Page 250 - Demo

Chapter 9248showed bilateral condylar resorption after orthognathic surgery. There was one female adolescent with unilateral craniofacial microsomia and one with TMJ ankylosis as a result of radiotherapy in childhood for a rhabdomyosarcoma. The indications for surgery varied between severe pain, refractory to conservative treatment and/or tissue sparing surgery, and severe trismus with severe dietary restrictions. Results were recorded in the electronic medical files, using Helkimo’s index and a patient-reported outcome measure questionnaire.(20) The criteria and indications for these TMJ replacements are as described by Sidebottom and as mentioned in CADskills BV’s TMJ manual.(21)ResultsThe main aim of the paper is to present technical evolutionary steps, not to analyze clinical end-results. However, in order to demonstrate the clinical behavior of the novel prosthesis, early results of this first small group of patients are described here for completeness.Group ResultsBecause the heterogeneity of indications, descriptive statistics about pain relief, increased mandibular movements, and dietary improvements are not representative for individual changes in wellbeing. The ankylosis and hemifacial microsomia caused no pain, whereas a maximal mouth opening of 28 mm was present in the patient with bilateral condylar resorption, who scored 10 in the Visual Analogue Scale (VAS, 0–10) before joint replacement. Therefore, the following results should be interpreted with caution. Two cases are described in detail to complement the group results.One patient was excluded from the descriptive statistics because she twice received joint replacements within a year interval, once on the righthand side and once on the lefthand side, leading to a disrupted follow-up. The total number of patients that were included in the descriptive analysis was 11, including one patient with a major component of neuropathic facial pain, whose pain score remained 8.Nikolas de Meurechy NW.indd 248 05-06-2024 10:14