Search Results (13)

(1) Background: Mandibular condylar fractures continue to be a subject of debate, traditionally framed as a choice between open and conservative management. However, this binary approach fails to adequately account for fracture-level anatomy, Temporomandibular joint (TMJ) involvement, and functional outcomes. (2) Purpose: To present an imaging-guided, fracture-level-based algorithm that integrates radiologic evaluation, surgical approach selection, fixation biomechanics, and functional rehabilitation. (3) Review Strategy: This invited review combines current evidence with a 13-year institutional experience involving 495 joints. High-resolution Computed Tomography (CT) Imaging was used to assess fracture morphology, displacement, and ramal height, while Magnetic Resonance Imaging (MRI) was selectively employed in intracapsular fractures to evaluate disc–condyle relationships when intra-articular involvement was suspected. Management decisions, including surgical approach and fixation strategy, were guided by an institutional algorithm tailored to fracture characteristics. (4) Results: Implementation of this approach yielded consistent and predictable outcomes. Mouth opening improved from approximately 18.77 mm preoperatively to 40 mm at 6 months. Lateral excursions became symmetrical (~9.6 mm), occlusion was restored in all patients, and bite force returned to near-physiological levels. Pain scores showed near complete resolution within 1 month. Postoperative morbidity remained low, with predominantly transient facial nerve weakness. (5) Conclusions: This imaging-guided, algorithmic framework provides reproducible functional outcomes and signifies a shift toward structured, anatomically driven management of condylar fractures. Full article

Background/Objectives: Restoration of mandibular anatomy following complex trauma remains challenging when conventional anatomical and occlusal references, such as dental occlusion, contralateral morphology, condylar position, or mandibular continuity are lost. This technical note describes the clinical application of a mandibular statistical shape model as an alternative anatomical reference for diagnosis, virtual planning, and postoperative evaluation in patients with severe post-traumatic deformities. Methods: The MAGIC-SSM, an open-source, age-, and sex-specific three-dimensional model derived from a normative population dataset, enables reconstruction of plausible mandibular geometry in the absence of residual landmarks. Three clinical cases were analyzed using MAGIC-SSM-based reference alignment, with distance mapping applied when indicated. Results: The model provided an additional anatomical reference that supported decision-making in secondary correction, hybrid reconstruction with patient-specific implants, and quantitative evaluation of postoperative outcomes. Conclusions: By replacing lost spatial references with population-based geometry, the MAGIC-SSM offered support for restoring mandibular form and symmetry. These preliminary findings illustrate the feasibility of applying the MAGIC-SSM as an anatomical framework in complex trauma when conventional guides are absent. As its clinical application involved clinician-guided alignment and scaling, reproducibility and reliability remain to be established and require further validation. Full article

Background: Condylar hyperplasia (CH) leads to mandibular overgrowth with anatomical, aesthetic, and functional consequences, particularly affecting facial harmony. It is characterized by severe mandibular prognathism (MP) in bilateral cases. This study aims to propose a therapeutic algorithm for diagnosing and treating bilateral condylar hyperplasia (BCH) based on demographic, clinical, craniofacial growth, and clivus ratio uptake conditions. Methods: Ten patients with severe skeletal Class III by MP, whose alteration was clinically associated with BCH, were consecutively evaluated in a specialized dentofacial deformity center between the period of 2019 and 2024. A detailed protocol was followed to gather clinical history, assess anatomical features, evaluate malocclusion, and identify potential BCH. When suspicion arose, a nuclear medicine test measured condylar scintigraphy uptake. If the result was positive, patients underwent bilateral condylectomy, following one of three treatment protocols. Results: Severe PM, pronounced Class III with excessive negative overjet, elongated condyles of normal anatomy, absence of family history, and accelerated growth since preadolescence and adolescence were common characteristics in these patients. Regarding the treatment protocol chosen according to the characteristics of the patients, five cases followed treatment protocol A: condylectomy and surgical correction of the alteration in two surgical stages. Two cases followed protocol B: bilateral condylectomy and orthognathic surgery in the same surgical time, and three cases followed protocol C: condylectomy and later post-surgical orthopedics and/or orthodontics without a second surgical intervention. Histopathological results confirmed bilateral hyperplastic growth and stability in mandibular size, and occlusion was observed during follow-up. Conclusions: Specialists need to recognize the clinical signs of BCH and use scintigraphy tests to measure condylar metabolic activity when suspected. Early detection of BCH is crucial, as it influences treatment decisions and helps prevent relapses in orthodontic or surgical interventions aimed solely at correcting or compensating for Class III malocclusion caused by MP. Full article

