CATEGORY AUSTRALASIAN DENTIST 89 Discussion The surgical correction of lower facial asymmetry can range from simple camouflage genioplasty all the way to complex bimaxillary osteotomies, with and without TMJ prosthetic total joint replacement. While bimaxillary osteotomies combined with orthodontics is the standard treatment for most lower facial asymmetries, there are some cases where camouflage genioplasty alone may work well, particularly in patients with limited financial resources. On the other extreme there are also cases where attention is required to the concomitant management of a diseased temporomandibular joint that may have caused the asymmetry in the first place as described in the case above. Essentially, the treatment objective in all lower facial asymmetries must always include a thorough assessment of the integrity and health of the TMJs, otherwise the outcomes may be compromised by an unstable TMJ resulting in chronic TMJ pain and relapse. The surgical correction of lower facial asymmetry is one of the most demanding of all orthognathic surgical procedures. Prior to the introduction of virtual surgical planning (VSP) and the use of cutting/ drilling guides and custom bone plates, the surgery itself relied on experience and guesswork. Facial asymmetry is a complex 3-dimensional problem that requires 3-dimensional imaging to best appreciate the extent of the deformity2. Virtual surgical planning has simplified the planning process and has given surgeons a whole new perspective that has enormously improved the treatment planning of complex jaw deformities. Fortunately, VSP is gradually becoming standard practice which allows surgeons to accurately assess and plan their jaw movements with a high degree of confidence3,4. The advent of custom printed medical devices has further improved the accuracy of corrective and reconstructive jaw surgery. Custom drilling and cutting guides help simplify and speed up the surgical procedure. Custom bone plates are simply positioned to match up with the pre-drilled holes. This eliminates the need for intermediate splints that rely on blind condylar positioning and removes the tedious task of bending plates which is often difficult and time consuming. Conclusion Virtual surgical planning and 3D printed custom medical devices have simplified and improved the accuracy of corrective jaw surgery in patients with complex lower facial asymmetries. NOTE: The custom devices described in this article are part of the Tri-FixTM Orthognathic System and the TMJ prosthesis is the custom TMJ ArthoJawTM which are designed and manufactured by MAXONIQ, a MedTech company based in Melbourne. www.maxoniq.com. The HDPE mandibular angle synthetic onlay StarPoreTM graft is manufactured by ANATOMICS. www.anatomics.com u For a complete list of references email gapmagazines@gmail.com Dr George Dimitroulis Suite 1, Ground Floor, 124 Grey Street East Melbourne Vic 3002 Tel: +61 03 9654 3799 Fax: +61 03 9650 3845 Mob: +61 0409 505 146 e-mail: geodim25@gmail.com LINICAL Fig.6 – Postoperative Lateral Ceph showing all the printed titanium hardware used to secure the jaw movements Fig.7 – Orthopantomogram clearly showing the right coronoidotomy to aid in vertical ramus lengthening and the asymmetrical genioplasty Fig.8 – Postoperative Frontal view Fig.9 – Postoperative frontal view showing corrected maxillary cant Fig.10 – Preoperative facial profile Fig.11 – Postoperative facial profile
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