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PURPOSE: To use computer assisted design (CAD) technique to help the diagnosis, treatment planning and the postoperative evaluation of exostosis osteochondroma in mandibular condyle, and to evaluate the outcome of the technique. METHODS: Eight patients with exostosis condylar osteochondroma according to the inclusion criteria was selected. Preoperative design of all the patients was done using Surgicase CMF 5.0 software. Postoperative CT data was merged with the preoperative one, and paired t test was done using SAS 8.0 software package to evaluate the pre- and the post-operative measurements of the condyle. RESULTS: The tumors in 8 patients were removed successfully. The merge of the pre- and the post-operative condylar shape showed a good match with a mean error of (1.82±1.25) mm. CONCLUSIONS: Computer assisted surgical planning of exostosis condylar osteochondroma can help the operator to design a proper osteotomy line before operation, and make a better surgical plan in order to resect the tumor entirely, with preservation of the condyle on the affected side. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100), Program for Innovative Research Team of Shanghai Municipal Education Commission, and Scientific Research Foundation for Returned Overseas Chinese Scholars, Ministry of Education. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the effect of using digital occlusal splint in the simultaneous treatment of children temporomandibular joint (TMJ) ankylosis with jaw bone deformities. METHODS: Two children with unilateral TMJ ankylosis combined with jaw bone deformities were measured three-dimensionally before surgery by SurgiCase CMF 5.0 software of their CT data. After simulation of bony fusion removal and chin midline correction, digital occlusal splint was made for further costochondral graft which lengthened the affected ramus height. Postoperative CT scan was taken and 3D measurement was made to evaluate the results. RESULTS: Digital occlusal splint was placed smoothly for the two patients. Postoperative CT showed high fitness with presurgical design. CONCLUSION: Digital occlusal splint can save the operation time and improve the accuracy in the simultaneous treatment of children temporomandibular joint ankylosis with jaw bone deformities. It has good prospects for clinical application. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100), Program for Innovative Research Team of Shanghai Municipal Education Commission, Scientific Research Foundation of Ministry of Education for Returned Overseas Scholars. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the effect of computer-aided navigation (CAN) technique in the resection margin control of tenosynovial giant cell tumor (TGCT) involving the temporomandibular joint and skull base. METHODS: CAN technique was used to assist the resection of TGCT in TMJ and skull base, as well as immediate reconstruction of the skull base. Postoperative CT scanning was taken to evaluate the effect of the operation. RESULTS: Postoperative CT scanning showed a complete resection of the tumor, with a fine reconstruction of the removed skull base region. Postoperative follow-up of 6 months showed no signs of recurrence. CONCLUSIONS: The application of CAN technique can help to control the surgical margins of lesions in TMJ and skull base region. It can help to mark the tumor boundaries, protect vital structures as well as facilitate the reconstruction process during the surgical procedure. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100), Scientific Research Foundation of Ministry of Education or Returned Overseas Chinese Scholars and Program for Innovative Research Team of Shanghai Municipal Education Commission. [ABSTRACT FROM AUTHOR]

PURPOSE: A surgical method for the treatment of traumatic temporomandibular joint (TMJ) ankylosis with medially displaced residual condyle was described, and the long-term results were compared. METHODS: From 2001 to 2009, 60 patients and 82 joints diagnosed with traumatic TMJ ankylosis with medially displaced residual condyle were included in the present study. Lateral arthroplasty (LAP) was performed, and either the masseter muscle flap (MMF) or temporal fascial fat flap (TFF) were used as interpositional material to fill the lateral space. The long-term results of these treatments were compared by performing postoperative CT and clinical follow-up. SPSS 13.0 software package was used to analyze mouth opening improvement. RESULTS: In total, 22 joints were treated with LAP, 28 joints were treated with LAP and MMF, and 32 joints were treated with LAP and TFF. Thirty-eight patients with 48 joints were followed up for 1 to 4 years. Four of the 11 joints (36.4%) treated with LAP had reankylosis, 3 of the 17 (17.6%) joints treated with LAP and MMF had reankylosis, and 0 of the 20 (0%) joints treated with LAP and TFF had reankylosis. Compared with LAP treatment, LAP with TFF significantly improved the maximal incisal opening (MIO) in long -term follow -up. CONCLUSION: LAP can reserve the residual TMJ structure. TFF is a reliable interpositional material in LAP for prevention of reankylosis. [ABSTRACT FROM AUTHOR]

