Template-based temporomandibular joint puncturing and access in minimally invasive TMJ surgery (MITMJS) - a technical note and first clinical results

Matthias Krause, Hans Martin Dörfler, Daniel Kruber, Heike Hümpfner-Hierl, Thomas Hierl, Matthias Krause, Hans Martin Dörfler, Daniel Kruber, Heike Hümpfner-Hierl, Thomas Hierl

Abstract

Background: Minimally invasive temporomandibular joint surgery (MITMJS) is an option for patients suffering from severe internal derangement or adhesions. To improve TMJ access, a workflow to create surgical templates is introduced.

Methods: A workflow to generate a dividable patient specific template based on CBCT and optical scanning to access the joint is introduced. In a first clinical trial 3 patients (6 joints) were treated by way of template-guided endoscopically-assisted TMJ therapy (3 arthrocenteses and 3 arthroscopies).

Results: Generation and clinical use of the templates was as planned. All templates showed perfect fit and permitted instant access to the TMJ. All surgeries were performed without complications.

Conclusions: Template-guidance could improve the feasibility of endoscopically-assisted TMJ therapy. An important issue is the capability to dis- and remount the template during surgery. Using in-house production, costs are affordable.

Trial registration: This study was registered at the Ethic Committee of the Berlin Medical Chamber ( Eth-30/17 , 12/06/2017).

Keywords: Computer-guided surgery minimally invasive temporomandibular joint surgery; Surgical template.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Berlin Medical Chamber (Eth-30/17, 12/06/2017; https://www.aerztekammer-berlin.de/10arzt/50_Ethik-Kommission/index.html). This report followed the Declaration of Helsinki on medical protocol and ethics.

Consent for publication

Written informed consent was obtained from the patient for publication of the technical note. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Planning of the pilot channels in FAT software
Fig. 2
Fig. 2
Surgical template prior to separation in 2 parts. The extensions to guarantee fit and the working channels are visible. Overlay of CBCT and optical scan
Fig. 3
Fig. 3
Template is split along the working channels to allow removal during surgery. Inferior and superior to the working channels two posts featuring an undercut are seen which are needed to connect the two parts firmly during surgery using heavy elastics or wire
Fig. 4
Fig. 4
The printed template. It is clear to see a potential imperfect fit, resp. intraoperative bleeding
Fig. 5
Fig. 5
Intraoperative view after insertion of the protecting sheats and the endoscope

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