2024 ASTMJS Scientific Program

American Society of Temporomandibular Joint Surgeons with the European Society of Temporomandibular Joint Surgeons

Joint Meeting Ponte Vedra, Florida February 29—March 2, 2024

TMJ Horizons: Unraveling the Mysteries of Condylar Growth, Resorption, and Regeneration Welcome to the Ponte Vedra Inn & Club!

It is my great honor, on behalf of the ASTMJS, to extend a warm welcome to each one of you to this joint meeting with the ESTMJS at the picturesque seaside setting of Ponte Vedra Beach, Florida.

I am glad, post pandemic, we can gather again in person with colleagues across the globe to exchange ideas and share insights on “TMJ Horizons: Unraveling the Mysteries of Condylar Growth, Resorption and Regeneration.”

The diversity of expertise and experiences represented at this meeting brings a wealth of knowledge that collectively enhances our capacity to address the complex challenges of managing temporomandibular joint disorders.

Throughout the course of this meeting, I encourage each of you to engage in vibrant discussions, challenge assumptions, and embrace the opportunity to broaden your perspectives. It is within the crucible of dialogue and debate that progress, and innovation take place and patient outcome improves.

Remember that our shared passion for management of TMD and patient care extends beyond the boundaries of the conference room. Let's also enjoy the social interactions and activities that complement our scientific discussions at this wonderful venue.

Once again, welcome!

Joli Chou, DMD, MD It is an absolute pleasure to welcome you all to this joint European and American meeting. With the disruption caused by the COVID pandemic and the cancellation of our meeting in 2020 it is indeed overdue that we should all now gather in such a fabulous sunny setting.

We have assembled a well-established group of lectures and look forward to the sharing of information and controversies in a friendly environment which is traditional for both the American and European societies. The theme of the conference will revolve around the condyle and its growth, resorption and regeneration.

There will be plenty of down time to allow for social interaction and I look forward to catching up with you all both personally and professionally.

Nadeem Saeed, BDS, MB BS FDSRCS, FRCS, (OMFS)

Thursday, February 29th, 2024 7:15-8:00

Continental Breakfast/Sponsor Exhibits

8:00-8:15

Welcome and Introductions – Dr. Joli Chou, DMD, MD

8:15 -8:45

Sponsor Introductions – Dr. Gary Warburton, DDS. MD

Member and Candidate Abstracts: 10 minute presentations followed by 5 minutes Q&A 8:45

Does botulinum toxin treatment for myofascial pain reduce pain, improve function, or enhance quality of life?

Michael Miloro, DMD, MD, FACS

9:00

A novel technique of Simultaneous Custom TMJ replacement with combine Free Fibular reconstruction for Large mandibular defects. Oualid Badri, DMD, MSC; Hadi SeiKaly, MD; Clayton M Davis, DDC, MD, MSC, FRDC(C)

9:15

Association of Serologic Antibody Status with Arthroscopic and Histologic Findings in Inflammatory Arthritis of the Temporomandibular Joint. Briana J Burris, DDS; Gregory McDermott, MD; Joseph P. McCain, DMD

9:30

Arthroscopic treatment of disc perforations. Daniel Jerez, DDS, Santiago, Chile

9:45

Is Autologous Fat Graft Necessary for TMJR? Felix Jose Amarista, DDS ; Mary Katherine Spinella, DMD, MD; Paola Paez, DDS; Rebeca Rodriguez, DDS; Daniel Perez DDS, MS Department of Oral and Maxillofacial Surgery. University of Texas Health San Antonio.

10:00 -10:30

Break and Sponsor Exhibits

10:30

FEATURE SPEAKER Carrol Saridin, MD, DDS PhD Topic: Unilateral Condylar Growth: terminology and treatment planning revised

10:50

Q&A

11:00

FEATURE SPEAKER Salvatore Sembronio, MD, PhD, FEBOMFS Topic: Virtual planning and surgical options for condylar hyperactivity

11:20

Q&A

11:30

FEATURE SPEAKER João Roberto Gonçalves, DDS Topic: Condylar healing after maxillomandibular advancement

11:50

Q&A

12:00

Adjourn

1:00 ESTMJS Annual Business Meeting Free Afternoon 6:30 – Cocktail reception 7:30 – Dinner

Friday March 1st , 2024 7:15 -8:00 am

Continental Breakfast and Sponsor Exhibits

Member and Guest Abstracts: 10 minute presentations followed by 5 minutes Q&A 8:00

Revolutionizing TMD Diagnosis: Utilizing Deep Learning Machine as Decision Support System. Prof. Samer Srouji DMD, Ph.D. Galilee College of Dental Sciences, Oral and Maxillofacial Surgery Department, Galilee Medical Center, Nahariya, Israel

8:15

Minimally invasive procedures on temporomandibular disorders in the pediatric population: a prospective study.

David Faustino Ângelo, MD. PhD; David Sanz, MD; Francesco Maffia, MD; Rute Marques, Henrique Cardoso, MD

8:30

Groningen TMJ total joint prosthesis: 2-year follow-up on surgical and patient reported outcomes. Fred K.L. Spijkervet, DDS, PhD; Joep Kraeima PhD; Carrol P. Saridin MD, DDS, PhD; Nico B. van Bakelen, MD, DMD, PhD; Bram J. Merema, PhD. Department Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.

8:45

A comprehensive management of inflammatory TMJ arthropathy with short scar facelift approach. Moorthy Halsnad, FRCS (OMFS) MBChB MRCS FFDRCSI MDS BDS, Queen Elizabeth University Hospital, Glasgow, UK

9:00

eTMJR: A series of manufacturer output data. D Zaiki, J Higginson, MA (Cantab), MD BChir, BDS, MRCSEd; Ross OC Elledge, FRCS (OMFS), FHEA, MAcadMedEd, MMedEd, MRCS, MBChB(Hons), MFDSRCPS (Glasg), BChD(hons), Louis G Mercuri, DDS, MS; B Speculand, MDS, FDSRCS (Eng), FFDRCS (Irel), FRACDS (OMS)

9:15

Outcomes of Double-Suture Arthroscopic Discopexy: Part 1-Technique, a Review of 77 Postoperative MRIs. Christopher K.B. Ward, DMD, M.Sc, Sharon Aronovich, DMD, Mohamed A. Hakim, DDS, MBA

9:30

Outcomes of Double-Suture Arthroscopic Discopexy: Part II - How does post-operative TMJ articular disk position affect Jaw Function and Pain? Johnson Cheung DDS, MD, MSc, MSc, Christopher Ward DDS, MSc, Jonathan P. Troost PhD, Sharon Aronovich DMD, FACS, and Mohamed Hakim DDS, MBA

9:45

Do patients with TMJ arthritis require open arthroplasty? Mohamed Hakim, DDS, MBA

10:00 -10:30

Break and Sponsor Exhibits

10:30

FEATURE SPEAKER Larry M. Wolford, DMD Topic: Adolescent internal condylar resorption (AICR)

10:50

Q&A

11:00

FEATURE SPEAKER Steven M. Sullivan, DDS, FACS, FACD Topic: Condylar resorption and systemic disease

11:20

Q&A

11:30

FEATURE SPEAKER Sharon Aronovich (Ron), DMD, FACS, FRCD(C) Topic: Injectable factors in TMJ Regeneration

11:50

Q&A

12:00

Adjourn

Free Afternoon and Evening

Saturday March 2nd, 2024 7:15 – 8:00 am Continental Breakfast and Sponsor Exhibits Member Abstracts: 10 minute presentations followed by 5 minutes Q&A 8:00

Spontaneous Repair and Remodeling of the mandibular head of the condylar process in young cats and dogs.

