China Journal of Oral and Maxillofacial Surgery ›› 2016, Vol. 14 ›› Issue (2): 144-148.

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Mandible resection and reconstruction with preservation of 10 mm condyle and temporomandibular joint attachment

BAI Guo1, YANG Chi1, ZHENG Zhi-wei2, FANG Yi-ming2   

  1. 1.Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology. Shanghai 200011; 2. Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Wenzhou Medical University. Wenzhou 325000, Zhejiang Province, China
  • Received:2015-08-22 Online:2016-03-20 Published:2016-04-06

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Abstract: PURPOSE: To explore the effect of temporomandibular joint (TMJ) preservation surgery in the treatment for a giant mandibular ameloblastoma with healthy condylar head. METHODS: For 1 case of a giant mandibular ameloblastoma, computer-assisted technology was applied to determine the margins of the tumor and its relationship with the condylar head. Then anatomical measurements and virtual osteotomy simulation were performed based on which digital templates were made to guide intra-operative osteotomy. The condylar head was preserved and connected to the remaining ramus by costochondral graft, fixed with a reconstructive titanium plate, in order to keep the original condyle-disc relationship and a stable occlusion. The clinical effects were evaluated by intra-operative preservation of important anatomical structures, postoperative joint function, joint-jaw-occlusion relationship, as well as results of imaging follow-ups. RESULTS: Digital osteotomy templates were smoothly positioned and attached to bone surface and guided the resection of the affected region along the pre-designed margin of the ameloblastoma. The inferior alveolar nerve bundle had been well preserved; TMJ disc and normal condylar head with a height of 10 mm was also saved for mandible reconstruction with costochondral graft. Postoperative CT showed complete elimination of the ameloblastoma and its affected mandible region. The preserved condylar head and rib graft grew into each other well. One-year follow-up CT showed no recurrence of the tumor, and the patient had satisfactory functional TMJ, symmetrical facial appearance as well as stable occlusion. No facial numbness or other complications occurred. CONCLUSIONS: In the treatment of mandibular benign lesion with healthy condylar head, the concept of TMJ preservation surgery should be advocated with the facilitation of digital templates. In this way, accurate resection of the affected bone with preservation of the condylar head as well as TMJ attachments could be realized. This procedure could help maintain TMJ function and three-dimensional joint-jaw-occlusion relationship with stable post-operative outcomes.

Key words: Temporomandibular joint, Preservative surgery, Digital template, Ameloblastoma

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