PMC7433953_01
Case #1. Planning in ProPlan CMF (Materialize, Leuven, Belgium). (A) Frontal view. (B) Frontal view. Planned maxillary and mandibular rotation repositioning osteotomy. The arrow indicates the sagittal split osteotomy on the side contralateral to the extended temporomandibular joint replacement. (C) Left profile view. (D) Left profile view. Planned maxillary and mandibular rotation repositioning osteotomy planned. The arrow indicates the coronoidotomy
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F2
Although neutral occlusion and midline correction were obtained during surgery, they were not fully maintained postoperatively [Figures 2 and 3].
Case #1 continued. (a) Preoperative profile cephalogram. (b) Postoperative profile cephalogram. (c) Orthopantomogram. The red line indicates the upper dental midline, and the yellow line indicates the lower dental midline
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F3
Although neutral occlusion and midline correction were obtained during surgery, they were not fully maintained postoperatively [Figures 2 and 3].
PMC7433953_02
Case # 2. Planning and postoperative result. (A) Surface tesselation language render with arrow indicating the mandibular defect. The left zygoma was replaced with a polyether ether ketone implant (blue). (B) Surface tesselation language render with the arrow indicating bony irregularities at the mandibular border after virtual removal of the titanium reconstruction plate using segmentalization. (C) Surface tesselation language render with the extended temporomandibular joint replacement indicated in gray. (D) Postoperative frontal view of the computerized scan of the cranium showing the condylar sag (arrow)
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F4
The mandibular reconstruction subsequently failed, and she presented to our institution with a chronic plate infection, malunion, a mandibular defect, and fibrous TMJ ankylosis on the affected side [Figure 4]. The residual bony and titanium irregularities were difficult to match in the parasymphyseal region [Figure 4].
PMC7433953_03
Case # 3. (A) Surface tesselation language render with the arrow indicating the defect. (B) Surface tesselation language render with planned reotational repositioning of the mandible. The arrow indicates the sagittal split osteotomy contralateral to the extended temporomandibular joint replacement. (C) Orthopantomogram demonstrating an osteosynthesis plate fracture (arrow). (D) Orthopantomogram demonstrating extensive osteosynthesis and iliac bone grafting (1), root-shaped dental implants (2), and an additively manufactured subperiosteal jaw implant (3) one has the impression that mandible was splitted at a higher position than indicated in B. This is due to the fact that the proximal segment rotated anterocranially because of the malunion and because of the projective geometry of orthopantomogram technology
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F5
The latter needed a repositioning osteotomy on the left [Figure 5]. eTMJR and unilateral sagittal osteotomy were thereby performed simultaneously.
PMC7433953_04
Case # 4. (a) Surface tesselation language render before planning demonstrating the anterior open bite. (b) Surface tesselation language render after planning for bilateral extended temporomandibular joint replacement and mandibular repositioning. The arrow indicates the concavity in the subcondylar area secondary to postoperative maintenance of the yaw position of the mandible and the attempt to symmetrize the mandibular angle area by augmentation. (c) Postimplantation computed tomography scan, frontal view. The arrow indicates the mid-cheek concavity. (d) Left : profile view of the preoperative occlusion. (e) Left : profile view of the post-extended temporomandibular joint replacement. occlusion
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F6
This patient previously underwent bimaxillary surgery alio loco for Class II, open bite occlusion[Figure 6].
PMC7433953_05
Case # 5. (a) Preoperative facial frontal view with open mouth. (b) Surface tesselation language render of the planned extended temporomandibular joint replacement. (c) Orthopantomogram showing the preoperative occlusion and left-sided mandibular defect. (d) Orthopantomogram showing the postoperative occlusion and extended temporomandibular joint replacement in situ
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F7
This patient was initially treated for fibrous dysplasia with continuity resection at her left mandibular angle [Figure 7].