Condylar Position is Maintained in Maxillomandibular Advancement Surgery Utilizing Custom Cutting Guides and Plates.

PURPOSE: The objective of this study is to compare virtual surgical planned (VSP) and postoperative condylar positioning outcomes in patients who underwent maxillomandibular advancement surgery with custom mandibular cutting guides and osteosynthesis plates to establish reliability and effectiveness using these forms of technology. METHODS: An ambispective case series was performed by obtaining preoperative and postoperative computed tomography (CT) scans of obstructive sleep apnea patients who underwent maxillomandibular advancement surgery with VSP and custom printed mandibular cutting guides and plates at the San Francisco Veterans Affairs Healthcare System from February 2019 to October 2021. The primary predictor variables were the use of custom guides and plates compared to VSP over the course of a year. The outcome variable was the maintained condylar position, defined as the mean differences between the VSP and postoperative positioning. The comparison group was the preoperative VSP position. Covariates were planned surgical movements, age, and gender. Measurements were taken bilaterally in sagittal CT sections measuring the condylar positioning within the posterior space, superior space, and anterior space of the glenoid fossae. Similarly, coronal CT section measurements were taken to measure the condylar positioning within the coronal lateral space, coronal central space, and coronal medial space. A Wilcoxon signed rank test was used. RESULTS: This study included 6 male participants (n = 6) aged 32 to 57 years (mean 46.5). The median differences for the posterior space, superior space, and anterior space planned versus postoperative position were 0.25 (0.40), 0.40 (0.35), and 0.40 (0.55) mm, respectively. The median differences for the coronal lateral space, coronal central space, and coronal medial space planned versus postoperative position were 0.30 (0.30), 0.78 (0.70), and 0.40 (0.30) mm, respectively. There was no statistically significant difference in the planned and postoperative condylar position (Wilcoxon signed rank test, P > .5). A qualitative analysis showed little to no displacement or rotation of the condyle in the virtually planned and postoperative condylar positions. CONCLUSIONS: Qualitative and quantitative comparisons of the preoperative virtual surgical planned and the postoperative condylar position with the use of custom-printed mandibular cutting guides and plates support the null hypothesis that there is no difference between planned and postoperative positioning.

Electroporation technique for joint pain - Pilot feasibility study on TMD patients.

OBJECTIVE(S): It is well appreciated that traditional analgesic delivery routes used to treat pain associated with temporomandibular disorder (TMD) often have harmful unintended side effects as a consequence of systemic distribution. Further, localized delivery of analgesic medication via intra-articular injections involves a different set of issues limiting their clinical viability. As an option, transdermal analgesic delivery provides for prolonged pain relief and flexibility in dose administration, while limiting systemic exposure and minimizing adverse events. Incorporation of a novel electroporation technique may further increase transdermal drug penetration into synovial tissue/fluid and enhance pain reduction. The present feasibility study compares the effectiveness of an electroporation-enhanced transdermal application of diclofenac sodium to a conventional intra-articular injection of triamcinolone acetonide suspension (corticosteroids) to treat patients with TMD associated pain. METHODS: Pre- and post-treatment maximal incisal mouth opening (MIO), pain visual analog scale (VAS) and surface electromyography (EMG) of 22 patients treated with electroporation-enhanced diclofenac and 37 patients treated with corticosteroids injections were collected and analyzed. RESULTS: In general, patients treated with electroporation exhibited better results in terms of pain improvement (corrected p-value = .01) compared to the standard treatment, but both methods were similarly effective for improvement of MIO (corrected p-value = .71) and improvement of all EMG indices (corrected p-values ≥ .05). CONCLUSION: The enhancing effect of electroporation in transdermal delivery of diclofenac sodium was demonstrated by decreased pain, increase MIO and EMG improvement to normal values. Its analgesic and inflammatory results are comparable with standard treatment offered by corticosteroids.