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The aim of this study was to analyse volumetric asymmetries between the right and left condyles in relation to age, gender, and dental status.A retrospective analysis of 150 cone beam computed tomography (CBCT) scans was conducted. A single investigator performed the volumetric analysis of the CBCT scans using Vesalius 3D software. The volumetric data were analysed in relation to the gender, age, and dental status.The mean right condylar volume was significantly higher (P.01) than the left condylar volume. Right and left condylar volumes were significantly higher (P.01) in male study participants when compared to female study participants. There was no significant difference (P = .47) in the volumetric asymmetry between the male and female study participants. The volumetric asymmetry was significantly higher (P.01) in the older age groups when compared to the younger age groups. The volumetric asymmetry was significantly higher (P.01) in the partially and completely edentulous patients when compared to the dentate study participants. The condylar volume on the side having a partially edentulous area was significantly lower than the condylar volume of the contralateral dentate side (P.001).The volumetric asymmetry between the right and left condyle significantly increases with age and edentulousness. The result of the study encourages the clinicians to perform volumetric evaluation of the condyles in cases of radiographically evident condylar asymmetries to obtain a more accurate diagnosis.

To review and report the demographic and diagnostic data in a population with active unilateral condylar hyperplasia. The surgical intervention, sequencing of surgery, and treatment outcomes, including a quality-of-life survey, are described.Eighty patients were diagnosed with active disease. Demographic, treatment, and treatment outcomes were assessed. Quality of life was assessed by a 21-question questionnaire.Women were affected more frequently than men (W - 52; 65%; P = .008). Hemimandibular elongation (HE) (49; 61%; P - .004) occurred more frequently than hemimandibular hyperplasia (HH) (24; 30%) and HH-HE (7; 9%). Right side was affected more than left (R - 49; 61%; P - .003) overall, and when stratified. All racial groups were represented. Of the 80 patients in the sample, 80 (100%) underwent condylectomy on the side of active growth, 70 (87%) underwent bimaxillary osteotomies, 53 patients (66%) had single-piece maxillary osteotomies, 17 (21%) underwent segmental maxillary osteotomies, and 38 (48%) genioplasties were performed. Four patients (5%) underwent a second operation within a year of the first surgery to adjust the position of the mandible. Four (5%) facial nerve deficits were recorded. Class I cuspid occlusion was achieved with coincident maxillary and mandibular midlines and resolution of crossbite in 70 (88%) patients. Twenty three of the 24 respondents (96%) reported that they were satisfied with the treatment.Both HH and HE are diagnosed through clinical and radiographic examinations. Our results showed that HE occurs more frequently, all deformity subclassifications occur more frequently in females, the majority present in adolescence, and all racial groups are affected. The right side predominated. This study suggests that simultaneous condylectomy and orthognathic surgery provides predictable and stable outcomes for patients with active unilateral condylar hyperplasia and associated dentofacial deformities with an improvement in quality of living.

Glenoid fossa morphology may change following orthognathic surgery and may subsequently affect skeletal stability and functionality, however hardly documented. Hence, the purpose of this study was to evaluate the morphological change of the glenoid fossa 2 years after bimaxillary surgery.A case series was performed including subjects diagnosed with maxillary and/or mandibular growth disturbances, who underwent bimaxillary surgery between March 2012 and November 2017 at the Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark. The study variables were gender, age, and postoperative condylar resorption. Subjects were sampled evenly within subgroups with and without postoperative condylar resorption. The outcome variable, three-dimensional morphological change of the glenoid fossa, was calculated as surface distance in mm between superimposed preoperative and postoperative (2 years) cone-beam computed tomography scans, and the glenoid fossa was spatially divided into 4 regions. Evaluation of glenoid fossa changes of more than one voxel (0.3 mm) and comparison of subjects with and without postoperative condylar resorption were performed by one-sample and unpaired t tests, respectively.Twenty subjects (16 women; 4 men; mean age = 27.6 years) with Class II malocclusion and maxillomandibular retrognathia were included. The glenoid fossa changes (0.36 mm) were significant (P = .021) and significantly larger in subjects with condylar resorption than in those without condylar resorption in the anterior-lateral (0.40 mm vs 0.27 mm, P = .021) and anterior-medial fossa region (0.48 mm vs 0.26 mm, P = .015).Significant morphological fossa changes were found 2 years after orthognathic surgery, and subjects with postoperative condylar resorption showed a significantly higher degree of morphological change in the anterior glenoid fossa than subjects without postoperative condylar resorption.

