Computer-assisted surgical simulation for temporomandibular joint reconstruction with costochondral graft

Abstract

Purpose This study was planned to evaluate the accuracy of virtual surgical planning and three-dimensional (3D) printed templates in reconstruction of temporomandibular joint (TMJ) with costochondral graft. Patients and methods Eight patients (15–45) years diagnosed with TMJ deformities were included. A composite skull model was obtained with data from computed tomography. A virtual surgical simulation was performed using Dolphin Imaging 11.7 Premium. Then, the virtual plan was transferred to the operative field using 3D (CAD-CAM) printed surgical template. These templates were designed by 3D printing using data from the virtual surgical simulation for optimum selection of the rib graft, accurate tailoring of chondral and costal graft and as an osteotomy guide. The preoperative measurement including mouth opening, facial asymmetry and differences between the actual mandibular position and the virtual plan were analyzed. Results All patients obtained satisfactory changes in the facial profile and marked improvement in postoperative mouth opening. Postoperative radiographs, computed tomography images, and quantitative analysis showed an acceptable precision for the position of the costochondral graft to the glenoid fossa. Conclusion The results of this study showed that virtual surgical planning and 3D printed guiding templates facilitated treatment planning, provided an accurate osteotomy guide, facilitated repositioning of bony segments and contouring of the mandibular anatomy in the treatment of TMJ deformity.