title: Successful reconstruction of nongrowing hemifacial microsomia patients with unilateral temporomandibular joint total joint prosthesis and orthognathic surgery.
abstract: OBJECTIVE
  Traditionally, patients with hemifacial microsomia (HFM) and significant ipsilateral hypoplasia or absence of the condyle and ramus undergo reconstruction on the ipsilateral side with autogenous tissues such as rib grafts, often with compromised results. This study analyzed the surgical treatment outcomes of nongrowing patients with HFM and reconstruction of the ipsilateral temporomandibular joint (TMJ) and advancement of the mandible with a patient-fitted TMJ total joint prosthesis (TMJ Concepts, Inc, Ventura, CA), a contralateral mandibular ramus sagittal split osteotomy, and maxillary osteotomies performed in 1 operation.
  
  
  METHODS
  All nongrowing patients with HFM treated with this surgical protocol from 1997 to 2010 in a single private practice were included in this study and subjectively evaluated before surgery and at the longest postsurgical follow-up for pain, diet, jaw function, and disability using a visual numerical scale (0 to 10). Surgical changes and postsurgical stability were analyzed using lateral cephalograms before surgery, immediately after surgery, and at the longest follow-up.
  
  
  RESULTS
  Six patients (4 female and 2 male) were included in this study, with an average age at surgery of 23.5 years (range, 14 to 39 yrs) and an average follow-up of 6 years 3 months (range, 1 yr to 11 yrs 4 mo). For all subjective parameters, all patients improved or remained the same. Incisal opening improved or remained the same in 4 of the 6 patients, with 2 patients having decreased opening. Excursive movements decreased. The maxillomandibular complex was surgically rotated counterclockwise, advanced, and transversely leveled, with the anterior maxillary reference points (anterior nasal spine, point A) undergoing relative small movements. The mandibular incisor tips (lower incisor tips) advanced a mean of 8.9 mm, point B 14.8 mm, pogonion 18.6 mm, menton 17.5 mm and the occlusal plane angle decreased -12.3°. Postsurgical long-term stability indicated that the anterior maxillary references changed a significant amount, whereas all horizontal and vertical anterior mandibular measurements (lower incisor tip, point B, pogonion, menton) and the occlusal plane showed no significant changes.
  
  
  CONCLUSIONS
  The TMJ Concepts total joint prosthesis in conjunction with orthognathic surgery for TMJ and jaw reconstruction in nongrowing patients with HFM is highly predictable for skeletal and occlusal stability, comfort, TMJ function, and improved facial balance.
authors.affiliation: Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas, TX, USA. Lwolford@swbell.net
authors.forename: Larry M
authors.initials: LM
authors.lastname: Wolford
authors.forename: T Campbell
authors.initials: TC
authors.lastname: Bourland
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodrigues
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Perez
authors.forename: Evelin
authors.initials: E
authors.lastname: Limoeiro
mesh_terms: D000293:Adolescent; D000328:Adult; D002508:Cephalometry / Q000379:methods; D002680:Chin / Q000473:pathology; D003766:Dental Occlusion; D004032:Diet; D005146:Facial Asymmetry / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007180:Incisor / Q000473:pathology; D007595:Joint Prosthesis; D008297:Male; D008334:Mandible / Q000473:pathology; D019186:Mandibular Advancement / Q000379:methods; D008437:Maxilla / Q000473:pathology; D063166:Maxillary Osteotomy / Q000379:methods; D009295:Nasal Bone / Q000473:pathology; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D010347:Patient Care Planning; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult