Background and objectives: The temporomandibular joint plays a very important role for the function of the mandible. The delicate and complex anatomy of TMJ area challenges for the reconstructive surgery of this region. The objective of this study is to verify the feasibility and the effectiveness of the intraoperative image-guide navigation for the TMJ surgery.
Methods: 45 Patients with TMJ diseases are enrolled in this study, including 30 cases with TMJ ankylosis, 10 with TMJ osteochondorma and 5 with post-surgical deformities due to TMJ ankylosis. The preoperative radiologic examinations involved thin-cut (0.625-mm) spiral CT scans for all patients. Using the DICOM protocol CT data sets, a virtual 3D skull model was created in navigation system TBNavis-CMFS (Shanghai, China). The preoperative individual planning and simulation data sets, including the generation of virtual models with TMJ arthroplasty (gap surgery) in 30 cases, articular fossa remodeling in 4 cases, condylar-ramus unit (CRU) reconstruction with rib graft in 1 cases, endoscopic-assisted osteochondroma resection/condylectomy in 10 cases, were used as a virtual template to guide surgical correction of those deformities by intraoperative instrument- and/or probe-based navigation.
Results: Using 4–5 invasive markers for registration, an accurate match between the intraoperative actual position and 3-dimensional virtual model was achieved within a systematic error of 1 mm difference. With the guidance of the real-time navigation system, all the surgical procedures went on smoothly. The average deviation of the morphologic change after surgical correction was less than 1.5 mm with superimposing the preoperative planning and postoperative CT images. The follow-up evaluation showed that the clinical complaint symptoms were alleviated, and the postoperative function and esthetics improved remarkably.
Conclusions: Navigation-guided surgery in the TMJ region provides better precision and safety for the surgeons and can be regarded as an ideal and valuable option for this potentially complicated procedure.