Case report impact on orthognathic surgery for counterclockwise rotation and effect on airway, with or without temporomandibular joint total joint prostheses

Propósito: Presentar informes de casos que han generado nuevos protocolos de tratamiento que mejoran los resultados de los pacientes con deformidades mandibulares y compromiso de las vías respiratorias que requieren rotación en sentido contrario a las agujas del reloj (CCWR) del complejo maxilomandibular (MMC) con o sin necesidad de prótesis articular total (TJP) de la articulación temporomandibular (ATM). Se presentan estudios que verifican la eficacia de estos procedimientos. Métodos: Se identificaron presentaciones de casos iniciales en referencia a la CCWR de la MMC sin y con prótesis articular total de la ATM en casos de patología de la ATM coexistente en fase terminal. Se realizó una búsqueda bibliográfica no sistemática para identificar estudios pertinentes al tema. Resultados: Se presentan dos informes de casos que han afectado significativamente a nuestra especialidad: 1) CCWR de la MMC y efecto sobre las vías respiratorias, y 2) TJP de la ATM con osteotomías maxilares concomitantes para CCWR de la MMC. Se identificaron 40 artículos que cumplían los criterios filtrados. Veintinueve trabajos se excluyeron como informes de casos, filosofía, técnica o series de casos pequeñas. Once estudios cumplieron los criterios de inclusión y se resumen según los datos incluidos. Estos estudios validan la eficacia y estabilidad de la CCWR de la MMC en presencia de articulaciones sanas, así como en pacientes con patología de la ATM en fase terminal, utilizando la TJP personalizada de la ATM junto con la cirugía ortognática. Conclusiones: Los pacientes con ATM sana pueden ser tratados con CCWR de la MMC con resultados predecibles y estabilidad. Los pacientes con patología de la ATM en fase terminal pueden beneficiarse de la PTM de la ATM y la cirugía ortognática para la CCWR de la MMC con buena estabilidad, mejor función, disminución del dolor, mejora de las vías respiratorias y de la calidad de vida. © 2023Purpose: Present case reports that have generated new treatment protocols improving treatment of patient outcomes with jaw deformities and airway compromises requiring counterclockwise rotation (CCWR) of the maxillo-mandibular complex (MMC) with or without a requirement for temporomandibular joint (TMJ) total joint prostheses (TJP). Presented are studies that verify the efficacy of these procedures. Methods: Initial case presentations were identified in reference to CCWR of the MMC without and with TMJ total joint prostheses in cases of co-existing end-stage TMJ pathology. A non-systematic literature search was conducted to identify studies pertinent to subject matter. Results: Two case reports are presented that have significantly affected our specialty: 1) CCWR of the MMC and effect on airway, and 2) TMJ TJP with concomitant maxillary osteotomies for CCWR of the MMC. Forty papers were identified meeting the filtered criteria. Twenty-nine papers were excluded as case reports, philosophy, technique, or small case series. Eleven studies met the inclusion criteria and are summarized according to the data included. These studies validate the efficacy and stability of CCWR of the MMC in the presence of healthy joints as well as patients with end-stage TMJ pathology using custom TMJ TJP in conjunction with orthognathic surgery. Conclusions: Patients with healthy TMJs can be treated with CCWR of the MMC with predictable outcomes and stability. Patients with end-stage TMJ pathology can benefit from TMJ TJP and orthognathic surgery for CCWR of the MMC with good stability, improved function, decreased pain, improved airway, and quality of life. © 202

Cone beam computed tomography-based models versus multislice spiral computed tomography-based models for assessing condylar morphology

To quantitatively compare condylar morphology using CBCT and MSCT virtual 3D surface models

Surgical correction of the severe jaw deformity in teenagers with juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) can create severe jaw deformities affecting function, esthetics and psychosocial health of teenagers afflicted with this disease. The aim of this chapter is to present the dentofacial manifestations of this disease and the proven surgical protocol to correct these debilitating deformities. Clinical and imaging characteristics of JIA patients with temporomandibular joint (TMJ) involvement and severe jaw deformities are presented as well as the surgical protocol to produce predictable stable outcomes. Clinical research studies documenting the efficacy of this surgical protocol will be reviewed. The most predictable, successful, and stable surgical protocol to treat JIA patients with severe dentofacial deformities includes: bilateral TMJ reconstruction and mandibular counterclockwise rotation-advancement with patient-fitted TMJ total joint prostheses (TJP) and concomitant maxillary osteotomies, as well as adjunctive procedures, performed in a single operation. This protocol provides improvement in jaw function, facial esthetics, pain, and airway. Research studies document the predictability of the treatment protocol. Case presentations illustrate the deformity and the expected outcomes with this surgical protocol. Patient-fitted TJP for TMJ and mandibular reconstruction in conjunction with maxillary orthognathic surgery provides long-term skeletal and occlusal stability in the JIA patient as well as improvement in jaw function, pain, esthetics and airway