Boaz Arzi, DVM, DAVDC, DEVDC, FF-AVDC-OMFS; Christopher Sauve, DVM; Santiago Peralta, DVM, DAVDS; David Hatcher, DDS, MSc, MRCD(c); Nadine Fiani, BVSc, DAVDC. University of California-Davis, Veterinary Institute for Regenerative Cures, School of Veterinary Medicine, University of California, Davis, Pulse Veterinary Specialists & Emergency, College of Veterinary Medicine, Cornell University, Ithaca, NY.

8:15

Biomechanical performance of an alloplastic temporomandibular joint replacement prosthesis under bite force conditions in dogs and cats. Boaz Arzi, DVM, DAVDC, DEVDC, FF-AVDC-OMFS; Morgan Weed, BD; Stephanie L. Goldschmidt, BVM&S, DAVDC; Denis J. Marcelin-Little, DEDV, DACVS, DECVS, DACVSMR, School of Veterinary Medicine, University of California-Davis.

8:30

Temporomandibular Joint Replacement in the Ehlers-Danlos Patient - A Case Series. Dr Christopher GT Lim, FRACDS (OMS), RACDS, Sydney, Australia

8:45

SAPHO Syndrome with bilateral TMJ ankylosis treated with total mandible and TMJ replacement: literature review and case report. Gerson Hayashi, DDS, MS, PhD - Depto. OMS Federal University of Rio de Janeiro; Eneida Chiappetta Hayashi, DDS, MS. Depto. OMS Brazilian Institute of Facial Rehabilitation - RJ - Brazil

9:00

FEATURE SPEAKER Nadeem Saeed, BDS, MB BS FDSRCS, FRCS, (OMFS) Topic: Expert consensus ESTMJS on TMJ Surgery Complications

9:20

Q&A

9:30

FEATURE SPEAKER Dusan Hirjak, MD PhD Topic: Current concepts in the treatment of condylar fractures

9:50

Q&A

10:00 -10:30 Break and Sponsor Exhibits 10:30 – 11:30 Open Forum 11:30 - 12:30

ASTMJS Annual Business Meeting

Adjourn Free Afternoon 5:30 – 7:30 pm Cocktail and

Hors d ‘oeuvres Reception

ABSTRACTS LIST Presenter Name Amarista, Felix

Burris, Brianna Jerez, Daniel Angelo, David Arzi, Boaz

Arzi, Boaz

Badri, Oualid

Cheung, Johnson Hakim, Mohamid Halsnad, Moorthy

Hayashi, Gerson Lim, Christopher Miloro, Michael Speculand, Bernard Spijkervet, Fred Srouji, Samer Ward, Christopher

Abstract Name Is Autologous Fat Gra Necessary for TMJR?

Status Candidate

Associa on of Serologic An body Status with Arthroscopic and Histologic Findings in Inflammatory Arthri s of the Temporomandibular Joint.

Candidate Arthroscopic treatment of disc perfora ons.

Candidate Minimally invasive procedures on temporomandibular disorders in the pediatric popula on: a prospec ve study.

ASTMJS/ESTMJS Spontaneous Repair and Remodeling of the mandibular head of the condylar process in young cats and dogs.

ASTMJS Biomechanical performance of an alloplas c temporomandibular joint replacement prosthesis under bite force condi ons in dogs and cats ASTMJS A novel technique of Simultaneous Custom TMJ replacement with combine Free Fibular reconstruc on for Large mandibular defects Guest Outcomes of Double-Suture Arthroscopic Discopexy: Part II - How does post-opera ve TMJ ar cular disk posi on affect Jaw Funcon and Pain?

Guest Do pa ents with TMJ arthri s require open arthroplasty?

ASTMJS A comprehensive management of inflammatory TMJ arthropathy with short scar faceli approach ESTMJS SAPHO Syndrome with bilateral TMJ ankylosis treated with total mandible and TMJ replacement literature review and case report.

ASTMJS/SATMJS

Temporomandibular Joint Replacement in the Ehlers-Danlos Paent - A Case Series.

ASTMJS Does botulinum toxin treatment for myofascial pain reduce pain, improve func on, or enhance quality of life?

ASTMJS eTMJR: A series of manufacturer output data ASTMJS/ESTMJS Groningen TMJ total joint prosthesis: 2-year follow-up on surgical and pa ent reported outcomes.

ASTMJS/ESTMJS Revolu onizing TMD Diagnosis: U lizing Deep Learning Machine as Decision Support System ASTMJS/ESTMJS Outcomes of Double-Suture Arthroscopic Discopexy: Part 1Technique, a Review of 77 Postopera ve MRIs Guest

ABSTRACTS IN ORDER OF PRESENTATION Thursday February 29, 2024

Does botulinum toxin treatment for myofascial pain reduce pain, improve function, or enhance quality of life?

Michael Miloro, DMD, MD, FACS

Background: The efficacy of onabotulinumtoxin A (botox A) for myofascial pain disorder (MPD) is controversial.

Purpose: To determine if botox A reduces pain, improves function or enhances quality of life (QoL) in MPD. Study design, setting, sample: Multi-center, prospective randomized, double-blind, placebo-controlled clinical trial. Subjects with orofacial pain were screened for MPD using Diagnostic Criteria for TMD (DC/TMD).

Predictor variable: MPD treatment with botoxA vs. placebo (saline). Outcome variables: Primary: pain (VAS) before Rx (T0), 1 month (T1), 2 months (T2), 3 months (T3).

Secondary: MIO, jaw function (jaw functional limitation scale), and QoL (Short Form 36) at T0, T1, T2, T3.

Covariates: Subject demographics, prior treatments, TMJ signs/symptoms. Analyses: Descriptive and bivariate analyses using chi-square, Fischer's exact t-test.

Results: n=75, botoxA group: 38, mean age=37+/-11 (p=.6), 86% female (p=.3), mean VAS: T0=58+/-15, T1=39+/-24, T2=38+/-23, T3=38+/-20 (p=.36) placebo group: 37, mean age=35+/-12 (p=.6), 76% female, mean VAS: T0=54 +/-14, T1=40+/-23, T2=34+/-20, T3=36+/-22 (p=.36) No differences: MIO (p=.12), jaw function (p=.24), or QoL (p>.05) at any time point.

Within group: pain (p<.005) and jaw function improved (p=.005), but no improvement in MIO or QoL. Conclusion: BotoxA and placebo (saline) injections both decrease pain and improve jaw function in MPD. References: Connelly ST, Myung J, Gupta R, et al. Clinical outcomes of Botox injections for chronic temporomandibular disorders: do we understand how Botox works on muscle, pain, and the brain? Int J Oral Maxillofac Surg.

3:322-327, 2017.

Sidebottom AJ, Patel AA, Amin J. Botulinum injection for the management of myofascial pain in the masticatory muscles. A prospective outcome study. Br J Oral Maxillofac Surg. 3:199-205, 2013.

Abboud WA, Hassin-Baer S, Joachim M, Givol N, Yahalom R. Localized myofascial pain responds better than referring myofascial pain to botulinum toxin injections. Int J Oral Maxillofac Surg. 11:14171423, 2017.

A novel technique of Simultaneous Custom TMJ replacement with combine Free Fibular reconstruction for Large mandibular defects.

Oualid Badri, DMD, MSC; Hadi SeiKaly, MD; Clayton M Davis DDS, MD. MSC. FRCD(c)

References

Association of Serologic Antibody Status with Arthroscopic and Histologic Findings in Inflammatory Arthritis of the Temporomandibular Joint Briana J Burris, DDS; Gregory McDermott, MD; Joseph P. McCain, DMD

Background Serologic tests are frequently obtained as part of the diagnostic work for temporomandibular joint (TMJ) arthropathies, in effort to screen patients for inflammatory, immune-based arthritis1. However, these serologic tests have not been validated for screening of inflammatory TMJ arthritis, and the clinical significance of positive serologic tests is not known2.

Aim: We aim to assess and report the incidence of pre-operative serologic positivity; determine the sensitivity, specificity, and positive predictive value for serologic tests associated with biopsy- proven inflammatory TMJ arthritis.

Methods: Retrospective chart reviews of 246 consecutive TMJ arthroscopy patients were conducted, using our RedCap TMJ surgical registry, developed and implemented at Massachusetts General Hospital. Serologic tests ordered as part of the diagnostic work up included: ANA, HLA-B27, RF, anti-CCP, and vitamin D. Patients were excluded if serologic testing was not completed pre-operatively, -operative synovial biopsies were not obtained.

Results: Of 246 patients included in our RedCap TMJ Arthroscopy Surgical Registry, 214 patients met inclusion criteria. Amongst the study population of TMJ arthropathy patients (n=214), there was a 48% (n=102) incidence of pre-operative serologic positivity. A diagnosis of inflammatory arthritis was established in ~20% (n=42) of the study cohort, in cases where histopathologic analysis of synovial biopsy specimens revealed the presence of plasma cells and/or inflammatory infiltrates. Approximately 60% (n=25) of the inflammatory arthritis patients were ANA-positive, at titers greater than or equal to a titer of 1:80. This resulted in a statistically significant association between ANA-positivity (titer 1:80) and inflammatory I nfiltrates on synovial biopsy (p= 0.043). Compared to histopathologic analysis in determining inflammatory arthritis of the TMJ: serologic-positivity (across all 4 serologic tests) was 64% sensitive and 56% specific; ANA-positivity was 48% sensitivity and 59% specific; and HLA B27-positivity was 9.5% sensitive and 94% specific. The positive and negative predictive value of ANA-positivity was 26% and 86%, respectively. There was a statistically significant association of the clinical-arthroscopic finding of petechiae synovitis and inflammatory arthritis of the TMJ, in this cohort.

Discussion: The incidence of serologic-marker positivity is high in patients presenting with TMJ arthropathies. There was a statistically significant association between ANA-positivity and the histologic findings of inflammatory infiltrates, in TMJ synovium. Additional research is necessary to establish diagnostic validity of serologic biomarkers and determine the utility of serologic markers in stratifying patients according to inflammatory arthritis risk and prognostication of TMJ arthropathies.

Arthroscopic treatment of disc perforations Daniel Jerez, DDS, Santiago, Chile

Introduction Disc perforation in temporomandibular joint (TMJ) disorders is a consequence of degenerative processes within joint structures. While not always requiring treatment, a perforated disc can act as a synovial irritant, potentially leading to joint pain, inflammation, and disease progression. Various surgical treatment alternatives, including discectomy, disc repair (discopexy), and joint replacement, have been described for disc perforations. However, there is limited evidence on how to manage this type of condition using arthroscopic techniques.

Purpose This study aims to present the outcomes of two arthroscopic techniques for treating disc perforations.

Materials and Methods The study assessed pre-operative joint pain (measured on a Visual Analog Scale from 0 to 10) and maximal interincisal opening (MIO) before and six months after surgery. A consecutive series of joints with confirmed disc perforation during arthroscopy was included. Treatment decisions were based on the size and position of the disc perforation. Joints were divided into two groups: Group 1 underwent arthroscopic discectomy (ADT), and Group 2 underwent disc repair using a double mattress loop technique. Statistical analysis was employed with SPSS software, with a significance level set at 0.05%.

Results The cohort comprised 40 patients (39 females) with a mean age of 32.8 years, involving 51 joints (Group 1: 35 joints and Group 2: 16 joints).

When comparing preoperative variables with postoperative ones, significant differences (p < 0.05) were observed in both groups (Group 1: MIO pre-operative = 31.6 mm, post-operative = 39.9 mm, pre-operative pain = 6.5, post-operative = 0.5. Group 2: MIO pre-operative = 28.5 mm, post-operative = 38.5 mm, pre-operative pain = 6.6, post-operative pain = 0.7), with no significant differences between the groups (p < 0.3 for MIO and p < 0.8 for pain). No complications were noted in any joint.

Conclusions Arthroscopic discectomy and disc repair demonstrated favorable outcomes in terms of preoperative symptoms and MIO, with no significant differences between the two techniques. The study emphasizes the importance of careful technique selection for optimal results. Long-term follow-up studies are necessary to elucidate the joint evolution following these techniques.

TITLE: Is Autologous Fat Graft Necessary for TMJR? Felix Jose Amarista, DDS; Mary Katherine Spinella, DMD, MD; Paola Paez, DDS; Rebeca Rodriguez, DDS; Daniel Perez DDS. Department of OMS. UT Health San Antonio.

INTRODUCTION: Heterotopic ossification (HO) is a potential complication that occurs following alloplastic TMJ reconstruction (TMJR). A study reported that HO was the most common reason for revision of an TMJR and the third for removal and replacement.1 Several options have been proposed to prevent it. Fat grafts harvested from the abdomen has been widely reported as an excellent approach to prevent HO.2,3 However, it involves an additional procedure for fat harvesting. The purpose of this study was to evaluate the subjective and objective outcomes in patients treated with SURGICEL SNoW packed around TMJR to prevent fibrosis and heterotopic bone formation.

MATERIALS AND METHODS: All patients who underwent TMJR at the Department of OMS, University of Texas Health San Antonio, between 2018 and 2023 were retrospectively reviewed. Patients treated with alloplastic TMJ reconstruction and SURGICEL SNoW packed around the prosthesis with complete records, and a minimum of 6 months’ follow-up were included in the study. Subjective and objective variables were recorded. The results were recorded on a Microsoft Excel spreadsheet and statistical analyses were conducted with the same software.

RESULTS: 137 patients (231 joints) underwent TMJR in our institution from 2018 and 2023. 76 patients (130 joints) met the inclusion criteria (71 female, 5 male) and were enrolled in the study. The mean age at the time of surgery was 39 years (min: 12, max: 77) and the mean follow-up time was 15 months (min: 6, max: 49).

The most common etiology why patients required TMJR were degenerative joint disorder (DJD) with osteoarthritis.

All subjective variables exhibited a statistically significant improvement. For objective variables, MIO with pain increased from 32 mm to 41 mm and MIO without pain increased from 29 mm to 39 mm, both with p < .0001.

Lastly, lateral excursions remained unchanged.

From this cohort, only one patient was diagnosed with heterotopic bone formation 2.5 years post-initial surgery, leading to the requirement for an additional arthroplasty.

CONCLUSIONS: Applying oxidized regenerated cellulose (SURGICEL SNoW combined with antibiotics around a TMJ prosthesis, as a substitute for fat, proves to be an effective and dependable approach in preventing fibrosis and heterotopic bone formation. The outcomes, both subjective and objective, exhibit comparability to the results reported when fat graft has been used.2–4

REFERENCES: 1. Amarista FJ, Mercuri LG, Perez D: Temporomandibular Joint Prosthesis Revision and/or Replacement Survey and Review of the Literature. Journal of Oral and Maxillofacial Surgery 78: 1692, 2020. 2. Mercuri LG, Ali FA, Woolson R: Outcomes of Total Alloplastic Replacement With Periarticular Autogenous Fat Grafting for Management of Reankylosis of the Temporomandibular Joint. Journal of Oral and Maxillofacial Surgery 66: 1794, 2008.

3. Amarista FJ, Jones JP, Brown Z, Rushing DC, Jeske NA, Perez DE: Outcomes of total joint alloplastic reconstruction in TMJ ankylosis. Oral Surg Oral Med Oral Pathol Oral Radiol 134: 135, 2022. 4. Wolford LM, Morales-Ryan CA, Morales PG, Cassano DS: Autologous Fat Grafts Placed Around Temporomandibular Joint Total Joint Prostheses to Prevent Heterotopic Bone Formation. Baylor University Medical Center Proceedings 21: 248, 2008.

UNILATERAL CONDYLAR GROWTH: terminology and treatment planning revised Carrol Saridin, DDS, DMD, PhD — Featured Speaker Haga Hospital/ University Medical Center Groningen, the Netherlands Objectives To discuss nomenclature concerning excessive unilateral mandibular condylar growth To discuss the search for the optimal method for diagnosing unilateral condylar hyperactivity (UCH) To discuss the management of UCH, which often requires variable approaches and differs between surgeons To discuss the ‘aftermath’ of performing condylectomy

Virtual planning and surgical options for condylar hyperactivity Sembronio S,- Featured Speaker Maxillofacial Surgery, Academic Hospital - Department of Medicine, University of Udine - Italy

Summary Condylectomy is a surgical technique used worldwide to correct the asymmetry due to condylar hyperactivity. Proportional condylectomy has been described as “low condylectomy”, and it is used with the double aim of removing the active growth center and restoring the posterior vertical height, correcting the asymmetry. Proportional condylectomy is usually performed as the first stage when condylar single photon emission computed tomography has a positive result, and the patient undergoes orthognathic surgery as the second stage only in cases of residual asymmetry. Generally, as reported in literature, proportional condylectomy reduces the need for secondary orthognathic surgery. However, there are several cases in which condylar hyperactivity is associated with dysmorphic patterns, such as Class II or III dentofacial deformities. These patients have not only asymmetry but also altered vertical and sagittal proportions. In such cases, because orthognathic surgery is necessary anyway, condylectomy and orthognathic surgery are planned from the beginning in 1 or 2 stages, with orthognathic surgery sequentially performed after condylectomy. Most important, orthognathic surgery and condylectomy are both very demanding procedures in terms of accuracy; they can benefit from modern computer-aided design (CAD)–computer-aided manufacturing (CAM) technologies to reach the desired clinical and surgical outcome. The use of CAD-CAM is widely reported in the field of orthognathic surgery, with evidence supporting its advantages in terms of the predictability of skeletal movements. In addition, computer-aided surgical simulation (CASS) allows patient-specific surgical guides and osteosynthesis plates to be designed, which allow the surgeon to intraoperatively reproduce the same skeletal osteotomy and movements established in the virtual scenario. The aim of the presentation is to discuss the surgical option for the treatment of condylar hyperactivity and to present a modern workflow for management of condylar hyperactivity and associated asymmetry by combining computer-guided surgery and orthognathic surgical planning.

Condylar Healing Following Maxillomandibular Advancement Joao Goncalves – Featured Speaker

The process of maxillomandibular surgical advancement can induce notable condylar changes, presenting a spectrum of outcomes. While certain patients undergo spontaneous condylar healing, others may exhibit degenerative changes and condylar resorption. This lecture explores the existing literature surrounding these events, emphasizing patient diagnosis and discussing a range of treatments, from non-invasive management to open joint surgery.

Friday March 1, 2024 Revolutionizing TMD Diagnosis: Utilizing Deep Learning Machine as Decision Support System Prof, Samer Srouji DMD, Ph.D 1 Galilee College of Dental Sciences, Oral and Maxillofacial Surgery Department, Galilee Medical Center, Nahariya, Israel 2 The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

Introduction Accurate diagnosis of temporomandibular disorders (TMD) is challenging, with the risk of misdiagnosis leading to inappropriate treatment strategies. Deep learning machine stands out as a robust tool for interpreting complex data and continuously improving through a 'learning by cases' approach. This research explores how deep learning machines can enhance diagnostic precision in TMD, guiding clinicians towards more effective and standardized treatment plans.

Materials and Methods: We have developed a deep learning algorithm that has been introduced to widely accepted maxillofacial and radiographic references. The algorithm concentrates on various TMD properties, encompassing clinical features, Orthopantomography images, CT scan segmentation for bony assessment, MRI segmentation for meniscal evaluation, and superimposition of both previous images, as well as arthroscopy data (when available).

After incorporating input data, the algorithm provides a diagnosis and treatment plan. The 'learning' process begins when clinicians provide feedback on the algorithm's output. Additionally, the algorithm is consistently evaluated for its accuracy and performance.

Our deep learning algorithm underwent thorough examination and preparation by being trained on a dataset comprising of 360 TMD cases.

Results: Through the utilization of deep learning, our algorithm has achieved an accuracy in differential diagnosis for TMD cases. As the deep learning algorithm learns from more cases, the rate of accuracy improvement slows, indicating a need for a larger dataset to significantly advance beyond the saturation point.

Conclusions: Deep learning algorithm is a decision support tool for TMD assessment and diagnosis. This emerging tool allows us to expedite the interpretation process and enhance workflow efficiency leading to improved clinical outcomes. Furthermore, it enhances accuracy and minimizes inconsistencies among different readers.

Minimally invasive procedures on temporomandibular disorders in the pediatric population: a prospective study Author David Faustino Ângelo, MD. PhD; David Sanz, MD; Francesco Maffia, MD; Rute Marques, Henrique Cardoso, PhD

Purpose: This study aims to investigate further and expand the research of pre- existing studies about the effectiveness of TMJ arthrocentesis and arthroscopy in the pediatric population.

