BACKGROUND:Active unilateral condylar hyperplasia (AUCH) leads to progressive facial asymmetry and occlusal imbalance and may coexist with preexisting skeletal discrepancies. In such cases, a single-stage approach combining condylectomy and orthognathic surgery can address both pathological growth and the associated dentofacial deformity. PURPOSE:The aim of this study was to present a treatment protocol and surgical algorithm for simultaneous orthognathic surgery and condylectomy in subjects with AUCH and to evaluate clinical outcomes in a retrospective case series. STUDY DESIGN, SETTING, AND SAMPLE:This retrospective case series included 24 adult subjects with AUCH treated between 2012 and 2018 in Santiago, Chile. Diagnosis was based on clinical evaluation, cone beam computed tomography, and single-photon emission computed tomography demonstrating ≥55% condylar activity. All subjects had completed growth and presented AUCH associated with dentofacial deformities requiring orthognathic correction, including maxillary hypoplasia, reduced upper airway, or mandibular advancement. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES:Not applicable. OUTCOME VARIABLES:Primary outcomes included postoperative occlusal stability (achievement and maintenance of Class I occlusion), facial symmetry (clinical and patient-reported), temporomandibular joint symptoms, mouth opening, complications, and need for reintervention. COVARIATES:Covariates included age, sex, follow-up duration, type of condylectomy (high or adapted), type of mandibular osteotomy, surgical sequence, and concomitant procedures, all determined through virtual surgical planning. ANALYSES:Descriptive statistics were used to summarize subject characteristics and outcomes. No inferential analyses were performed. RESULTS:Twenty-four subjects (mean age 20.8 ± 3.6 years; 66.7% female, 33.3% male) were included, with a median follow-up of 6 years. All subjects achieved stable Class I occlusion and satisfactory facial symmetry. No temporomandibular joint symptoms or reinterventions were observed. The mean mouth opening was 45 mm. Minor complications (transient facial paresis) occurred in 12.5% of subjects. CONCLUSIONS AND RELEVANCE:Simultaneous orthognathic surgery and condylectomy is an effective approach for managing AUCH associated with dentofacial deformities, providing stable functional and aesthetic outcomes. Virtual surgical planning enables a structured surgical algorithm, guiding both the surgical sequence and the selection of the appropriate type of condylectomy, and may reduce the need for more invasive mandibular procedures.

Temporomandibular disorder (TMD) significantly impairs the quality of life of patients due to chronic pain and limited jaw function. Many treatment options have been used such as pharmacologic management, physical therapy, oral appliance therapy, and surgery. However, effective treatment options remain limited. In this study, we investigated the potential of botulinum toxin (BoNT) as a therapeutic approach for TMD using a forced mouth opening-induced TMD male mouse model. BoNT injection significantly alleviated mechanical hypersensitivity in the temporomandibular region over a 2 week period as demonstrated by von Frey behavioral tests. Additionally, the mouse grimace test confirmed that BoNT alleviated pain in mice. The open field test and pasta gnawing test showed that BoNT injection effectively alleviated mouth motor and food intake problems and did not cause impairments in general behavior. Moreover, direct observation of neural activity via in vivo Pirt-GCaMP3 calcium imaging of intact trigeminal ganglia (TG) revealed that BoNT suppressed both stimulus-evoked and spontaneous activity in TG neurons. Mechanistically, BoNT downregulated the expression of pain-promoting proteins (TRPV1, TRPA1, and TRPC1) and glutamate transporting protein (VGLUT2), thereby suppressing peripheral neural activity in the TG. In summary, our study identified a novel mechanism by which BoNT alleviates TMD pain. These new findings not only expand our understanding of the effects of BoNT on pain but also provide a new therapeutic approach to TMJ pain management.

The management of patients with orofacial pain and temporomandibular disorders is challenging. Recognizing the opportunity to advance patient care, in 2019 the National Academies of Science, Engineering, and Medicine (NASEM) convened representatives from the Food and Drug Administration, Medical Device Epidemiology Network (MDEpiNet), patient advocacy groups, oral and maxillofacial surgeons, and orofacial pain experts to identify specific steps to improve care for patients. In response, the American Association of Oral and Maxillofacial Surgeons (AAOMS) created the Special Committee on Temporomandibular Joint Care (SCTMJC) whose assignment was to develop contemporary evidence-based guidelines for the management of patients with orofacial pain and temporomandibular disorders. These guidelines represent the findings and recommendations of that committee.