PURPOSE: To discuss the application of CAD/CAM technique in the treatment of condylar osteochondroma accompanying with oral-maxillofacial bone deformity. METHODS: Pre-operational planning of a patient with condylar osteochondroma was conducted, maxillary and mandibular bone deformities was performed with CAD technique (Surgicase CMF 5.0 based on CT data), including virtual tumor resection, virtual osteotomy, virtual occlusal plate/osteotomy template designing and post -operative simulation. RP technique was used to make occlusal plates and osteotomy templates. Postoperative CT scan was performed and merged with the operation plans to evaluate the accuracy. RESULTS: Postoperative CT showed the effect of the operation matched with the preoperative planning well. The face of the patient was symmetrical 6 months after operation, there was no sign of recurrence. CONCLUSIONS: The pre -operative application of CAD/CAM technique can improve the accuracy of the tumor resection of the condyle and the correction procedure of facial asymmetry, as well as saving operating time. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100), Research Fund of Biomedicine Engineering of Shanghai Jiao Tong University (YG2009MS42) and Program for Innovative Research Team of Shanghai Municipal Education Commission. [ABSTRACT FROM AUTHOR]

PURPOSE: To demonstrate temporomandibular joint (TMJ) changes after acute trauma to the mandible without condylar fracture by radiography and surgical exploration. METHODS: Seven patients with 11 joints who had acute trauma to the mandible without condylar fracture complained of mouth opening limitation from 1 month to 1 year after trauma were treated in the temporomandibular joint (TMJ) division of Shanghai Ninth People' s Hospital from 2009 to 2010. Six patients had combined facial fractures which were treated in other hospitals or by other surgeons in this hospital before. CT scans with coronal reconstruction through the condyle immediately after injury and few months later when they came to the TMJ division for treatment were compared. MRI was taken before treatment to check the TMJ changes. Surgical treatment was performed for all patients. RESULTS: CT scan showed 87.5% (7/8) of the joints with "intact" condylar surface bone immediately after injury developed bone destruction 1 month to 1 year later. MRI showed all 11 joints had TMJ disc displaced anteriorly. Ninety percentage (10/11) of the joints also had condylar surface bone destruction. Surgical exploration showed bony ankylosis in 2 joints; fibrous ankylosis with destroyed condyle stuck to the fossa in 3 joints; TMJ osteoarthritis with degenerated condylar surface bone and fibrous adhesion in 5 joints; and internal derangement with relatively normal condylar surface cartilage and disk shape in 1 joint. CONCLUSIONS: Acute trauma [ABSTRACT FROM AUTHOR]

Temporomandibular joint ankylosis (TMJA) is a severe disease which affects the function of oral and maxillofacial system. It leads to mouth opening limitation, facial deformity and OSAHS in the severe cases. Since trauma is the main cause of TMJA, this article reviewed the diagnosis, classification and treatment progress in traumatic TMJA. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100). [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the usefulness of computer-assisted surgery (navigation and stereolithographic model guided surgery) and compare the results with traditional surgery on the treatment of delayed orbitozygomatic fracture with enophthalmos. METHODS: Sixty-four patients diagnosed as delayed unilateral orbito-zygomatic fractures with enophthalmos were treated in the Department of Oral and Maxillofacial Surgery and Department of Ophthalmology in Shanghai Ninth People's Hospital from October, 2008 to December, 2010. Among them, 25 cases were treated by computer-assisted surgery with the mean enophthalmos of 5.71mm, the other 39 were treated traditionally with the mean enophthalmos of 4.96mm. Materials used for orbital reconstruction were: titanium mesh (n =35); titanium mesh combined with porous polyethylene (Medpor) or hydroxyapatite (HA) (re=12); Medpor (n=12) and HA (n=5). CT scan before and after surgery were acquired with orbital