Materials and Methods: A prospective study was conducted in Instituto Português da Face (IPF) - Lisbon, Portugal, including pediatric patients treated for TMD from June 1, 2019, to June 30, 2023.

Results: In the present study, 26 patients (17 female and 9 male) were included, representing a total of 48 joints operated. A statistically significant reduction was observed in the primary outcome, TMJ pain, from 3.93±280 preoperatively (mean±SD) to 0.50±1.533 (mean±SD) postoperatively (p < 0.0001). An improvement in maximum mouth opening from 36.92 ±8.79 preoperatively to 42.96±5.07 postoperatively was observed (p <0.001). The overall success rate was 84.62%. No irreversible complications were observed.

Conclusions: This prospective study showed that TMJ arthrocentesis and arthroscopy appear to benefit pediatric patients with TMD, significantly lowering pain and improving MMO, without relevant postoperative complications.

Keywords: Minimally Invasive Surgical Procedures, Temporomandibular joint disorders; Arthroscopy; TMJ Arthrocentesis; Pediatrics

Groningen TMJ total joint prosthesis: 2-year follow-up on surgical and patient reported outcomes.

Fred K.L. Spijkervet1, DDS, PhD; Joep Kraeima1, PhS; Carrol P. Saridin1,2, MD, DDS, PhD; Nico B. van Bakelen1, MD, DMD,. PhD; Bram J. Merema1 PhD. 1 Department Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.

2 Department Oral & Maxillofacial Surgery, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545 AA, The Hague, The Netherlands.

Contact: f.k.l.spijkervet@umcg.nl

For patients who suffer from severe dysfunction or resorption of the temporomandibular joint (TMJ), a prosthetic total joint replacement (TJR) may be indicated. Currently, the patient-specific or custom TMJ-TJR prosthesis options are plentiful, however, thorough (long term) follow-up studies generally lack.

The aim of this prospective study was to assess the 2-year follow-up outcomes of the patient-specific Groningen temporomandibular joint total joint replacement (GTMJ-TJR) prosthesis (Xilloc Medical®, Geleen, The Netherlands). Longitudinal assessment of surgical outcomes, changes in maximum mouth opening (MMO), and patient reported outcomes (PROMs) on functional mandibular impairment (MFIQ) and pain (VAS) was studied. These outcomes were collected preoperatively, and 6, 12 and 24 months postoperatively.

Fourteen patients (13 female, 1 male) who had received patient-specific GTMJ-TJR with a minimum follow-up period of 24 months were included.

The patient-specific GTMJ-TJR prosthesis was successfully implanted in all 14 patients without any mechanical failures or adverse effects during the minimum of 2-year follow-up. All GTMJ-TJR devices were accurately implanted within < 1 mm Euclidean distance to the VSP. There were no post-operative infections; in 2 patients a temporary weakness of the facial nerve was reported. The median MMO increased from 19.5 to 30.0 mm (R: 6-34) while the median VAS pain reduced from 72 to 9 mm. The median MFIQ reduced from 47.0 to 18.5. In one chronic pain patient the pre-operative pain was not relieved by the GTMJ-TJR, however the MMO appeared to be significantly improved.

This study shows considerable functional improvement when compared to a prior follow up study of the former stock Groningen TMJ-TJR. This indicates that a thorough 3D planning, subsequent patient-specific modeling, and accurate guided placement of the Groningen TMJ-TJR improves clinical outcomes significantly.

References 1 Kraeima J, Merema BJ, Witjes MJH, Spijkervet FKL. Development of a patient-specific 2 temporomandibular joint prosthesis according to the Groningen principle through a cadaver test series. J Craniomaxillofac Surg. 2018;46:779-84 2 Merema BJ, Kraeima J, Witjes MJH, Van Bakelen NB, Spijkervet FKL. Accuracy of fit analysis of the patient-specific Groningen temporomandibular joint prosthesis. Int J Oral Maxillofac Surg. 2021;50:538 –45 3 Merema BJ, Witjes MJH, Van Bakelen NB, Kraeima J, Spijkervet FKL. Four-Dimensional 4 Determination of the Patient-Specific Centre of Rotation for Total Temporomandibular Joint 5 Replacements: Following the Groningen Principle. J Pers Med. 2022;12:1439 4 Schuurhuis JM, Dijkstra PU, Stegenga B, de Bont LGM, Spijkervet FKL. Groningen temporomandibular total joint prosthesis: an 8-year longitudinal follow-up on function and pain. J Craniomaxillofac Surg. 2012;40:815-20

A comprehensive management of inflammatory TMJ arthropathy with short scar facelift approach Moorthy Halsnad, FRCS (OMFS) MBChB MRCS FFDRCSI MDS BDS, Queen Elizabeth University Hospital, Glasgow UK

Introduction/Aims: The management of younger patient groups with inflammatory arthropathy and dentofacial disproportions are often considered challenging clinical scenarios. Most such patients routinely undergo several surgical procedures often not reaching satisfactory functional and aesthetic outcomes. The most common concerns that discourage such individuals seeking surgery are; a) complications of surgery b) facial weaknesses c) scar d) need for multiple surgeries e) sub optimal outcomes of join function & aesthetics. The purpose of this presentation is to demonstrate the author is technical modifications with minimal access temporomandibular joint replacement (TJR) surgery with our without orthognathic procedures in a cohort of inflammatory arthropathy.

Materials and Methods: The presentation will review case series of tmj inflammatory arthropathy many of them with severe forms of dentofacial disproportions. This will include assessments, investigation findings, surgical preparations including 3 dimensional planning for patient specific implants for tmj prosthesis and surgical technique utilized.

Results: All surgical cases are assessed and operated by single surgeon. The case series included a total of 14 cases (22 joints, 8 bilateral, 6 unilateral, 6 with simultaneous orthognathic procedures). All TJRs are done via short scar facelift approach (SSFA). The presentation will elaborate on the variety of inflammatory arthropathy.

Apart from one case of temporary temporal branch deficits of facial nerve, all other cases had no facial nerve deficits. Patient reported outcomes have been consistently very good.

Conclusions: The presentation will conclude that the author’s technical modifications with SSFA for total joint replacement surgery in younger cases series of inflammatory arthropathy is advantageous by enhancing the overall outcomes particularly with minimal morbidity. The presentation will demonstrate the SSFA-TJR outcomes in cases with and without orthognathic procedures. Author strongly feels the SSFA approach can be considered by an experienced TMJ surgeon in pursuit to get an “un-operated appearance” with minimal morbidity for his TJR patient.

eTMJR: A series of manufacturer output data D Zaiki, J Higginson, MA(Cantab), MB BChir, BDS, MRCSEd, Ross OC Elledge FRCS (OMFS), FHEA, MAcadMedEd, MMedEd, MRCS, MBChB(Hons), MFDSRCPS(Glasg), BChD(Hons), Louis G Mercuri, DDS, MS, B Speculand, MDS, FDSRCS (Eng), FFDRCS (Irel), FRACDS (OMS) Introduction There are not as many publications about extended TMJ replacements (eTMJRs) , compared with standard replacements, despite their clinical use over more than a decade. We therefore looked a series of all TMJ devices from one manufacturer (Stryker/TMJ Concepts) to assess the range of output of their extended devices using our 2022 classification(1). The purpose of this study was to assess the extent of use of eTMJRs. Methods After setting up a Stryker research contract, we obtained the prosthesis design images for a series of TMJRs ( normal and extended) manufactured by Stryker TMJ Concepts. These were then classified according to Higginson et al (2022). We also looked at the adjunctive use of genioplasty and coronoidectomy.