Patients with temporomandibular disorders (TMD) typically experience facial pain and discomfort or tenderness in the temporomandibular joint (TMJ), causing disability in daily life. Unfortunately, existing treatments for TMD are not always effective, creating a need for more advanced, mechanism-based therapies. In this study, we used in vivo GCaMP3 Ca 2+ imaging of intact trigeminal ganglia (TG) to characterize functional activity of the TG neurons in vivo , specifically in TMJ animal models. This system allows us to observe neuronal activity in intact anatomical, physiological, and clinical conditions and to assess neuronal function and response to various stimuli. We observed a significant increase in spontaneously and transiently activated neurons responding to mechanical, thermal, and chemical stimuli in the TG of forced mouth open (FMO) mice. An inhibitor of the CGRP receptor significantly attenuated FMO-induced facial hypersensitivity. In addition, we confirmed the attenuating effect of CGRP antagonist on FMO-induced sensitization by in vivo GCaMP3 Ca 2+ imaging of intact TG. Our results contribute to unraveling the role and activity of TG neurons in the TMJ pain animal models of TMD, bringing us closer understanding the pathophysiological processes underlying TMD. Our study also illustrates the utility of in vivo GCaMP3 Ca 2+ imaging of intact TG for studies aimed at developing more targeted and effective treatments for TMD.

The understanding of the causes of temporomandibular joint pain and dysfunction has evolved over 50 years. Historically, the term internal derangement has been used to describe the abnormal relationship between the articular disc, condyle, and glenoid fossa, which was thought to correlate with patient symptoms. It is now known that the pathophysiology of intra-articular pain and dysfunction (IPD) involves synovitis, capsular impingement, symptomatic disc displacement, or a combination of these. Symptomatic disc displacement should only be considered to be a potential source of IPD after synovitis and capsular impingement have been treated. This philosophy provides the opportunity for most patients with IPD to be initially treated nonsurgically or with minimally invasive procedures such as arthrocentesis or arthroscopy. (c) 2024 American Association of Oral and Maxillofacial Surgeons

Nasotracheal intubation is crucial for many oral and maxillofacial surgery procedures; however, it presents more challenges than orotracheal intubation and requires a higher level of training, along with various execution options. The routine use of an endotracheal tube (ETT)-first nasal fiberoptic intubation protocol is recommended, specifically in cases where orotracheal intubation is not possible or feasible. In this proposed technique, 137 randomly selected patients underwent fiberoptic nasotracheal intubation for general anesthesia utilizing a strict ETT first protocol. The mean preintubation ETT depth was 14 cm from the nares, correlating this distance with the patient's height, weight, and gender, proposing a formula for depth selection. Inserting the nasal ETT to a mean depth of 14 cm prior to insertion of the fiberoptic scope resulted in excellent visualization of the glottis with a first pass success rate for intubation of 97.8% and a mean intubation time of 68.5 seconds, regardless of the expertise of the provider.

The treatment of patients with severe temporomandibular joint (TMJ) disorders and associated skeletal discrepancies presents a complex challenge for oral and maxillofacial surgeons. It is widely recognized that TMDs can impact the stability and outcomes of surgical treatments for dentofacial deformities. Consequently, addressing TMDs prior to or in conjunction with orthodontic or surgical interventions may be necessary to achieve optimal and long-lasting results. Alloplastic temporomandibular joint replacement (TMJR) and orthognathic surgery have emerged as the standard approach due to their predictability, long-term stability and excellent outcomes when addressing end-stage TMJ disease in conjunction with DFDs as it provides a comprehensive solution to address both functional and aesthetic aspects of these patients' conditions. Understanding the appropriate utilization of TMJR in conjunction with orthognathic surgery can lead to improved treatment planning and successful outcomes for patients with complex TMJ disorders and associated dentofacial deformities. This review aims to discuss the indications, preoperative evaluation, staging, sequencing, and surgical considerations involved in utilizing alloplastic TMJ replacement in the presence of dentofacial deformities.

OBJECTIVE:The purpose of this study was to evaluate subjective and objective outcomes in patients with temporomandibular joint (TMJ) ankylosis treated with TMJ alloplastic reconstruction (TMJR).STUDY DESIGN:All patients diagnosed with TMJ ankylosis that underwent TMJR at our institution between 2010 and 2019 were retrospectively reviewed. Patients were divided into 2 cohorts: bony and fibrous ankylosis. Subjective variables assessed were facial pain and headaches, TMJ pain, jaw function, diet, and disability. Objective variables assessed were maximum interincisal opening and lateral excursions. The Mann-Whitney test was employed to analyze subjective variables and an unpaired t-test was used to analyze the objective variables. P < .05 was considered statistically significant.RESULTS:Twenty-eight patients met the inclusion criteria (21 female, 7 male). The mean age at the time of surgery was 42 years, and the mean number of prior TMJ surgeries was 3. A total of 52 TMJRs were performed in the 28 patients, and the mean follow-up time was 46 months. All subjective variables were significantly improved, and the mean maximum interincisal opening increased from 16.9 mm to 37.25 mm.CONCLUSIONS:The results of the study demonstrate that TMJR is an effective and reliable method for the management of both fibrous and bony TMJ ankylosis.

