Orthognathic surgery in instability of the TMJ using surgical guides and customized plates: 3 case reports

Abstract

Purpose: Patients with facial deformities and temporomandibular joint (TMJ) instability present unique challenges in orthognathic surgery (OGS). This report presents three complex cases of syndromic or post-traumatic deformities treated with virtual surgical planning (VSP), surgical guides, and customized fixation plates. Methods: Three patients with syndromic or post-traumatic deformities and TMJ instability underwent OGS. Planning was performed using Dolphin Imaging software. Surgical guides and patient-specific plates were designed with CAD software and fabricated via selective laser melting. Surgical workflows incorporated bone- and tooth-borne guides, with fixation achieved using customized titanium plates. Postoperative accuracy was evaluated by superimposing pre- and postoperative computed tomography (CT) scans. Results: Superimposition analysis revealed maximum surface deviations of less than 2 mm in all patients, with the maxilla demonstrating superior accuracy (<1 mm). Clinically, all patients showed improved facial symmetry, occlusion, and profile. The use of surgical guides and customized plates enhanced intraoperative precision and reduced the risk of root and nerve injury. Conclusion: Guided surgery with customized fixation improve surgical accuracy and outcomes in patients with complex deformities and TMJ instability. These results support the application of surgical guides and customized plates in challenging orthognathic cases.