Results There were 1179 joints manufactured, of which 1020 were standard M0F0 devices. There were 159 eTMJRs. The most frequent combination was M1F0 (80), with M2F0 (26) in second place, followed by M0FT (15) and M3FT (14).

In the whole group there were 789 patients, of whom 386 had bilateral and 403 had unilateral components fitted. 120 patients had eTMJRs fitted, 37 of whom had bilateral replacements. Data on genioplasty and coronoidectomy in these eTMJR patients will also be presented.

Conclusion In the series under study, eTMJRs accounted for 13.5% of all TMJR devices manufactured by Stryker TMJ. Reference 1.Modification of an extended total temporomandibular joint replacement (eTMJR) classification system.

J Higginson, C Panayides, B Speculand, LG Mercuri, ROC Elledge. Br J Oral Maxillofac Surg 2022; 60:983-986

Title: Outcomes of Double-Suture Arthroscopic Discopexy: Part 1-Technique, a Review of 77 Postoperative MRIs Christopher K.B. Ward, DMD, M.Sc, Sharon Aronovich, DMD, Mohamed A. Hakim, DDS, MBA

Background: There are several published techniques for arthroscopic TMJ discopexy, but there are controversies in the literature about their outcomes and indications.

Purpose: To present a modification of the arthroscopic discopexy technique and to assess the stability of this modification using postoperative MRIs in the first sample study from the United States.

Study Design: This retrospective single-institution cohort study evaluated patients who underwent arthroscopic discopexy for internal derangement (Wilkes II-V) and obtained postoperative MRIs at least 3 months following the procedure. Patients were excluded from the analysis if there was no postoperative MRI examination, an MRI obtained less than 3 months after the surgical procedure, or an uninterpretable MRI examination with respect to postoperative disc position.

Predictor/exposure/independent variables: patient age, preoperative Wilkes stage, and preoperative disc position, classified using the imaging addendum to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), were evaluated.

Main outcome variable: Stability of the postoperative disc position. Disc position in post-surgical MRIs was determined to be post-surgically reduced if greater than 50% of the disc resided between the 10-2 o’clock position in relation to the condylar-ramus axis in the closed-mouth sagittal views.

Analyses: Interrater reliability was assessed using Cohen's kappa coefficient (κ). The χ2 test was used to assess relationships between variables. Generalized non-linear mixed effects models with random effects terms for subject were utilized for modeling odds ratios (ORs). Statistical significance for this study was set at P ≤ 0.05.

Results: 77 joints, 54 (70%) demonstrated a reduced disc position, 19 (25%) re-displaced anteriorly, with 10 demonstrating postoperative displacement with reduction and 9 without reduction, while 4 were posteriorlydisplaced. Patient age demonstrated a statistically significant impact on stability, with a model estimate for an odds ratio (OR) of stability of 0.61 for every 10-year increase in age (95% confidence interval (CI) = 0.37 0.98, p = 0.04).

Conclusion: An experienced arthroscopic surgeon that performs a double-suture discopexy using this technique should expect disc stability in 70% of cases with Wilkes stage II-V articular disorders.

Outcomes of Double-Suture Arthroscopic Discopexy: Part II - How does post-operative TMJ articular disk position affect Jaw Function and Pain? *Johnson Cheung DDS, MD, MSc, MSc, Christopher Ward DDS, MSc, Jonathan P. Troost PhD, Sharon Aronovich DMD, FACS, and Mohamed Hakim DDS, MBA

Do patients with TMJ arthritis require open arthroplasty?

Mohamed Hakim, DDS, MBA

Introduction Management of patients with TMJ disorders have significant heterogeneity in approaches to treatment with no clear guidelines. It is common practice to manage patients with varying degrees of arthritis with open discectomy or total arthroplasty. The purpose of this study is to present the outcomes of advanced arthroscopy on patients with perforated discs and varying degrees of TMJ arthritis. This analysis of the data in this abstract is preliminary while the designated biostatistician at the University of Michigan further analyses it.

Patients and Methods A retrospective study of all patients who underwent advanced TMJ arthroscopy with documented disc perforation, varying degrees of condylar changes and 3 months follow up with adequate documentation of preoperative and postoperative JFLS-20 scores, and preoperative and postoperative documentation of pain scores.

Results 30 patients were included in the study, 19 unilateral, 11 bilateral, a total of 41 patients. All patients were females, mean age was 48.5 (16-69), mean duration of postop follow up was 7.5 months (3-14). The average preop JFLS-20 in the unilateral group was 68, while the average postoperative score was 32, reflecting an average of 52% improvement. 11 out of the 19 unilateral patients achieved JFLS score below 35. 10 out of the 19 achieved improvement of more than 50%, while 5 achieved improvement of more than 80%. The mean preop JFLS score in the bilateral group was 64 and the mean postoperative score was 52, reflecting a modest 12% improvement. The mean preop pain in the unilateral group was 57 and postoperatively it was 30, reflecting 47% reduction in pain. The mean preop pain in the bilateral group was 64, while the postoperative score was 48, reflecting a modest 25% reduction in pain. Only 3 out of the 30 patients were planned for total arthroplasty after their 6 months follow up.

Conclusion Advanced arthroscopy is a viable treatment option for patients with TMJ arthritis. Further analysis of this data will evaluate the predictive variables for patients who had the greatest improvement in the JFLS and pain scores. Those predictive variables will include age, degree of condylar resorption, the number of true allergies and number of drug sensitivities. Given that Andrew Sidebottom demonstrated that 40 of patients who failed lysis and lavage and underwent open arthroplasty required total arthroplasty, surgeons should consider advanced arthroscopy as a viable treatment option.

Can Adolescent Internal Condylar Resorption (AICR) be successfully Treated by Articular Disc Repositioning?

Larry M. Wolford, DMD — Featured Speaker

Background: Adolescent internal condylar resorption (AICR) develops predominately in teenage females during pubertal growth. The condition causes anterior displacement of the articular discs, progressive condylar resorption, and mandibular retrusion. AICR is a specific TMJ pathology different from all other forms of TMJ arthrides causing condylar resorption.

Clinical and Imaging Presentation: Diagnosis of AICR is based on patient history, clinical examination, and imaging. AICR usually occurs bilaterally with the following clinical and radiographic characteristics: 1) Slow but progressive posterior shift of the mandible initiated during pubertal growth; 2) High occlusal plane angle (HOP) facial morphology with retruded mandible; 3) Development of the Class II occlusion with or without an anterior open bite; 4) TMJ symptoms such as pain, headaches, noises, etc.; and 5) Airway compromise and sleep apnea in more severe cases. MRI imaging demonstrates: 1) Decreased condylar head size and volume; 2) Anterior disc displacement; 3) May have normal or increased joint space with amorphous appearing soft tissue between the condyle and fossa.