Primary xanthomas of the mandible and maxilla, or primary intraosseous xanthomas of the jaw are exceptionally rare with only 36 cases previously reported. We present another case of a primary xanthoma of the mandible in where a novel approach was used. A conventional sagittal split osteotomy was performed for wide access and a complete enucleation of the lesion and curettage of the adjacent bone was performed. At 1 year follow-up, the patient showed evidence of full healing with no signs of recurrence found clinically or radiographically.

Objective This project aimed to analyze the proximity of orthognathic surgical fixation to specific anatomical landmarks and to assess postoperative symptoms. Study Design The data consisted of an available pool of CT scans from the oral surgery department at the University of Texas Health at San Antonio from 2015 to 2020. We investigated the proximity of orthognathic fixation to the maxillary sinus, nerve, and tooth. The inclusion criteria were full volume CBCT or MDCT scans, age of 14-60 years, primary orthognathic surgery. The exclusion criteria were past surgery or augmentation, congenital syndromes, acquired abnormalities, pathological lesions, and inadequate image quality. Screening of an available patient pool resulted in 400 patient scans. The pilot data consisted of 50 patients. We gathered information about patients’ symptoms from their charts. We viewed the scans on the Dell NVIDIA Quadro P1000 23” monitor with 1920 × 1200 desktop resolution, 8-bit depth, and standard dynamic range for the image analysis. We performed measurements from the fixation to the closest point of the nearest vital structure (tooth, nerve, or sinus) on the Invivo6 version 6.0 Anatomage software, using axial, coronal, and sagittal views with the ruler tool to perform these measurements. We divided the measurements into three groups based on their proximity to the vital structures: A=0 mm, B≤2mm, and C>2mm. Finally, we compared patients' complaints and complications relative to the proximity of the surgical fixation to the vital structures. Results The preliminary data suggested a significant difference in symptoms associated with fixation at less than 2 mm. Conclusion We expect to find an increase in postoperative symptoms with proximity to the above-mentioned landmarks, to be determined by the chi-squared test for statistical analysis. Support of the hypothesis could encourage an emphasis on creating preoperative analysis standards affecting the identification, evaluation, and marking of vital structures on the images during preoperative surgical planning. Statement of Ethical Review Ethical Review or exemption was not warranted for this study This project aimed to analyze the proximity of orthognathic surgical fixation to specific anatomical landmarks and to assess postoperative symptoms. The data consisted of an available pool of CT scans from the oral surgery department at the University of Texas Health at San Antonio from 2015 to 2020. We investigated the proximity of orthognathic fixation to the maxillary sinus, nerve, and tooth. The inclusion criteria were full volume CBCT or MDCT scans, age of 14-60 years, primary orthognathic surgery. The exclusion criteria were past surgery or augmentation, congenital syndromes, acquired abnormalities, pathological lesions, and inadequate image quality. Screening of an available patient pool resulted in 400 patient scans. The pilot data consisted of 50 patients. We gathered information about patients’ symptoms from their charts. We viewed the scans on the Dell NVIDIA Quadro P1000 23” monitor with 1920 × 1200 desktop resolution, 8-bit depth, and standard dynamic range for the image analysis. We performed measurements from the fixation to the closest point of the nearest vital structure (tooth, nerve, or sinus) on the Invivo6 version 6.0 Anatomage software, using axial, coronal, and sagittal views with the ruler tool to perform these measurements. We divided the measurements into three groups based on their proximity to the vital structures: A=0 mm, B≤2mm, and C>2mm. Finally, we compared patients' complaints and complications relative to the proximity of the surgical fixation to the vital structures. The preliminary data suggested a significant difference in symptoms associated with fixation at less than 2 mm. We expect to find an increase in postoperative symptoms with proximity to the above-mentioned landmarks, to be determined by the chi-squared test for statistical analysis.

