关键词: 颞下颌关节, 肋骨软骨移植, 计算机辅助手术模拟

Abstract: PURPOSE: This study was to introduce the application of computer-assisted surgical simulation (CASS) for temporomandibular joint (TMJ) reconstruction with costochondral graft (CCG). METHODS: Patients who underwent TMJ reconstruction with CCG from November 2013 to March 2015 were included in this study. Cranio-maxillofacial and chest CT scans were performed and imported into the Mimics software for virtual positioning and osteotomy planning to guide the selection and placement of the rib and bone trimming of the condyle and ramus before surgery. The implanted deviation of the rib was measured or calculated in Mimics software. RESULTS: Seven patients (9 joints) who underwent CCG utilizing CASS were included. There were 5 females and 2 males with a mean age of 30.2 years (range, 21 to 45 years). There were 5 patients with unilateral joints reconstruction and 2 patients with bilateral joints reconstruction. In 7 joint reconstructions, the 6th rib was selected, while the 7th rib was selected in 2 joints. All the grafted ribs were not trimmed or contoured intraoperatively. Postoperative CT scans indicated that all patients had successful reconstruction of the mandibular condyle with CCG using CASS. 46 titanium screws in total were implanted and located behind the inferior alveolar neurovascular bundle. There were 16 titanium screws protruding from the medial surface of the ramus, and the mean exposed length was 0.7 mm (range, 0.2 to 1.3 mm). The merged CT scans indicated that the distal end of the CCG was implanted obliquely and anteriorly compared with the predesigned positions, and the mean deviated degree was 5.4°(range, 1.7 to 7.3°). CONCLUSIONS: CASS is an accurate method to select a suitable rib (usually the 6th and 7th) matching with the TMJ anatomy and avoid the blindness of CCG.

Key words: Temporomandibular joint, Costochondral graft, Computer-assisted surgical simulation