Treatment Protocol: AICR can be successfully treated when the condyles and discs are salvageable and meet the inclusion criteria, with the following surgical protocol: 1) removal of the bilaminar tissue surrounding the condyle; 2) reposition the disc with the Mitek anchor technique; and 3) orthognathic surgery to advance the maxillo-mandibular complex in a counter-clockwise direction. Research studies will be presented documenting the outcome success of this protocol.

Conclusion: AICR can be successfully treated using this specific protocol that will arrest condylar resorption, provide skeletal and occlusal stability, decrease or eliminate pain, increase the airway dimension, improve jaw function and normalize facial balance.

Condylar Resorption: Systemic Disease Causes Steven M. Sullivan, DDS, FACS, FACD — Featured Speaker Condylar resorption is an insidious process that is believed to be multifactorial. Clearly, there are systemic diseases that will impact small joints, including the condyle. This presentation will discuss the more common causes of condylar resorption and result of systemic disease that can result in the necessity for TMJ reconstruction.

This presentation will cover treatment planning and demonstration of outcomes.

Injectable Factors in TMJ Regeneration Sharon Aronovich (Ron), DMD, FACS, FRCD© - Featured Speaker

Demand for total arthroplasty procedures in synovial joints such as the knee, hip, and TMJ are projected to increase significantly over time based on current trends. While outcomes with alloplastic implants are promising and improve quality of life, surgical morbidity, cost, recovery time, and longevity are some of the concerns. With the rapid pace of biomedical research, patients and clinicians have reason to be optimistic about minimally invasive injectable therapies, which may hold the promise of regeneration, restoring damaged tendons, ligaments, cartilage, and bone.

Excitement about the potential of growth factor-rich platelet concentrates of plasma, namely platelet rich plasma (PRP) and platelet rich fibrin (PRF), have paved the way for numerous studies exploring the applications of these autogenous treatments for a wide array of clinical problems such as bone regeneration during grafting, third molar socket healing, soft tissue healing, osteonecrosis, and most notably, the TMJ. This presentation will explore current knowledge regarding the clinical and preclinical effects of injectable therapies for various stages of TMJ disease, and advances in the use of stem cells for osteoarthritis of synovial joints.

Saturday March 2, 2024 Spontaneous repair and remodeling of the mandibular head of the condylar process in young cats and dogs Boaz Arzi, DVM, DAVDC, DEVDC, FF-AVDC-OMFS, Christopher Sauve, DVM, Santiago Peralta, DVM, DAVDC, David Hatcher, DDS, MSc, MRCD(c), Nadine Fiani, BVSc, DAVDC 1

Department of Surgical and Radiological Sciences, University of California, Davis, CA, USA; Veterinary Institute for Regenerative Cures, School of Veterinary Medicine, University of California, Davis, CA, USA.3 Pulse Veterinary Specialists & Emergency, Sherwood Park, AB, Canada; 4 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA 2

Address correspondence to Dr. Boaz Arzi (barzi@ucdavis.edu).

Purpose Spontaneous repair and remodeling of the mandibular head of the condylar process is a rarely reported outcome following condylectomy in dogs and cats. This case series describes the spontaneous repair and subsequent remodeling of the mandibular head of the condylar process in four immature dogs and two cats that sustained traumatic injuries, necessitating surgical intervention through arthroplasty via partial or complete condylectomy, or caudal mandibulectomy.

Materials and Methods: A Retrospective study was performed and included signalment as well as surgery reports and pre, post and follow up conventional computed tomography or cone beam CT. Results Clinical and computed tomographic evaluations revealed that all dogs and cats exhibited clinically functional TMJs, as evidenced by an appropriate range of motion. These findings were corroborated by the owners’ reports of the patient’s normal eating and drinking abilities. Conventional and cone-beam computed tomography studies demonstrated the repair and remodeling of the osseous tissues of the mandibular head of the condylar process. Histopathology was unavailable to assess the novel tissues. No evidence of intraarticular or extraarticular ankylosis or osteoarthritic changes was observed.

Conclusion This case series provides an illustration of the clinical outcomes and tomographic features of spontaneous repair of the mandibular head of the condylar process following arthroplasty, involving either condylectomy or caudal mandibulectomy, in four immature dogs and 2 cats.

The observed capacity for regrowth of excised osseous tissues underscores the need for further research aimed at refining treatment options for TMJ trauma.

Biomechanical performance of an alloplastic temporomandibular joint replacement prosthesis under bite force conditions in dogs and cats Boaz Arzi, DVM, DAVDC, DEVDC, FF-AVDC-OMFS, Morgan Weed, BS, Stephanie L. Goldschmidt, BVM&S, DAVDC, Denis J. Marcelin-Little, DEDV, DACVS, DECVS, DACVSMR

From the department of Surgical and Radiological Sciences and the J.D. Wheat Veterinary Orthopedic Research Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Address correspondence to Dr. Boaz Arzi (barzi@ucdavis.edu).

Purpose To evaluate the biomechanical and kinematic properties of the TMJ of cats and dogs with and without an alloplastic TMJ replacement under bite forces.

Materials and Methods All masticatory muscles were excised from eight canine and feline cadaver skulls. Intact TMJ were non-destructively tested. A left-sided condylectomy and coronoidectomy was performed. The left TMJ was replaced by a TMJR prosthesis and the skull were non-destructively tested. For 4 dog and 4 cat skulls, a right -sided TMJR was fitted and the skulls with bilateral TMJR were non-destructively tested. Parameters evaluated included motion of the prosthetic TMJ and motion of the mandibular and zygomatic prosthetic components relative to the mandible and zygomatic arch, respectively. To determine TMJR motion, mandibular motion was measured relative to a region on the zygomatic arch. The displacements evaluated were in the rostrocaudal (x-plane), ventrodorsal (y-plane), and mediolateral (z-plane) directions. The bite motion was recorded and evaluated from just before bite contact to peak bite force. The mouth opening motion was recorded and evaluated from a neutral point where the mandible was relaxed to the full range of motion of a mouth opening with the appropriate artificial digastricus force and with a hold, while open and loaded. Maximum displacements were compared between the TMJR and native TMJ. Results The TMJR prosthesis resulted in clinically similar articulation to the function of the native joint, with the ability of opening and closing the mouth and minimal laterotrusion. Also, the TMJR prosthesis demonstrated similar stability in both unilateral and bilateral replacement conditions under bite force and open mouth positions.

There was significantly less rostrocaudal motion of the TMJR compared to the native TMJ. Minimal (0.5 mm) dorsal motion during torque movement was noted for the TMJR as compared to the native TMJ. In the cat, when the mandibles were extended (mouth open), slightly more ventral motion (0.1 mm) compared to the native TMJ was noted after unilateral TMJR but not after bilateral TMJR. Conclusion The use of a novel alloplastic TMJR is feasible in a cadaver model. The TMJs in dogs and cats that are devoid of muscular support were mechanically inferior to TMJs after TMJR.

Temporomandibular Joint Replacement in the Ehlers-Danlos Patient - A Case Series Christopher GT Lim, FRACDS (OMS), RACDS, Sydney, Australia

Purpose: To review the outcomes of TMJ replacement in Ehlers-Danlos Syndrome(EDS) patients with end stage degenerative joint disease.

