Computer-assisted total temporomandibular joint replacement with a hybrid basket-type mandibular component in recurrent mandibular keratocysts: Report of two cases

Odontogenic keratocysts (OKCs) are benign lesions with aggressive biological behavior and high recurrence rates, particularly when involving anatomically complex regions such as the mandibular condyle and adjacent skull base structures. In these settings, repeated conservative approaches often fail, while radical resection poses major functional and esthetic challenges. Two patients with recurrent, aggressive mandibular OKC involving the condylar, pterygoid, and zygomatic regions were treated by en bloc resection followed by computer-assisted total temporomandibular joint replacement (TMJ-TJR). Virtual surgical planning based on fused CT–MRI datasets and intraoperative navigation were used to guide both resection and reconstruction. Reconstruction was performed using patient-specific prostheses incorporating a hybrid basket-type mandibular component designed to accommodate an autologous iliac crest bone graft. Complete removal of the affected hard and soft tissues was achieved in both cases. At long-term follow-up (7 and 9 years), no evidence of recurrence was observed. Both patients demonstrated stable occlusion, satisfactory facial symmetry, and adequate mandibular function. In carefully selected cases of recurrent OKC involving the condylar region, computer-assisted TMJ-TJR using a hybrid basket-type mandibular component may represent a viable reconstructive option, enabling radical disease control while restoring mandibular form and function in anatomically challenging scenarios. • Recurrent condylar odontogenic keratocysts may require radical surgical management • Computer-assisted temporomandibular joint replacement enables precise reconstruction • Hybrid prostheses combining titanium and autologous bone were used • Long-term follow-up showed stable function and no recurrence