{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T03:27:06Z","timestamp":1773977226776,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Patients with a triad of severe temporomandibular joint (TMJ) pathologies, obstructive sleep apnea (OSA), and dentofacial deformities often experience significant functional and aesthetic impairments. A combination of total TMJ reconstruction and maxillomandibular advancement (MMA) has emerged as a promising treatment option, which can address the complexity of these conditions simultaneously. Methods: This paper presents a practical protocol for TMJ reconstruction using patient-specific alloplastic total joint prosthesis in conjunction with additional splintless osteotomies. This approach integrates the recent advancements in virtual surgical planning (VSP), custom TMJ prostheses, and three-dimensional (3D) custom osteotomy guide and implant manufacturing, allowing for precise anatomical correction and enhanced treatment outcomes. Three patients were treated with the present protocol. Postoperative assessments mainly included maximum inter-incisal opening, apnea\u2013hypopnea index (AHI), and patient satisfaction with facial aesthetics. Results: All surgeries were performed without complications. The follow-up period ranged from 7 to 12 months. For the two patients with TMJ ankylosis, the postoperative maximum inter-incisal opening (MIO) increased from 3\u20135 to 35 mm and from 12 to 32 mm, respectively. Additionally, all three cases demonstrated that the protocol could significantly decrease AHI (with improvements of 57.5, 49, and 66.4 events\/h, respectively) and achieve satisfactory aesthetics. Conclusions: These findings suggest that this protocol is a viable option for addressing complex cases involving severe TMJ pathologies, OSA, and dentofacial deformities. Future studies with larger cohorts and long-term follow-up are needed to further validate these findings.<\/jats:p>","DOI":"10.3390\/jcm14051719","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T04:58:17Z","timestamp":1741064297000},"page":"1719","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Concomitant Unilateral\/Bilateral Temporomandibular Joint Reconstruction and Maxillomandibular Advancement for Temporomandibular Joint Pathologies and Obstructive Sleep Apnea: Technical Note and Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8396-2501","authenticated-orcid":false,"given":"Jean-Pierre T.F.","family":"Ho","sequence":"first","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"},{"name":"Department of Oral and Maxillofacial Surgery, Northwest Clinics, 1815 JD Alkmaar, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1927-3784","authenticated-orcid":false,"given":"Ning","family":"Zhou","sequence":"additional","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9652-2855","authenticated-orcid":false,"given":"Cornelis","family":"Klop","sequence":"additional","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadeem R.","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Great Ormond Street Hospital, London WC1N 3JH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0096-8217","authenticated-orcid":false,"given":"Jan","family":"de Lange","sequence":"additional","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"ref_1","first-page":"231","article-title":"The role of surgery in the management of disorders of the temporomandibular joint: A critical review of the literature. Part 2","volume":"34","author":"Dimitroulis","year":"2005","journal-title":"Int. J. Oral Maxillofac Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.cdip.2005.10.005","article-title":"Pathology of the temporomandibular joint","volume":"12","author":"Franklin","year":"2006","journal-title":"Curr. Diagn. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.oooo.2019.04.012","article-title":"Temporomandibular joint total replacement using the Zimmer Biomet Microfixation patient-matched prosthesis results in reduced pain and improved function","volume":"128","author":"Boyo","year":"2019","journal-title":"Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1053\/j.sodo.2019.08.002","article-title":"The role of total joint replacement surgery in the orthognathic patient","volume":"25","author":"Matthews","year":"2019","journal-title":"Semin. Orthod."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/S0266-4356(02)00139-0","article-title":"Reconstruction of the temporomandibular joint autogenous compared with alloplastic","volume":"40","author":"Saeed","year":"2002","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"ref_6","first-page":"E34","article-title":"Surgical treatment of temporomandibular joint ankylosis: Follow-up of 15 cases and literature review","volume":"14","author":"Vasconcelos","year":"2009","journal-title":"Med. Oral. Patol. Oral. Cir. Bucal."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.joms.2014.10.032","article-title":"Twenty-year follow-up study on a patient-fitted temporomandibular joint prosthesis: The Techmedica\/TMJ Concepts device","volume":"73","author":"Wolford","year":"2015","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/j.joms.2016.01.017","article-title":"Temporomandibular Joint Ankylosis Can Be Successfully Treated With TMJ Concepts Patient-Fitted Total Joint Prosthesis and Autogenous Fat Grafts","volume":"74","author":"Wolford","year":"2016","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_9","unstructured":"Maini, K., and Dua, A. (2023, January 30). Temporomandibular Syndrome, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK551612\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e714","DOI":"10.1097\/SCS.0000000000005689","article-title":"Temporomandibular Joint Ankylosis Leading to Obstructive Sleep Apnea","volume":"30","author":"Shaeran","year":"2019","journal-title":"J. Craniofac Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e379","DOI":"10.18295\/squmj.2018.18.03.019","article-title":"A Triad of Temporomandibular Joint Ankylosis, Mandibular Retrognathia and Severe Obstructive Sleep Apnoea: Case report","volume":"18","author":"Bakathir","year":"2018","journal-title":"Sultan Qaboos Univ. Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0140-6736(02)09464-3","article-title":"Obstructive sleep apnoea","volume":"360","author":"Malhotra","year":"2002","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"263","DOI":"10.5664\/jcsm.27497","article-title":"Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults","volume":"5","author":"Epstein","year":"2009","journal-title":"J. Clin. Sleep. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"301","DOI":"10.5664\/jcsm.7638","article-title":"Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment","volume":"15","author":"Patil","year":"2019","journal-title":"J. Clin. Sleep. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1513\/pats.200708-119MG","article-title":"Adherence to continuous positive airway pressure therapy: The challenge to effective treatment","volume":"5","author":"Weaver","year":"2008","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40463-016-0156-0","article-title":"Trends in CPAP adherence over twenty years of data collection: A flattened curve","volume":"45","author":"Rotenberg","year":"2016","journal-title":"J. Otolaryngol. Head. Neck Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1053\/joms.2002.31849","article-title":"Obstructive sleep apnea and maxillomandibular advancement: An assessment of airway changes using radiographic and nasopharyngoscopic examinations","volume":"60","author":"Li","year":"2002","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1016\/j.jcms.2018.10.012","article-title":"Toward a higher accuracy in orthognathic surgery by using intraoperative computer navigation, 3D surgical guides, and\/or customized osteosynthesis plates: A systematic review","volume":"46","author":"Liebregts","year":"2018","journal-title":"J. Craniomaxillofac Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1016\/j.joms.2017.01.004","article-title":"Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery","volume":"75","author":"Azarmehr","year":"2017","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.jcms.2022.05.010","article-title":"Custom made cutting guides and osteosynthesis plates versus CAD\/CAM occlusal splints in positioning and fixation of the maxilla in orthognathic surgery: A prospective randomized study","volume":"50","year":"2022","journal-title":"J. Craniomaxillofac Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1080\/08998280.2008.11928350","article-title":"Outcomes of treatment with custom-made temporomandibular joint total joint prostheses and maxillomandibular counter-clockwise rotation","volume":"Volume 21","author":"Wolford","year":"2008","journal-title":"Baylor University Medical Center Proceedings"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2884","DOI":"10.1016\/j.joms.2012.02.021","article-title":"Staged treatment of temporomandibular joint ankylosis with micrognathia using mandibular osteodistraction and advancement genioplasty","volume":"70","author":"Li","year":"2012","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/08869634.2020.1765600","article-title":"Bilateral temporomandibular joint reconstructions with stock alloplastic prostheses on a distracted mandible\u2014A case report","volume":"40","author":"Kamath","year":"2022","journal-title":"Cranio"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.cxom.2018.11.006","article-title":"Bilateral Temporomandibular Joint Reconstruction and Maxillomandibular Advancement for Concomitant Temporomandibular Joint Degeneration and Obstructive Sleep Apnea","volume":"27","author":"Gupta","year":"2019","journal-title":"Atlas Oral. Maxillofac. Surg. Clin. N. Am."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Movahed, R., and Semensohn, R. (2023). Indications for alloplastic total joint replacement in obstructive sleep apnea patients requiring maxillomandibular advancement. Front. Oral. Maxillofac. Med., 5.","DOI":"10.21037\/fomm-22-14"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.bjoms.2016.01.025","article-title":"Natural position of the head: Review of two-dimensional and three-dimensional methods of recording","volume":"54","author":"Cassi","year":"2016","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.bjoms.2014.01.004","article-title":"Single stage treatment of ankylosis of the temporomandibular joint using patient-specific total joint replacement and virtual surgical planning","volume":"52","author":"Haq","year":"2014","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.ijom.2019.08.022","article-title":"Splintless orthognathic surgery in edentulous patients-a pilot study","volume":"49","author":"Ho","year":"2020","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"142e","DOI":"10.1097\/PRS.0000000000001920","article-title":"Stryker SMARTLock Hybrid Maxillomandibular Fixation System: Clinical Application, Complications, and Radiographic Findings","volume":"137","author":"Kendrick","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0278-2391(97)90535-8","article-title":"Autologous fat transplantation around temporomandibular joint total joint prostheses: Preliminary treatment outcomes","volume":"55","author":"Wolford","year":"1997","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.joms.2018.12.027","article-title":"Postoperative Physiotherapy After Open Temporomandibular Joint Surgery: A 3-Step Program","volume":"77","author":"Loos","year":"2019","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_32","first-page":"187580","article-title":"TMJ Ankylosis: Multidisciplinary Approach of Treatment for Dentofacial Enhancement-A Case Report","volume":"2011","author":"Vibhute","year":"2011","journal-title":"Case Rep. Dent."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.jcms.2015.08.019","article-title":"Quantifying the outcome of surgical treatment of temporomandibular joint ankylosis: A systematic review and meta-analysis","volume":"44","author":"Troch","year":"2016","journal-title":"J. Craniomaxillofac Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.ijom.2022.10.009","article-title":"Complications of total temporomandibular joint replacement: A systematic review and meta-analysis","volume":"52","author":"Rios","year":"2023","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1016\/j.jcms.2017.07.011","article-title":"Temporomandibular joint reconstruction with stock and custom-made devices: Indications and results of a 14-year experience","volume":"45","author":"Gerbino","year":"2017","journal-title":"J. Craniomaxillofac Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1719\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:46:44Z","timestamp":1760028404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":35,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051719"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051719","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]}}}