In-and-out Technique: An In-house Efficient Predictive Hole Fabrication Workflow.

Virtual surgical planning (VSP) and three-dimensional (3D) printing can increase precision and reduce surgical time in craniofacial reconstruction. However, the elevated cost and manufacturing time of outsourced workflows is increasing the development of in-house solutions. One of the main challenges in in-house workflows is to create cutting guides that hold plate position information. This is due to the fact that hospitals usually lack the infrastructure required to design and 3D print custom-made plates. Including plate-positioning information in resection guides is especially relevant in complex reconstructions and when tumor extension limits plate placement before resection. Current in-house workflows revolve around the idea of 3D scanning the bent plate's shape and to fuse it with the VSP. The goal of this article is to share our technique to transfer plate position information to resection guides. Our protocol uses a 3D model of the reconstruction as an intermediate step to transfer the plate position of a bent stock reconstruction plate to cutting guides. Two patients who required mandibular reconstruction with fibula flap are presented to illustrate the technique. This workflow requires a 3D-printed model of the desired outcome, cutting guides, and a stock plate. Results were satisfactory in terms of cutting location and angulation, plate adaptation and condylar position. This technique allows for a simple, safe, cheap, and quick alternative to add reconstruction plate information to cutting guides.

"Management of recurrent temporomandibular dislocation using orthodontic traction screws."

Temporomandibular joint dislocation is defined as the loss of joint congruency between the mandibular condyle and the glenoid fossa of the temporal bone. Multiple therapeutic options have been proposed for the treatment of recurrent TMJ dislocation. The aim of this paper is to present two recently treated cases with a modification of Wolford's technique, replacing the Mitek anchors with orthodontic screws. Case series: The first case concerns a 36 year-old women with recurrent temporomandibular dislocation, and the second one a 26 year-old patient with the same diagnosis. In both cases, one 8mm orthodontic screw was placed in the lateral pole of mandibular condyle, sutured with PremiCron® 2/0 to a hole made in the root of each zygomatic arch. At twelve-month follow-up (first patient) and at six-month follow-up (second patient), patients had not presented new episodes of mandibular dislocation and mouth opening range remained stable. This technique can be considered as an alternative to Wolford's technique in treating recurrent temporomandibular dislocation when conservative management fails.