![]() Thus an entrance into the TMJ capsule ranging from anterior to posterior can be planned. choosing a joint entrance spot which will allow all later movements of the endoscope or further working channels. It is important to integrate the desired surgical plan in this stage in the template, i.e. Thus the template acts as a puncturing aid of the skin and directs the endoscope to the desired spot within the TMJ. The template has two extensions to the forehead and cheek and a centering plug to the cavum conchae to guarantee its exact position (Figs. As soon as the pilot channels have been placed, the template can be designed in FAT. The length of the channels can be tailored according to the working length of the endoscope to ensure the exact position. two working channels for the endoscope and the manipulation instruments according to the given anatomy, pathology, and the instrument dimensions following the described access by Muracami and Hoshino. Next step is the conversion of the DICOM data to surface data which is matched with the optical scan data of the face using the iterative closest point algorithm in FAT. The optical scan adds information to the CBCT as it shows areas of hair-bearing skin which will not be included in the template and adds realism as the texture of the skin is shown. It allows a fast, radiation free and precise generation of a detailed 3D surface mesh of the face. ![]() The second step is optical scanning of the face (Vectra® M3, Canfield Scientific Inc., Fairfield, NJ, USA). If CT or CBCT was to be used, the orbits should be not included due to unnecessary radiation exposure. Alternatively CT or MRI data could be used. It is used for TMJ diagnosis and provides volumetric images of the anatomic structures of the patients’ craniofacial skeleton. The first step is the CBCT (Kodak 9500 3D, Carestream Health, Toulouse, France). The preoperative 3D planning procedure is performed after obtaining a cone beam computed tomography (CBCT) of the skull, an optical facial scan and using a planning software (Facial Analysis Tool: FAT). The workflow to generate a surgical template via CAD/CAM is fully digitally. ![]() This is the first known report of template-guided therapy in the TMJ other than the use of a cutting guide for tumor resection and one of the first considering joint surgery besides arthroplasty resection guides. It should assist minimally invasive temporomandibular joint arthrocentesis or arthroscopy to combine the potential advantages of these novel techniques and first clinical results are presented. In this technical report, a novel workflow to design and generate a surgical template via CAD/CAM to gain access to the TMJ is introduced. Computer-assisted design (CAD) and computer-assisted manufacturing (CAM) procedures combined with three-dimensional printing techniques facilitate the use of surgical templates and are well described in craniomaxillofacial surgery. It is, however, desirable to reduce bleeding which could be achieved using new techniques.Ĭomputer-assisted arthroscopy is a promising technology to decrease complication rates and operation time for MITMJS. Although bleeding within the superior TMJ space was observed in 8.5% of the arthroscopies, it was not severe in any of the cases and was not considered as a real complication. MITMJS seems to be connected with a relatively low complication rate less than 1.5%. In 1982, Muracami and Hoshino developed the nomenclature of arthroscopic anatomy. Minimally invasive temporomandibular joint surgery (MITMJS) like arthrocentesis or arthroscopy has been successfully used in the treatment of internal derangement (ID) of the temporomandibular joint (TMJ) and was first described by Onishi, who also reported the use of the arthroscope for diagnostics. This study was registered at the Ethic Committee of the Berlin Medical Chamber ( Eth-30/17, ). Using in-house production, costs are affordable. An important issue is the capability to dis- and remount the template during surgery. Template-guidance could improve the feasibility of endoscopically-assisted TMJ therapy. All surgeries were performed without complications. All templates showed perfect fit and permitted instant access to the TMJ. Generation and clinical use of the templates was as planned. 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). MethodsĪ workflow to generate a dividable patient specific template based on CBCT and optical scanning to access the joint is introduced. To improve TMJ access, a workflow to create surgical templates is introduced. Minimally invasive temporomandibular joint surgery (MITMJS) is an option for patients suffering from severe internal derangement or adhesions.
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