coronal reconstruction and three-dimensional bone reconstruction. Zygomatic reduction and globe projection of different treatment methods were evaluated by post-operative CT scan and clinical follow-up. RESULTS: In computer-assisted surgery, good zygomatic reduction was acquired in 92% of the cases; globe projection was good in 82% of the cases, 17% still had mild enophthalmos (≤3mm). In traditional treated cases, good zygomatic reduction was acquired in 74.3% of the cases; globe projection was good in 74% of the cases, 19% still had mild enophthalmos and 6% had moderate enophthalmos (≤4mm). Good globe projection was acquired in 74% of the cases with titanium mesh only; 83% with combined materials; 67% with Medpor and 20% with HA. CONCLUSION: Computer-assisted surgery can improve the treatment results of delayed orbitozygomatic fracture with enophthalmos. Titanium mesh with Medpor for orbital reconstruction is a good way to treat severe enophthalmos. Supported by the Cooperated Foundation of Medical and Engineering Science of Shanghai Jiao Tong University (40YG2009ZD102), and Pujiang Talent Program of Shanghai Municipality[PJ(2009)00840]. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the role of retaining condylar cartilage on open reduction and internal fixation (ORIF) of intracapsular condylar fracture (ICF) in growing goats by three-dimensional (3D) computed tomography (CT) analysis. METHODS: Twelve 6-month-old goats were randomly divided into two groups, experimental group (n=&) and control group (n=4). ICF was created in bilateral mandibular condyles and then treated with ORIF. One side of the condylar cartilage was retained, while the other side of the condylar cartilage was removed. Condyles in the control group were untouched. CT scans were taken immediately after surgery, 3 months and 6 months post-operation to evaluate the growth of the ramus. Heights of the ramus were measured by 3D-CT analysis. SAS 6.12 software package was used for statistical analysis. RESULTS: Heights of the ramus in cartilage retained group immediately after operation, 3 months and 6 months postoperatively were (42.47±0.99)mm, (51.85±1.67)mm and (56.25±4.49)mm, respectively, while (42.69±0.76)mm, (45.18± 1.31)mm and (46.59±1.66)mm in cartilage removed group, and (42.61±0.99)mm, (51.52±1.95)mm and (56.19±3.38)mm in control group. There were no significant differences between the control group and cartilage retained group (P>0.05). While significant differences were shown between the cartilage retained group and cartilage removed group in both 3 months and 6 months post-operative measurements (P<0.05). CONCLUSION: ORIF for ICF in the growing goats has no effect on condylar growth when the condylar cartilage is retained, but growth restriction occurs when the cartilage is removed. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100). [ABSTRACT FROM AUTHOR]

PURPOSE: This study was to investigate the classification of traumatic temporomandibular joint ankylosis (TMJA) based on coronal CT scan and to present our treatment experience in the TMJ division of Shanghai Ninth People' s Hospital. METHODS: From 2001 to 2009, 130 patients diagnosed of TMJA were treated in TMJ division. Among them, 84 patients with 124 joints were caused by trauma and treated first by our group of surgeons. They were included in this study. All of them had CT scan, especially coronal reconstruction through the TMJ area before and after surgery. A new classification based on the coronal CT scan was proposed. The treatment protocol for Type Al ankylosis was fibrous tissue release or condylar head resection with costochondral graft (CCG) and temporalis myofascial flap (TMF). For Type A2 and A3 ankylosis, the lateral bony fusion was resected while the intact residual condylar fragment displaced medially was remained. The operation was named "lateral arthroplasty" (LAP). TMF or masseter muscle flap (MMF) was used as a barrier in the lateral gap between temporomandibular joint fossa and stump of the mandibular ramus. If the medial condylar fragment in Type A3 ankylosis was too small to bear the load, it was resected with the bony mass. The joint was then reconstructed with CCG and TMF or MMF. For Type A4 ankylosis, the bony fusion was completely removed and the joint was reconstructed with CCG and TMF or MMF. The result of the treatment were evaluated by CT scan and clinical follow-up. RESULTS: Among the 124 ankylotic joints, 14 were Type Al ankylosis (11.3%); 43 were Type A2 (34.7%); 46 were Type A3 (37.1%) and 21 were Type A4 ankylosis (16.9%). Part of Type Al, all Type A2 and A3 ankylosis had residual condylar head displaced medially which accounted for 75% (93/124) of the TMJ ankylosis. Treatment according to the classification was: LAP for 82 joints (66.1%); CCG for 33 joints (26.6%); and other treatment for 9 joints (7.3%). Forty-eighty patients with 68 joints had long time follow-up from 10 months to 4 years. Among them, 4 out of 17 joints reconstructed with CCG had reankylosis (23.5%), 7 out of 48 joints treated with LAP had reankylosis (14.6%). CONCLUSION: The new classification of TMJ ankylosis based on coronal CT scan is useful and valuable in guiding clinical treatment. LAP with TMF is a good way to treat traumatic TMJ ankylosis when the medially displaced condylar head and disc are intact. CCG with TMF has a good result for Type A4 ankylosis. