title: Custom Anatomical 3D Spacer for Temporomandibular Joint Resection and Reconstruction.
abstract: Two cases are presented using a two-stage approach and a custom antibiotic spacer placement. Temporomandibular reconstruction can be very demanding and accomplished with a variety of methods in preparation of a total joint and ramus reconstruction with total joint prostheses (TMJ Concepts, Ventura, CA). Three-dimensional reconstructions from diagnostic computed tomography were used to establish a virtually planned resection which included the entire condyle-ramus complex. From these data, digital designs were used to manufacture molds to facilitate intraoperative fabrication of precise custom anatomic spacers from rapidly setting antibiotic-impregnated polymethyl methacrylate. Molds were manufactured using vat polymerization (stereolithography) with a photopolymer in the first case and powder bed fusion (electron beam melting) with Ti6AL4V for the second. Surgical methodology and the use of molds for intraoperative spacer fabrication for each case are discussed.
authors.affiliation: Department of Oral Maxillofacial Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: John Marshall
authors.initials: JM
authors.lastname: Green
authors.affiliation: Department of Oral Maxillofacial Surgery, Naval Hospital Bremerton, Bremerton, Washington.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Lawson
authors.affiliation: Department of Radiology, 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Liacouras
authors.affiliation: Department of Oral Maxillofacial Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Wise
authors.affiliation: Department of Oral Maxillofacial Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gentile
authors.affiliation: Department of Radiology, 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Gerald Thomas
authors.initials: GT
authors.lastname: Grant
keywords: 3D printing; TMJ Concepts; additive manufacturing; antibiotic spacer; joint resection; virtual surgery