Latest clinical guidelines recommend biological prostheses as a reasonable choice in patients ≥65 years requiring aortic valve replacement (AVR). The aim is to compare clinical outcomes (major adverse events survival at short and long term) and resource-consumption (health resources, anticoagulation rates and post-surgery length of stay in ward -LoS- and intensive care unit -ICU-) between mechanical (MAVI) and biological aortic valve implants (BAVI) in AVR. An observational, retrospective study including all consecutive patients undergoing AVR with an isolated BAVI or MAVI between 2003 and 2016. Patients were followed-up until June 30th, 2020. In this analysis, patients >65y were considered (n=1,055: 881 BAVI, 174 MAVI). Propensity score matching and multivariate competing risks models with HR correction were applied to estimate differences in the clinical outcomes. Besides, non-parametric tests and multivariate count models were conducted to evaluate differences in resource-consumption. At short term, low complication rates in both types of implants were observed among the matched sample. At long term, no differences in all-cause mortality were found (HR=0.848; CI: 0.663—1.086; p>0.1). Furthermore, BAVIs were associated to a lower prevalence of postoperative anticoagulant treatment (31.6% vs. 82.8%; p<0.01). Regarding ICU, BAVI were found to have a 51% shorter stay until discharge (p<0.01) than patients with MAVI. Analyses by time periods showed a downward trend in ward and ICU stays. During follow-up, other healthcare resources (i.e., number of echocardiograms, visits to cardiologist) were higher among BAVI. Low perioperative rates of complications in both MAVI and BAVI were found, and long-term survival was similar in patients over 65y of age. BAVI was associated with a shorter post-surgery ICU stay and lower rates of anticoagulants, which might be related to recent advancements in biological implant technology and should be incorporated in further economic analyses.

Temporomandibular joint replacement (TJR) with an alloplastic (metal/ultra-high-molecular-weight polyethylene) device has proven to be a successful and predictable procedure. This paper describes a novel technique for performing TJR with an endaural incision alone. The technique we are describing uses only an endaural incision with supplemental trocar incision(s), to perform a TJR. There were 4 patients for a total of 8 temporomandibular joints that were selected. All 4 patients were assessed immediately following surgery, on postoperative days 1 and 7 and at 6 months following surgery. Maximal interincisal opening and subjective variables were assessed at each of the time points. Additionally, the total operative time was measured and compared to a previous age and diagnosis matched control group using the traditional 2 incisions TJR.There were 3 females and 1 male (ages 19-67) who underwent TJR with an endaural incision alone. There were 4 females (ages 19-68) who underwent traditional TJR surgery. None of the patients in either group had major complications and all patients were discharged on postoperative day 1. All patients in the endaural incision alone group had increased maximal interincisal opening and reported a quicker subjective decrease in pain and disability following surgery with less average time in the operating room. However, all patients in the endaural incision alone group had CN VII weakness that lasted longer than those in the traditional TJR group.The minimally invasive approach for TJR was successful in the present pilot study and could be used in specific situations to decrease the morbidity associated with additional incisions for this procedure. Ultimately, the endaural only incision approach offers promising outcomes for future patients undergoing temporomandibular joints TJR in the right patient population.

The advent of virtual surgical planning (VSP) in oral and maxillofacial surgery has aided surgeons and patients by reducing preoperative treatment planning and improving accuracy of surgery. It has become a “game changer” for providers and changed the way surgery is practiced, especially for the asymmetric patient.1 In this article, the authors focus on the use of VSP for cases involving concomitant orthognathic and temporomandibular joint (TMJ) surgery. Although there are a range of conditions affecting the TMJ in which computer-aided treatment planning can be advantageous, the authors focus their discussion on conditions of the TMJ that can cause resorption or malformation, needing operative intervention and correction, specifically (1) excessive growth conditions and (2) TMJ resorption needing alloplastic reconstruction.

Purpose: The purpose of the present study was to report the temporomandibular joint (TMJ) alloplastic reconstruction (TMJR) revision and/or replacement rates and associated complication outcomes data gathered from experienced TMJ surgeons and to review the recent relevant data. Materials and Methods: A 21-question anonymous on-line survey was sent to all Commission on Dental Accreditation-approved oral and maxillofacial surgery program directors and to members of the European Society of TMJ Surgeons and the American Society of Temporomandibular Joint Surgeons. Results: Of the surgeons sent the survey, 22% completed the full questionnaire. Most responses were from surgeons who routinely perform TMJR surgery (93.5%). Of the respondents, 28.3% had more than 30 years of experience and 73.9% were full-time academic faculty. A total of 4638 TMJR procedures were recorded and analyzed. The incidence of TMJR revision (keeping the same device) was 3% and that of replacement (placing a new device) was 4.9%. The most common reason for revision was heterotopic ossification (27.5%). The most common reason for replacement was infection (21.1%). Revision was successful in 86.7% and replacement in 94.6% of the patients at the longest follow-up reported. Conclusions: The data from the present study have shown that the incidence is low and the success rate is high for TMJR revision and replacement. (C) 2020 American Association of Oral and Maxillofacial Surgeons