Concomitant Unilateral/Bilateral Temporomandibular Joint Reconstruction and Maxillomandibular Advancement for Temporomandibular Joint Pathologies and Obstructive Sleep Apnea: Technical Note and Case Report

<b>Background:</b> 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. <b>Methods:</b> 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-hypopnea index (AHI), and patient satisfaction with facial aesthetics. <b>Results:</b> 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 3-5 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. <b>Conclusions:</b> 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.