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Temporomandibular joint (TMJ) lesions, when large and extensive, will often involve skull base destruction and result in extensive resections, requiring a challenging reconstruction. This study introduces a special type of craniomaxillofacial prosthesis for massive combined skull base-TMJ lesions. Patients who presented with combined skull base-TMJ lesions were recruited. Enhanced computed tomography (CT) data were obtained for all patients and transformed into three-dimensional (3D) reconstruction models. The combined skull base-TMJ prosthesis was designed and fabricated with a customized principle by 3D-printing technology. Clinical follow-up and radiographic evaluations were performed to assess the feasibility of the combined prosthesis in clinical application. A series of five consecutive patients were included in this study. No severe complications occurred after surgery. Based on a mean follow-up period of 13.8 months, the preliminary results suggest that the combined prosthesis has a positive impact on clinical outcomes: there was a mean 75.0% reduction in pain, 55.6% improvement in diet, 54.5% improvement in mandibular function, and 33.6% increase in mouth opening, with significant differences when compared with the preoperative state (all P

The aim of this study was to compare the surgical outcomes of deep lateral orbital decompression using the rim-sparing technique versus the rim-removal technique in Graves’ orbitopathy (GO). A retrospective cohort study of 75 orbits in 50 patients with GO was performed. Proptosis, best corrected visual acuity (BCVA), intraocular pressure (IOP), upper and lower lid margin to reflex distances (MRD-1 and MRD-2, respectively), diplopia, ocular restriction, and GO quality of life (GO-QOL) questionnaire results were analyzed pre- and postoperatively. The average proptosis reduction ranged from 3.5 mm to 6.7 mm with the rim-sparing technique and from 3.6 mm to 6.7 mm with the rim-removal technique ( P > 0.05). All orbits with dysthyroid optic neuropathy in the rim-sparing group and 87.5% of such orbits in the rim-removal group showed improved BCVA ( P = 0.321). Reductions in IOP, MRD-1, and MRD-2 were observed with both techniques. Patients in the rim-sparing group had greater improvements in GO-QOL appearance score ( P = 0.043). In conclusion, rim-sparing orbital decompression provides efficacious outcomes with greater improvements in patient quality of life than the rim-removal technique. The rim-sparing technique should be considered as a preferable option because it preserves the integrity of the lateral vertical maxillary buttress and bony protection for the orbital contents.

The aim of this study was to evaluate the validity of navigation-guided en bloc tumour resection and defect reconstruction in the treatment of craniomaxillary bony tumours. Three patients with ossifying fibroma and two patients with fibrous dysplasia were enrolled in this study. After preoperative planning and three-dimensional simulation, the osteotomy lines for resection were delineated and the normal anatomic structures for defect reconstruction were ascertained. With the guidance of an Accu-Navi navigation system, an en bloc tumour resection and simultaneous defect rehabilitation were performed. The system provided continuously updated information on the position and movement of surgical instruments in the operating field in relation to the preoperative imaging data set. The system error measured by the computer did not exceed 1 mm. The osteotomy lines and reconstruction contour were checked by postoperative computed tomography, and good matching with the preoperative planning was achieved. Patients showed no signs of tumour recurrence or prosthesis infection during follow-up (range 12–35 months). Image-guided navigation makes radical bone tumour resection more reliable by implementing preoperative planning, showing the determined safety margins, preserving vital structures and guiding reconstruction.

An unusual case of ossifying fibroma involving the right temporomandibular joint (TMJ) in a 7-year-old girl is presented. The treatment protocol comprised TMJ reconstruction with a costochondral graft following radical tumour resection, with the use of both pedicled and free fat grafts to improve the surgical outcome. Pathological examination confirmed the diagnosis. Aspects of the treatment are discussed.

The purpose of this study is to investigate the diagnostic accuracy of magnetic resonance arthrography (MRAr) on the diagnosis of intraarticular adhesions of the temporomandibular joint (TMJ). Twenty-four patients (31 joints) diagnosed as internal disorders of TMJ were examined to establish the presence, suspicion or absence of intraarticular adhesions through MRAr according to the MRAr radiographic criteria in a blind fashion, subsequent arthroscopy were performed on all 31 joints. The findings were compared to MRAr with those of arthroscopy. The comparison data were assessed by generating receiver operating characteristic curve (ROC curve) and analyzing the area (Az) under the curve with SPSS11.0 software. The area under the ROC curve was 0.91 (0.86, 0.95), P < 0.05. MRAr proves to be an excellent modality to diagnose intraarticular adhesions of TMJ.

PURPOSE:To establish a computer-assisted three-dimensional(3-D) virtual surgical planning and simulation system for orthognathic surgery.METHODS: Craniomaxillofacial bone 3-D model was constructed using contiguous series of computer tomography(CT) axial images.Le Fort Ⅰ osteotomy,bilateral sagittal split ramus osteotomy(BSSRO) and genioplasty were performed on the 3-D model with Simplant software.Tree-structure model of craniomaxillofacial bone was established.Virtual orthognathic surgery on the computer-generated 3-D craniomaxillofacial model was simulated.RESULTS: The virtual reality(VR) workbench was used in surgical planning and simulation.Surgeons immersed in a VR environment with stereo glasses,operated on "real" patient(3-D visualization) to simulate orthognathic surgery(3-D bony segment rotation and movement).The model can be visualized from any arbitrary viewing point and the interaction between operator and model,concomitant with image and tactile perception feedback was realized.CONCLUSIONS: Craniomaxillofacial 3-D virtual surgical simulation system can help orthognathic surgical planning,simulation and operation training.Surgical simulation with real-time image and tactile perception feedback was realized in VR.

PURPOSE: To summarize the findings of imaging studies and arthroscopy in patients with septic arthritis of temporomandibular joint who were managed with arthroscopy,and to recommend the operative procedures for acute and chronic stage.METHODS: Seven patients were included in this study.Their demographics,predisposing factors,clinical manifestation,imaging findings,joint aspiration,joint fluid culture,arthroscopic findings,treatments,and outcomes were collected and analyzed.RESULTS: The common symptoms were trismus and pain.Series of imaging studies showed widening of joint space in 1 patient with plain film;MRI demonstrated increased joint effusion in 4 patients;accompanied cellulitis in adjacent tissues was discerned by CT in 2 patients;under arthroscope,the reddened and swollen synovial membrane was found in 2 patients who were in acute stage,while severe adhesions,destruction of cartilage and bony defects were discovered in other 5 patients in chronic stage.Additionally,the disc was ruptured in 3 patients,and fibrosis was confirmed for 2 patients.Lavage,lysis of adhesion and debridement of articular surface were common procedures for treatments.The average follow-up period was 57.4 months,and no recurrence was found.CONCLUSION: Arthroscopy is proved to be a useful method for management of septic arthritis of TMJ,especially for the patients in chronic stage.