Larry M. Wolford D.M.D.

Wolford, L. M. (2016). “Computer-Assisted Surgical Simulation for Concomitant Temporomandibular Joint Custom-Fitted Total Joint Reconstruction and Orthognathic Surgery.” Atlas Oral Maxillofac Surg Clin North Am 24(1): 55-66.

Full text of this article.

Patients with temporomandibular joint (TMJ) conditions and coexisting dentofacial deformities can have these conditions corrected with concomitant TMJ and orthognathic surgery (CTOS) in 1 surgical stage or separated into 2 surgical stages. The 2-stage approach requires the patient to undergo 2 separate operations (surgery to correct the TMJ condition and a second operation to perform the orthognathic surgery) and 2 general anesthetics, significantly lengthening the overall treatment time. Performing CTOS in a single operation significantly decreases treatment time and provides better outcomes but requires careful treatment planning and surgical proficiency in the 2 surgical areas. Some TMJ conditions require total joint prostheses for best results. The application of computer technology for TMJ and orthognathic surgical planning and implementation has significantly improved the accuracy and predictability of treatment outcomes. This article presents the treatment planning and surgical protocol for the application of computer-assisted surgical simulation (CASS) for CTOS cases requiring TMJ reconstruction with patient-fitted total joint prostheses and orthognathic surgery. The CASS protocol decreases the preoperative workup time and increases the accuracy of model preparation and subsequent surgery.