Background: As advanced technology continues to evolve, incorporating robotics into surgical procedures has become imperative for precision and accuracy in preoperative planning. Nevertheless, the integration of three-dimensional (3D) imaging into these processes presents both financial considerations and potential patient safety concerns. This study aims to assess the accuracy of a novel 2D-to-3D knee reconstruction solution, RSIP XPlan.ai™ (RSIP Vision, Jerusalem, Israel), on preoperative total knee arthroplasty (TKA) patient anatomies. Methods: Accuracy was calculated by measuring the Root Mean Square Error (RMSE) between X-ray-based 3D bone models generated by the algorithm and corresponding CT bone segmentations (distances of each mesh vertex to the closest vertex in the second mesh). The RMSE was computed globally for each bone, locally for eight clinically relevant bony landmark regions, and along simulated bone cut contours. In addition, the accuracies of three anatomical axes were assessed by comparing angular deviations to inter- and intra-observer baseline values. Results: The global RMSE was 0.93 ± 0.25 mm for the femur and 0.88 ± 0.14 mm for the tibia. Local RMSE values for bony landmark regions were 0.51 ± 0.33 mm for the five femoral landmarks and 0.47 ± 0.17 mm for the three tibial landmarks. The RMSE along simulated cut contours was 0.75 ± 0.35 mm for the distal femur cut and 0.63 ± 0.27 mm for the proximal tibial cut. Anatomical axial average angular deviations were 1.89° for the trans epicondylar axis (with an inter- and intra-observer baseline of 1.43°), 1.78° for the posterior condylar axis (with a baseline of 1.71°), and 2.82° (with a baseline of 2.56°) for the medial–lateral transverse axis. Conclusions: The study findings demonstrate promising results regarding the accuracy of XPlan.ai™ in reconstructing 3D bone models from plain-film X-rays. The observed accuracy on real-world TKA patient anatomies in anatomically relevant regions, including bony landmarks, cut contours, and axes, suggests the potential utility of this method in various clinical scenarios. Further validation studies on larger cohorts are warranted to fully assess the reliability and generalizability of our results. Nonetheless, our findings lay the groundwork for potential advancements in future robotic arthroplasty technologies, with XPlan.ai™ offering a promising alternative to conventional CT scans in certain clinical contexts. Full article

Based on computed tomography (CT) images, volume rendering was used to obtain a three-dimensional representation of data (3DVR). The aims of this study included: describing the bone anatomy of the temporomandibular joint (TMJ) of dogs; comparing the TMJs of each dog by skull type and age; comparing 3DVR images with three-standard-plane CTs; assessing soft tissues adjacent to the TMJ and assessing pathological cases. Multidetector computed tomography scans of bilateral TMJs of 410 dogs were observed. From a ventral view, slight displacements in the positions of the skulls were seen, whereas from a caudal view, differences in amplitude of the articular space were observed. Dolichocephalic and mesaticephalic dogs showed more similar TMJ features than brachycephalic dogs. The shape of the TMJ bones were irregular in dogs under 1 year old. The 3DVR images related to the three-standard-plane CT improved the overall comprehension of the changes in the articular space amplitude and condylar process morphology. The fovea pterygoidea, mandibular fossa and retroarticular process were perfectly shown. A better spatial situation of adjacent soft tissues was obtained. The 3DVR represents an ancillary method to the standard-plane CT that could help in the understanding of the anatomy and diagnoses of different pathologies of the TMJ in dogs. Full article

Objective: To describe the position of the mandibular condyle, the size of the joint spaces and the condylar angulation in patients with facial asymmetry (FA), and to classify these results according to the type of FA and compare them with a reference group without FA. Materials and Methods/Patients: An observational, cross-sectional, descriptive study using computed tomography (CT) was conducted on a sample of 133 patients with a clinical diagnosis of FA derived from the following entities: hemimandibular elongation (HE) (n = 61), hemimandibular hyperplasia (HH) (n = 11), condylar hyperplasia in its hybrid form (HF) (n = 19), asymmetric mandibular prognathism (AMP) (n = 25), glenoid fossa asymmetry (GFA) (n = 9) and functional laterognathism (FL) (n = 8). Likewise, a group of 20 patients without clinical or tomographic characteristics of FA was taken and their complete cone beam tomography (CBCT) scans were analyzed. The quantified variables were joint spaces (anterior, middle and posterior), angle of the condylar axis and condylar position. All measurements were performed using the free, open-source Horos software. Results: Most of the subjects without FA had a right middle condylar position (55%), while in the patients with FA the anterior condylar position predominated. On the left side, the most frequent condylar position was anterior, including the group without FA, except in the HH group. Considering the measurements of the anterior, middle and posterior joint space (mm) on the right side (anterior JS: 1.9 mm, middle JS: 2 mm and posterior JS: 2.8 mm) and on the left side (anterior JS: 2.7 mm, middle JS: 2.1 mm and posterior JS: 2.6 mm) of the subjects without FA, compared to those with FA, the latter presented smaller distances in all diagnoses and only for the right posterior JS (1.9 mm) in HH, was not significant. The condylar axis of the AF group showed significant differences with smaller angles for the left side in those diagnosed with HE (65.4°) and HH (56.5°) compared to those without AF (70.4°). Conclusions: The condylar position of patients with FA tends to be anterior, both on the right and left sides, while for cases without FA it is middle and anterior, respectively. Patients with FA have smaller joint spaces (mm) compared to patients without FA, with the exception of HH for the right posterior JS. Full article

