Page 280 - Demo

Chapter 10278Facial contouring can be performed with eTMJR. The less than ideal outcome in case #4 was related to the decision to not delay the eTMJR surgery. The importance of facial contouring and correct anatomical reconstruction of the face was clear when evaluating patient-reported outcomes with the FACE-Q ‘Satisfaction with outcome’ questionnaire. While four of our five patients reported a perfect or excellent score, case #1 reported a considerably lower score (59/100). It should, however, be noted that this patient had hemifacial microsomia and underwent several other treatments (e.g., autologous ear reconstruction and free gluteal fat grafting) before and after eTMJR and facial rotation surgery to improve her facial appearance. As such, only partial esthetic facial reconstruction could be achieved by eTMJR, which likely explained the reported esthetic result. Elledge et al.(3) stated that any classification system for eTMJR must be “unambiguous and easy to use; exhaustive and mutually exclusive so that each possibility exists in only one class; clinically relevant and appropriate; and flexible enough to accommodate any advances or changes in technology.” Considering our (albeit limited) experience, it appeared that unidimensional extension was not the only factor affecting technical difficulties and outcomes. Indeed, we found no difference between M1 and M2 eTMJR with respect to surgical difficulties or clinical outcomes. In contrast, mandibular repositioning in three dimensions to deal with dental occlusion, with or without contralateral mandibular osteotomies, posed major obstacles and complications. Contour corrections increased the difficulty of implantation and resulted in compromised esthetic outcomes. Elledge et al.(3) agreed that other subclassifications can be considered when autogenous tissue transfer is used in conjunction with eTMJR. We, therefore, suggest adding the aforementioned potential obstacles (contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy) as a subclassification system. (Table 3) Identification and anticipation of these obstacles may lead to facilitating actions.Bredell et al.(6) described 15 patients requiring ablative surgery of the mandible (including the condyles), mainly for oncological reasons. Two patients received a reconstruction plate with a metallic condyle, whereas the others underwent autologous replacement, primarily with a free fibula Nikolas de Meurechy NW.indd 278 05-06-2024 10:15