Single stage treatment of ankylosis of the temporomandibular joint using patient-specific total joint replacement and virtual surgical planning.
Ankylosis of the temporomandibular joint (TMJ) is a debilitating condition that can result in pain, trismus, and a poor quality of life. It can be caused by injury, infection, and rheumatoid disease. Current management includes gap arthroplasty, interpositional arthroplasty, and reconstruction. Traditionally, joints are reconstructed using stock implants, or the procedure is done in two stages with an additional computed tomography (CT) scan between the resective and reconstructive procedures and use of stereolithographic models to aid the design of the definitive prostheses. We describe a technique for the resection of ankylosis and reconstruction of the joint in a single operation using virtually designed custom-made implants. Five patients with ankylosis of the TMJ had a single stage operation with reconstruction between 2010 and 2012. All had preoperative high-resolution CT with contrast angiography. During an international web-based teleconference between the surgeon and the engineer a virtual resection of the ankylosis was done using the reconstructed CT images. The bespoke cutting guides and implants were designed virtually at the same time and were then manufactured precisely using computer-aided design and manufacture (CAD-CAM) over 6 weeks. After release of the ankylosis and reconstruction, the patients underwent an exercise regimen to improve mouth opening. Follow-up was for a minimum of 6 months. Four patients had one operation, and one patient had two. Median/Mean maximum incisal opening increased from 0.6mm before operation to 25 mm afterwards (range 23-27), and there was minimal surgical morbidity. This new method effectively treats ankylosis of the TMJ in a single stage procedure. Fewer operations and hospital stays, and the maintenance of overall clinical outcome are obvious advantages.
Dept. of Oral & Maxillofacial Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Jahrad
J
Haq
Dept. of Oral & Maxillofacial Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Nishma
N
Patel
Medical Modeling Inc., 17301 West Colfax Avenue, Suite 300 Golden, CO, USA.
Katherine
K
Weimer
Dept. of Oral & Maxillofacial Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK. Electronic address: shaun.matthews@nhs.net.
N Shaun
NS
Matthews
D000328:Adult; D000792:Angiography / Q000379:methods; D000844:Ankylosis / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000379:methods*; D001672:Biocompatible Materials / Q000737:chemistry; D001698:Biomedical Engineering / Q000379:methods; D002858:Chromium Alloys / Q000737:chemistry; D017076:Computer-Aided Design; D003287:Contrast Media; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011095:Polyethylenes / Q000737:chemistry; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D025321:Surgery, Computer-Assisted; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014584:User-Computer Interface
D001672:Biocompatible Materials; D002858:Chromium Alloys; D003287:Contrast Media; D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene
TMJ ankylosis; Temporomandibular joint; Total joint replacement; Virtual surgical planning