Materials and Methods: A retrospective review was undertaken of all TMJ replacement cases in a solo practice in Christchurch, New Zealand between 2018 - 2023. Patients with a formal diagnosis of EDS were identified and their clinical histories reviewed and evaluated. Outcomes of post-operative pain reduction, inter-incisal distance and patient satisfaction were reviewed.

Results: Six patients(5 bilateral, 1 unilateral - 11 TJRs) were identified from the cohort over the time period(43 bilateral, 22 unilateral - 108 joints). Follow up time was between 10- 24 months. There was no delayed healing noted and all implanted prosthesis were still present with no signs or symptoms of periprosthetic joint infection. All but one was satisfied with outcomes in terms of pain and function. This patient developed a serious mental health disordered which was thought to be a separate issue.

Conclusion: Although small, this case series demonstrates that Temporomandibular Joint Replacement is a viable option in treating end-stage disease in the EDS patient. All patients healed appropriately with no signs or symptoms or PJI. Care must be taken to assess the psychological fitness of these patients prior to embarking on these cases.

SAPHO Syndrome with bilateral TMJ ankylosis treated with total mandible and TMJ replacement: literature review and case report Gerson Hayashi, DDS, MS, PhD. - Depto. OMS Federal University of Rio de Janeiro - RJ - Brazil Eneida Chiappetta Hayashi, DDS, MS. - Depto. OMS Brazilian Institute of Facial Rehabilitation - RJ - Brazil

SAPHO Syndrome is a rare condition with skin manifestations and inflammatory osteoarticular disorders.

Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) are the most common characteristics. Its etiology is still unknown and probably involves genetic factors, infection and immunological components.

The lesion mainly affects the external bone, clavicle and ribs, being very rare in the mandible (10% of cases) and the TMJ. It mainly affects adolescents, young adults and women (1:2). Its treatment seeks to improve symptoms and is multimodal and empirical, using medications such as: NSAIDs, Corticosteroids, antibiotics, immunomodulators, anti-tumor necrosis factor therapy, bisphosphonates and hyperbaric oxygen therapy.

Surgical treatment in the jaw often includes decortication, curettage and bone resection, although it has a high recurrence rate over the years, but must be treated early at diagnosis to avoid functional limitations and the possibility of TMJ involvement. This paper addresses a case of a man with bilateral mandibular ramus and body involvement that progressed to bilateral TMJ ankylosis, requiring resection of the mandible and ankylosis and replacement with a customized mandibular prosthesis.

Case report: A 33-year-old patient with a history of pain and swelling in the mandible was diagnosed with SAPHO and initially treated with medication without improvement. After 3 years, the patient became completely limited in opening his mouth due to the appearance of TMJ ankylosis and major osteolysis of the mandibular ramus and body, with the exception of the anterior region of the mandible, confirmed by biopsy.

We performed resection of the ankyloses, ramus and mandibular body bilaterally and replacement with a customized total mandible and TMJ prosthesis (TMJ concepts inc., Ventura CA), the anterior region of the mandible was preserved and fixed to the mandibular prosthesis and put into function. The patient recovered opening movements (0 to 35mm) and right and left laterality (0 to 2mm), and recovered masticatory and phonatory function. The case has been followed up for 10 years without any treatment complications to date.

Conclusion: Due to the involvement of almost the entire bone structure of the mandible by the lesion and the presence of bilateral ankylosis, the use of a total mandible prosthesis associated with TMJ TJR was essential for resolving the case, as we do not believe that fixing the prosthesis in bone mandibular with lesion would be appropriate, so the use of a total mandible prosthesis became essential.

Bibliographic references - A. MCPhillips, L.M. Wolford, D.B. Rodrigues: SAPHO syndrome with TMJ involvement: review of the literature and case report. Int. J. Oral and Maxillofac. Surg. 39: 1160-1167, 2010.   L.G. Mercuri: The use of aloplastic prostheses for temporomandibular joint reconstruction.  J. Oral and Maxillofac. Surg. 58: 70-75, 2000.

- U. D. A. Miller-Richter, J.C. Roldán, M. Mötil, M. Behr, T.E. Reichert, O. Dreimal: SAPHO syndrome with ankylosis of the temporomandibular joint. Int. J. Oral and Maxillofac. Surg. 38: 1335-1341, 2009.

The ESTMJS consensus on complications and complication rates in TMJ surgery.

Nad Saeed, BDS, FDSRCS, FRCSMS, BS — Featured Speaker

Complications in surgery are inevitable and need to be considered by both patient and surgeon when undergoing or considering treatment. In Oxford in 2023 the European Society of TMJ Surgeons attempted to produce a consensus recommendation on complications and their rates associated with 3 broad groups, namely arthroscopy, open surgery and total TMJ replacement.

A working party had previously systematically reviewed the literature in these areas and provided a template based on reported complications and their severity. Based on this template complications were divided into common, uncommon, rare and very rare.

An independent moderator documented and evaluated voting results on described complications and their frequency allowing an expert consensus to be reached on which complication should be considered in each category.

It was agreed that patients should always be informed of uncommon and common complications and surgeon discretion be implemented with regards to rare and very rare complications.

This presentation will discuss the final agreement reached accepting the limitations of an expert consensus.

Current concepts in the treatment of condylar fractures Dusan Hirjak, MD, PhD, — Featured Speaker Bratislava, Slovakia

The aim of the presentation is to present an experiences in complex treatment of mandibular condylar fractures. Mandibular condylar fractures are common and account for 29% to 52 % of all mandibular fractures.

Treatment methods for condyle fractures, including condylar base, neck and condylar head location cause ongoing controversy. Traditionally , these fractures were treated by closed reduction(CR). However clinicians have frequently attemped to obtain more predictable results by open reduction and internal fixation (ORIF).

Typical fracture-related complications such as malocclusion, impair incisal vertical opening and condylar translation, facial asymmetry, chin deviation, internal derangement, degeneration and even ankylosis, may not be initially apparent. These sequelae are highly associated with displaced and dislocated fractures and mostly develop during long time.

Nowadays reports and experiences of author favor ORIF in a treatment of all levels of the condyle fractures.

ORIF is still not indicated for non-dislocated and non-displaced fractures in the absence of malocclusion.

Conservative treatment is still generally recommended in children up to 12 years due to high local remodelation and regeneration capacity.

For open reduction and anatomic reconstruction, internal fixation using plates and screws author recommends different modification of approaches, transoral for „easy cases“, periangular (transmaseteric, anteroparotid) for low fractures (condylar base, condylar low neck fractures) and preauricular for condylar head and condylar high neck fractures. There are presented preliminar experiences with perioperative artorscopy in a treatment of condylar head fractures to minimize a risk of ankylosis.

In conclusion general rules for treatment is that ORIF is indicated for displaced and dislocated fractures of all the levels connected with malocclusion. Anatomical reconstruction and early rehabilitacion is the best way to avoid rare but still existing risk of postrauamtic ankylosis.

NOTES ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

NOTES ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

NOTES ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

Thank You Sponsors!

DIAMOND

GOLD

SILVER