A step-by-step instructional course to prepare for temporomandibular joint replacement surgery

1. CUSTOMISED TMJ
REPLACEMENT

2. I 2
GOAL
- TO ENCOURAGE YOU TO PERFORM A FIRST ALLOPLASTIC TMJ
REPLACEMENT
- FOR SURGEONS FAMILIAR WITH TMJ, SUCH AS OPEN DISC SURGERY
AND CONDYLE FRACTURE TREATMENT
- NO COMPLEX JOINT REPLACEMENT SUCH AS AN ENTHESIS
RECONSTRUCTION, AN EXTENDED PROSTHESIS, A LINGUAL LIP AND
MINIMAL SCREW OSTEOSYNTHESIS
- JUST A SIMPLE TOTAL JOINT REPLACEMENT, NO MORE, NO LESS

3. 3
Innovation manager & co-owner
Disclosure

4. I
CT scan
Components
Access
Coronoidectomy
12
1
11
2
10
3
9
4
8
5
7
6
Presentation timeline
4
Step by step

5. CT scan of the head of the patient
Maximal occlusion
Centric relation when orthognathic surgery
0.5 – 0.7mm slice thickness, same slice spacing

6. CT scan or optical scan of the dental models

7. I
COMPONENTS
7
Cutting guide in Ti
Dummies in SLA
Fossa component
Mandibular component

8. I
CORONOIDECTOMY?
8
Kr’-Go’:Cd’-Go’ > 1.1

9. I
“This ratio showed that under normal anatomic
conditions the length of the coronoid is about
20% shorter than the condyle in both adults
and adolescents.”
9

10. I 10

11. I
CN VII, A&V
11

12. I
SUBMANDIBULAR INCISION
12

13. I
Ayoubi A et al. The International Annals of Medicine (2017)
13
FACIAL ARTERY & VEIN, MARGINAL BRANCH CN VII
1.5 -1.7 cm
2.2 – 3.8 cm
4 – 4.5 cm
Yang HM et al. Aesthetic Surgery Journal (2016)

14. I 14
FACIAL ARTERY & VEIN, MARGINAL BRANCH CN VII
1.5 cm
4 cm
0.5 cm

15. I 15

16. I 16

17. I
RETROMANDIBULAR APPROACH
17

18. I 18

19. I 19

20. I 20

21. I
EXPOSURE
21
Submandibular vs Retromandibular

22. I 22
6 months postop

23. I
RESECTION HEIGHT
08-02-17 24
Cases from Torino - Prof Gerbino & Prof Ramieri

24. I
08-02-17
Titel van de presentatie
25

25. I 26
CN VII FRONTOTEMPORAL BRANCHES

26. I
PRE/POST
AURICULAR &
TEMPORAL
APPROACHES
27
Al-Kayat & Bramley, BJOS 1980

27. I
08-02-17
Titel van de presentatie
28

28. I 29
DISSECTION & RESECTION OF LOWER PART OF CAPSULE
AND LATERAL LIGAMENT

29. I 30
DISSECTION & RESECTION OF UPPER PART OF CAPSULE
AND DISK REMNANTS

30. I 31
Vessels! sta
eca
fta
ma
masa
pdta
4 to 7 mm, on average 6 mm

31. I 32

32. I
EXTERNAL CAROTID LIGATION
33

33. I
REMOVAL OF UPPER PART OF THE CONDYLAR HEAD
34

34. I 35
LOW HORIZONTAL AND VERICAL OSTEOTOMY

35. I
REMOVAL OF THE CONDYLE AND MEDIAL CAPSULE
36

36. I 37
CURRETAGE OF THE FOSSA, DUMMY FOSSA TRY-IN

37. I 38
INSERTION OF MANDIBULAR AND FOSSA COMPONENT

38. I
FIXATION OF THE FOSSA COMPONENT - IMF
39

39. I
FIXATION OF THE MANDIBULAR COMPONENT
40

40. I
FIXATION OF THE MANDIBULAR COMPONENT
41

41. I 42
Fat graft

42. I 43
Suturing over redon drain

43. I 44
Some considerations as for indications

44. I
2015 2019

45. I

46. I

47. I
pre
post

48. I

49. I
Age at surgery: 25 y

50. I

51. THANK YOU!
mauricemommaerts@me.com
European Face Centre