A complex prosthodontic treatment is believed to be more successful when the condylar path is replicated using the articulator. However, there is an ongoing major disagreement between the researchers as the exact relationship between the posterior and anterior determinants has not been clear. The purpose of this study was to investigate whether the protrusive movement of the mandible does correlate with the temporomandibular joint (TMJ) anatomy or with incised features. Subjects (15 males and 15 females) were qualified for this study based on an initial interview including the following criteria: age 21–23 (+/−1), no history of trauma, orthodontic treatment, or temporomandibular disorders (TMD). For each patient, the angle of the condylar path, incisal guidance angle (IGA), interincisal angle, as well as overbite and overjet were measured on cone beam computed tomography (CBCT). This was followed by the examination with the Modjaw^® electronic axiograph recording and calculating the functional sagittal condylar guidance angle (SCGA) for the right and left TMJ during the protrusion. The results show that the mean functional axiographic measurement of SCGA in protrusion significantly correlates with the TMJ anatomy presented on CBCT. Moreover, a significant correlation was found between the values of SCGA in the functional and anatomical measurements in all its variants. It turned out that, statistically, the AB measurement was the most accurate. Finally, results showed that incisal relationships of permanent teeth such as overbite, overjet, incisal guidance angle and interincisal angle do not correlate with TMJ anatomy, and therefore, regarding an analyzed study group, do not affect the TMJ formation in young adults. Full article

Osteoporotic vertebral compression fractures are a global issue affecting the elderly population. To explore a new calcium silicate bone cement, polylactic acid (PLGA)–polyethylene glycol (PEG)–PLGA hydrogel was compounded with tricalcium silicate (C₃S)/dicalcium silicate (C₂S)/plaster of Paris (POP) to observe the hydration products and test physical and chemical properties. The cell compatibility and osteogenic capability were tested in vitro. The rabbit femoral condylar bone defect model was used to test its safety and effectiveness in vivo. The addition of hydrogel did not result in the formation of a new hydration product and significantly improved the injectability, anti-washout properties, and in vitro degradability of the bone cement. The cholecystokinin octapeptide-8 method showed significant proliferation of osteoblasts in bone cement. The Alizarin red staining and alkaline phosphatase activity test showed that the bone cement had a superior osteogenic property in vitro. The computed tomography scan and gross anatomy at 12 weeks after surgery in the rabbit revealed that PLGA-PEG-PLGA/C3S/C2S/POP was mostly degraded, with the formation of new bone trabeculae and calli at the external orifice of the defect. Thus, PLGA-PEG-PLGA/C₃S/C₂S/POP composite bone cement has a positive effect on bone repair and provides a new strategy for the clinical application of bone tissue engineering materials. Full article

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990–2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; p = 0.07), and titanium hardware was more frequently removed on an elective basis (p < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (p = 0.01); whereas angle fractures were more often treated with titanium hardware (p < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference. Full article

