specific template based on CBCT and optical scanning to access the joint is introduced. In a first clinical trial 3 patients (6 joints) were treated by way of template-guided endoscopically-assisted TMJ therapy (3 arthrocenteses and 3 arthroscopies). Results Generation and clinical use of the templates was as planned. All templates showed perfect fit and permitted instant access to the TMJ. All surgeries were performed without complications. Conclusions Template-guidance could improve the feasibility of endoscopically-assisted TMJ therapy. An important issue is the capability to dis- and remount the template during surgery. Using in-house production, costs are affordable. Trial registration This study was registered at the Ethic Committee of the Berlin Medical Chamber ( Eth-30/17 , 12/06/2017).

Improved Access in Minimally Invasive Temporomandibular Joint Surgery via A Novel Endaural Template

“…The alignment was directed to the upper joint space (Figure 4). 4. Finally, the template was manufactured using a 3D printer (Formlab 2; Formlabs Inc., Somerville, USA),) and a CE certi ed biocompatible photopolymer resin (Dental SG Resin; Formlabs, Somerville, USA) ( gure 5).…”

“…To simplify and standardize the approach, we have previously described the use of a computer aided designed and computer aided manufactured (CAD-CAM) template for TMJ-surgery in 2019, yet several modi cations have been proposed to this promising technology. [4] Most of the described modi cations require a 3D imaging (e.g. CT, cone beam CT, MRI) of the corresponding TMJ and the surrounding tissue, in addition to an optical three-dimensional (3D) scan of the face.…”

Improved Access in Minimally Invasive Temporomandibular Joint Surgery via a Novel Endaural Template

“…4). 4. Finally, the template was manufactured using a 3D printer (Formlab 2; Formlabs Inc., Somerville, USA),) and a CE certi ed biocompatible photopolymer resin (Dental SG Resin; Formlabs, Somerville, USA) ( Fig.…”

“…To simplify and standardize the approach, we have previously described the use of a computer aided designed and computer aided manufactured (CAD-CAM) template for TMJ-surgery in 2019, yet several modi cations have been proposed to this promising technology. [4] Most of the described modi cations require a 3D imaging (e.g.…”

Improved access in minimally invasive temporomandibular joint surgery through a novel endaural template

“…To simplify and standardize the approach, we described the use of a computer-aided designed and computer-aided manufactured (CAD-CAM) template for TMJ surgery in 2019, yet several modifications have been proposed to this promising technology. [ 4 ] Most of the described modifications require 3D imaging (e.g., CT, cone beam CT, MRI) of the corresponding TMJ and the surrounding tissue, in addition to an optical three-dimensional (3D) scan of the face. Out of these data, a stereolithic template was designed.…”