Unilateral patient specific total temporomandibular joint reconstruction plus contralateral mandibular sagittal split osteotomy - indications and functional outcomes in comparison to total temporomandibular joint reconstruction alone

The purpose of this retrospective cohort study is to assess the indications for combining a unilateral total temporomandibular joint replacement (TTJR) with a contralateral mandibular sagittal split osteotomy (SSO) and to compare the functional outcomes with unilateral TTJR alone. Fourteen patients who received TTJR were divided into 2 groups according to whether an additional sagittal split osteotomy (and further ostotomies) had been performed. The indications for the SSO (and further bone corrections) were acquired or congenital mandibular asymmetry, dysgnathic skeletal deformities and malocclusion. Postoperative results (average follow up time = 25 months) of the entire patient cohort were as follows: jaw opening (maximal interincisal distance) ranged from 28 mm to 45 mm (mean 35 mm). Laterotrusive movement to the non-reconstructed side varied between 2 mm and 7 mm (mean 4.3 mm). Laterotrusion to the reconstructed side reached from 5 mm to 15 mm. Protrusion extended between 2 mm and 8 mm; The separate analysis for the two patient groups did not reveal significant functional differences. Our patient series confirmed that a combination of TTJR and contralateral SSO does not lead to any functional disadvantages. In patients with stable occlusion where unilateral TTJR is used as a kind of reconstruction after condylar resection contralateral SSO is usually not necessary.