Open reduction and internal fixation (ORIF) is becoming increasingly common in treatment of the condylar process, including mandible head fractures. This approach significantly improves the results in terms of anatomical reduction of bone fragments, and shortens the treatment time, allowing for early functional recovery. The success of ORIF is largely determined by the stability of the osteosynthesis. The stabilization effect depends on the screw type and length of the plate used, in addition to the diameter and length of the screws used. The aim of this study was to determine the largest possible screw length that can be used in ORIF of the mandibular condyle considering the variable bone thickness. A total of 500 condyles were examined using computer tomography (CT)-based 3D models in Caucasians. For all models, three measurements were made in the frontal projection in places typical for the stabilization of osteosynthesis plates in the fractures of the condylar process: the base, the top, and the sigmoid notch. In addition, one measurement of the mandible head was made in the place of the greatest width. The results showed that 8 mm screws should be used in the region of the condylar base as the longest anatomically justified screw, whereas in the area of a sigmoid notch only 1.5–2 mm screws should be used. Measurements in the area of the neck top revealed statistically significant differences in the measurements between the sex of patients, with average differences below 1 mm (p < 0.05). In this area, the maximal length of the screw was found to be 10 mm. In mandibular head fractures, the use of long screws is extremely important due to the desired effect of fragment compression. Statistically significant differences were found in the measurement results between women and men. The maximal screw length for bicortical fixation was found to be 22 mm in men and 20 mm in women. In post-traumatic patients, the ability to obtain a clear measurement is often limited by a deformed anatomy. Taking into account the fact that the fracture stability is influenced by both the plate length and the length of the fixation screws, an assessment of the standard measurement values in a cohort group will improve the quality of the surgical fixations of the fractures. Full article

The accuracy of 3D reconstructions of the craniomaxillofacial region using cone beam computed tomography (CBCT) is important for the morphological evaluation of specific anatomical structures. Moreover, an accurate segmentation process is fundamental for the physical reconstruction of the anatomy (3D printing) when a preliminary simulation of the therapy is required. In this regard, the objective of this study is to evaluate the accuracy of four different types of software for the semiautomatic segmentation of the mandibular jaw compared to manual segmentation, used as a gold standard. Twenty cone beam computed tomography (CBCT) with a manual approach (Mimics) and a semi-automatic approach (Invesalius, ITK-Snap, Dolphin 3D, Slicer 3D) were selected for the segmentation of the mandible in the present study. The accuracy of semi-automatic segmentation was evaluated: (1) by comparing the mandibular volumes obtained with semi-automatic 3D rendering and manual segmentation and (2) by deviation analysis between the two mandibular models. An analysis of variance (ANOVA) was used to evaluate differences in mandibular volumetric recordings and for a deviation analysis among the different software types used. Linear regression was also performed between manual and semi-automatic methods. No significant differences were found in the total volumes among the obtained 3D mandibular models (Mimics = 40.85 cm³, ITK-Snap = 40.81 cm³, Invesalius = 40.04 cm³, Dolphin 3D = 42.03 cm³, Slicer 3D = 40.58 cm³). High correlations were found between the semi-automatic segmentation and manual segmentation approach, with R coefficients ranging from 0,960 to 0,992. According to the deviation analysis, the mandibular models obtained with ITK-Snap showed the highest matching percentage (Tolerance A = 88.44%, Tolerance B = 97.30%), while those obtained with Dolphin 3D showed the lowest matching percentage (Tolerance A = 60.01%, Tolerance B = 87.76%) (p < 0.05). Colour-coded maps showed that the area of greatest mismatch between semi-automatic and manual segmentation was the condylar region and the region proximate to the dental roots. Despite the fact that the semi-automatic segmentation of the mandible showed, in general, high reliability and high correlation with the manual segmentation, caution should be taken when evaluating the morphological and dimensional characteristics of the condyles either on CBCT-derived digital models or physical models (3D printing). Full article

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandible at the precision level 2 allowing description of their topographical distribution. A short introduction about the anatomy is made. Mandibular fractures are classified by the anatomic regions involved. For this purpose, the mandible is delineated into an array of nine regions identified by letters: the symphysis/parasymphysis region anteriorly, two body regions on each lateral side, combined angle and ascending ramus regions, and finally the condylar and coronoid processes. A precise definition of the demarcation lines between these regions is given for the unambiguous allocation of fractures. Four transition zones allow an accurate topographic assignment if fractures end up in or run across the borders of anatomic regions. These zones are defined between angle/ramus and body, and between body and symphysis/parasymphysis. A fracture is classified as “confined” as long as it is located within a region, in contrast to a fracture being “nonconfined” when it extents to an adjoining region. Illustrations and case examples of mandible fractures are presented to become familiar with the classification procedure in daily routine. Full article

Dislocated subcondylar fractures often require open reduction and internal fixation. This treatment modality results in better anatomy, early function, and facilitated physical therapy. Ideal stable fixation is obtained by use of two miniplates to control the tension zone in the sigmoid notch area and stabilize the posterior border region or, if there is not enough space, one stronger plate. That is most frequently achieved through extraoral approaches. Recently new instruments have facilitated the use of an intraoral approach, which is used usually with the aid of an endoscope. However, it is possible to perform the procedure without the endoscope if proper instruments and clinical mirrors for checking the posterior border reduction and fixation are used. A case of reduction and fixation of a medially dislocated condylar fracture is presented and discussed. Full article