DR CHRISTOPHER LIM
ORAL AND MAXILLOFACIAL SURGEON
Sydney II NSW II Australia
OSTEOMA OF THE RIGHT TMJ WITH PAIN AND DYSFUNCTION
This patient presented with severe dysfunction with limited mouth opening to the extent that eating was limited to soft foods and cut up into small pieces. The patient saw multiple clinicians to no avail.
Pain was severe particularly on function. This started to affect the other joint as well due to overuse.
Examining the right TMJ(on the left side of the image), a large bony outgrowth was present with significant joint degeneration. There is limited joint space which most likely represents a mixed ankylosis.
TREATMENT PLAN
The severe deformed anatomy of the right TMJ needed to be modified to fixate the prosthesis accurately. We addressed this by utilising customised guides and designing the prosthesis to fit the bony anatomy perfectly.
To the left are guides to help the surgeon make the accurate bony cuts to fit the prosthesis. With current technology, it is possible to have the position of the prosthesis placed EXACTLY as planned in well trained and capable hands.
Here is a 3D printed model of the joint fossa to help the surgeon assess the bony anatomy prior to the operation.
The prosthesis is designed to fit the bony anatomy that is prepared by the surgeon during the procedure. To the left is the joint that was prepared for this patient.
Below are post-operative CT images demonstrating a precisely placed prosthesis which has perfect adaptation to the surrounding bone.
FINAL RESULT
To the left below is the patient who achieved normal function and no pain after the recovery period. The left photo is at 2 months post surgery. The wounds have become minimally visible after 12 months in the right photo. The patient can eat a normal diet in comfort without any pain or dysfunction.
