ABSTRACT
The authors aim to present an updated protocol for mandibular reconstruction in nongrowing patients with Pruzansky/Kaban type IIb/III congenital craniofacial microsomia with customized temporomandibular joint (TMJ) prosthesis to reduce facial nerve (FN) damage and improve surgical accuracy. This is illustrated (using 3 cases) and is based on preoperative mapping of the FN using MRI for better virtual surgical planning of custom-made TMJ prosthesis. Intraoperative FN mapping and monitoring, as well as verification of the final result with intraoperative cone-beam computed tomography (CBCT) and 3D-reconstructed images is also achieved. All 3 patients presented mild transient postoperative facial palsy due to surgical soft tissue stretching which resolved within 2 months of surgery. All patients presented proper occlusion and mouth opening without pain, with an average incisal opening of 38.8 mm (range 35.5-42 mm) at two months of follow-up. Moreover, superposition of intraoperative and preoperative 3D reconstruction images ensured surgical accuracy and avoided the need for a potential reintervention. In conclusion, the proposed surgical protocol for mandibular reconstruction with customized alloplastic TMJ prosthesis in nongrowing patients with type IIb/III Pruzansky-Kaban congenital mandibular hypoplasia may reduce FN morbidity, improve surgical accuracy and final outcomes.
Subject(s)
Goldenhar Syndrome , Joint Prosthesis , Mandibular Reconstruction , Temporomandibular Joint , Humans , Mandibular Reconstruction/methods , Temporomandibular Joint/surgery , Temporomandibular Joint/diagnostic imaging , Temporomandibular Joint/abnormalities , Goldenhar Syndrome/surgery , Goldenhar Syndrome/diagnostic imaging , Female , Male , Imaging, Three-Dimensional/methods , Cone-Beam Computed Tomography , Magnetic Resonance Imaging , Child , Prosthesis Design , Adolescent , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint Disorders/diagnostic imaging , Facial Nerve/surgery , Facial Nerve/diagnostic imaging , Facial Nerve/abnormalitiesABSTRACT
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