Charles H. Henry

Reconstruction of the temporomandibular joint using a temporalis graft with or without simultaneous orthognathic surgery

PURPOSE This article reports the outcome of free temporalis fascia and muscle graft (TFG) reconstruction of the temporomandibular joint (TMJ) with and without simultaneous orthognathic surgery (SOS). MATERIALS AND METHODS Twenty-nine patients (45 joints) were evaluated retrospectively. Group 1 consisted of 17 patients (16 women 1 man) and 30 joints. Fifteen (88%) patients had sagittal split ramus osteotomies (SSRO); 8 (53%) of these patients also had Le Fort I osteotomies, and 2 patients (12%) had only Le Fort I osteotomies with TFG. Group 2 consisted of 12 patients (15 joints) who received only TFG and no SOS. RESULTS Group 1 had 9 patients (53%) with an incisal opening greater than 35 mm, 11 joints (37%) with greater than 6 mm lateral excursive movement, and 11 patients (65%) were asymptomatic postoperatively. Average follow-up was 57.4 months (range, 23 to 69 months). Group 2 had eight patients (67%) with an incisal opening greater than 35 mm, six joints (40%) with greater than 6 mm lateral excursive movement, and seven patients (58%) were asymptomatic postoperatively. Average follow-up was 55.1 months (range, 48 to 64 months). CONCLUSION TFG with and without SOS produced similar treatment outcomes in comparing groups 1 and 2. No significant differences were observed for the number of patients with an incisal opening > 35 mm (P = .703), lateral excursion > 6 mm (P = 1.00), and successful elimination of pain (P = 1.00), even though group 2 had a significantly greater number of patients (P < 0.01) that were operated on unilaterally. Combining treatment outcomes for both groups, the number of previous joint surgeries significantly affected success (P < .01). The presence of osteoarthritic changes did-not significantly affect treatment outcome (P = .187).

Modified Boley gauge for use as a reference plane in orthognathic surgery.

Changes in the angle at which the Boley gauge is held while measuring the anteroposterior and vertical distances between the incisal guide pin and the upper member of the articulator to the dento-osseous segments can result in significant changes in the measurement of planned model surgery movements. To avoid this situation, a modified Boley gauge was developed to serve as a reference plane in measuring the anteroposterior and vertical positions of the dento-osseous segments from the incisal guide pin and upper member of the articulator