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100). [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the results of two different treatment methods in intracapsular condyle fracture (ICE) of the mandible by coronal CT. METHODS: One hundred and eighty-three ICF cases with 242 condyles treated in the division of TMJ in Shanghai Ninth People's Hospital from 2002 to 2008 were evaluated by coronal CT before and after non-surgical and surgical treatment. RESULTS: There were ninety-four cases with 127 condyles in the non-surgical treatment group. Forty-eight cases with 64 condyles had more than 3 months CT follow-up. Among them, 41 cases with 52 condyles healed or remodeled, which accounted for 81.2%; seven cases with 12 condyles developed TMJ ankylosis, which accounted for 9.4% in the non-surgical treatment group. There were eighty-nine cases with 115 condyles in the surgical treatment group. Post-operative CT showed anatomic reduction in 81.7% of the condyles, near anatomic reduction in 13.9% and not anatomic reduction in 4.3% of the condyles. Thirty-five cases had more than 3 months CT follow ups. Among them, 32 cases with 44 condyles showed good healing, which accounted for 91.7%. Two cases with 3 condyles had the plates located too high, which accounted for 6.2%. One case with 1 condyle had plate removed because of resorption, which accounted for 2.1%. CONCLUSIONS: Coronal CT has a very important role in the diagnosis and treatment evaluation of ICF. With non-surgical treatment, most of the condyles healed with deformity or remodeling, few developed TMJ ankylosis. By surgical treatment, the condyles can be reduced anatomically, which is good for the restoration of TMJ functional activities. [ABSTRACT FROM AUTHOR]

PURPOSE: The study aims to evaluate the value of panoramic films in diagnosis of condylar fractures. METHODS: Panoramic films of 163 cases (220 joints) diagnosed as condylar fractures by CT were examined. Panoramic films of all types of condylar fractures classified by CT were analyzed. According to the position of fracture, the samples were divided into two groups, intracapsular fractures and extracapsular fractures(condylar neck fractures and subcondylar fractures). The detection of fractures in two groups were compared and statistically analyzed with SAS6.12 software package. RESULTS: All 163 condylar fractures (220 joints) could be classified by CT as intracapsular fractures (155 joints), neck fractures (45 joints) and subcondylar fractures (20 joints). Panoramic films showed 38 joints without fractures and 182 joints with fractures. Among them, 33 joints without fractures and 122 joints with fractures were in the group of intracapsular fractures. The detection rate of intracapsular fractures group was significantly lower than that of condylar neck fractures and subcondylar fractures group (P=0.0149). CONCLUSION: Panoramic films can initially diagnose condylar fractures, but the misdiagnosis rate is high for intracapsular fractures, particularly for minor fractures and fractures without fragment displacement. CT should be considered for positioning of fracture lines and confirming the displacement angle of fragment on coronal plane. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (Grant No.08DZ2271100). [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the clinical characteristics and treatment results of condylar fractures. METHODS: A retrospective study was conducted in 339 patients (461 sides) with condylar fractures on the sex, age, cause, fracture characteristics, concomitant injury, etc. RESULTS: Condylar fractures occurred mainly in the male, especially over 18 years, the male to female ratio was 1.73:1. Fall (69.32%) was the leading cause of condylar fractures. Intracapsular condylar fracture (67.24%, 219 cases and 310 sides) was the most fracture site. Mental fracture was the main concomitant injury, up to 24.48%. CONCLUSIONS: Fall was the main cause of condylar fracture, and fracture occurred mainly in young and adult males. Most fractures were unilateral. [ABSTRACT FROM AUTHOR]