Unilateral posterior crossbite, one of the most frequent malocclusions, is often associated with functional lateral shift of the mandible. Although the effects of functional lateral shift on the mandible and temporomandibular joint have been examined in various animal experiments, cranial and maxillary changes have received less attention.The aim of this study was to investigate the effects of functional lateral shift on the craniofacial complex in growing rats.Eighty 5-week-old male Sprague-Dawley rats were randomly divided into an experimental group (n = 40), which received an oblique guide appliance that shifted the mandible to the left during closure, and a control group (n = 40). The rats were scanned by cone-beam computed tomography at 3 days and 1, 2, 4 and 8 weeks. The dimensions of the mandibular bone, condyle, maxilla and cranium were measured.The mandibles of rats in the experimental group were smaller than those of the rats in the control group and were asymmetrical. The condyles of the rats in the experimental group were thinner than those of the control rats. The condylar length on the ipsilateral side was shorter and wider than that on the contralateral side from 4 to 8 weeks. No significant differences in cranial length or height were observed between the experimental and control groups. The height of the upper first molar and alveolar bone on the contralateral side was significantly smaller than that on the ipsilateral side and in the controls from 4 to 8 weeks.Functional shift in the mandible produces morphological asymmetries in the mandible and maxillary region and may cause bilateral condylar degenerative changes.

Measuring bone density (BD) is a common method of determining bone quality; however, the relationship between condylar BD and the occurrence of temporomandibular joint (TMJ) disorders has not been investigated. To address this knowledge gap, we aimed to investigate condylar BD in terms of TMJ disk displacement (TMJ DD) using computed tomography (CT) and magnetic resonance imaging (MRI). We classified TMJ MRI results according to the position of the disk: normal disk position (Normal), anterior disk displacement with reduction (ADDR), and anterior disk displacement without reduction (ADDNR). After retrospectively evaluating 86 female condyles, we determined the total, cortical, and trabecular BD in the upper-joint portion of the condyle and the whole condyle using CT data. To standardize condylar BD, we calculated the BD ratios by dividing the condylar BD by the cervical axis BD. The Kruskal-Wallis test analyzed the differences in BD measurements in the TMJ DD patient groups and showed significant between-group differences in condylar BD. The total and trabecular BD was significantly higher in ADDNR condyles than in Normal or ADDR condyles (Normal = ADDRADDNR). However, there was no significant difference in the cortical BD among the three TMJ DD groups. The BD ratios showed a similar tendency with condylar BD. These results suggest that increased condylar BD - specifically total and trabecular BD - may be significantly associated with ADDNR condyles. Our findings will help clinicians determine the course of treatment for patients with disk-related TMJ disorders.

+The aim: To investigate the peculiarities of hinge axis trajectories in patients with condyle-disc complex intraarticular Temporomandibular Disorders (TMD) and determine the average coordinates of the reciprocal clicking location by axiography. Materials and methods: The results of axiographic examination of 151 patients (108 females and 43 males) with TMD confirmed by MRI were analyzed. This population included 44 persons with disc displacement with reduction (DDR), 45 persons with disc displacement with reduction and intermittent locking (DDRI), 62 persons with disc displacement without reduction (DDWR). Axiographic examination was carried out using CADIAX diagnostic device. Analysis of hinge axis movements was performed and the coordinates of articular disc reduction were determined. Results: The quality of hinge axis trajectories in persons with DDR, DDRI was defined mainly as average and in patients with DDWR as poor. Quantitative indicators of trajectories during protrusion-retrusion movements were not beyond the average level. The length of the mouth opening-closing trajectory in patients with DDRI and DDWR has shown a tendency to decrease. We found that on average the reciprocal closing clicking (disc reduction) occurs at a distance of 0-1.4 mm on the X-axis, 0.1-2.9 mm on the Z-axis, and 0-0.85 mm on the Y-axis. Conclusions: The obtained wide range of reciprocal clicking location parameters indicates the priority of a personalized approach when planning preliminary treatment in order to restore the disc-condylar complex of TMJ.

Purpose This study aimed to evaluate the condylar position changes in 12 months after bilateral sagittal split ramus osteotomy (BSSO) with and without a Le Fort I osteotomy in patients with Class III malocclusion and the influence of the 2 surgical approaches on the condylar position. Methods In this prospective cohort study, patients with skeletal Class III malocclusion who underwent orthognathic surgery between 2017 and 2019 were included. The main predictive variable is the effect of increasing Le Fort I osteotomy on condyle position, which is divided into BSSO-only group and BSSO + Le Fort I osteotomy group. The main outcome variables were the displacement of the condylar head and the rotation/inclination of the condylar long axis before and after surgery. Other study variables were according to the degree of asymmetry of the left and right side of the mandible, the measured values of both sides were divided into mandibular deviation and nondeviation. The cone-beam volumetric imaging images were obtained before surgery (T1) and immediately after surgery (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after surgery by computerized tomography (CT). One-way ANOVA and Tukey test was used for correlation analysis. The p-value is set to 0.05. Results Twenty-four adult patients diagnosed with skeletal Class III malocclusion were included in this study, 12 patients (male/female = 6:6, mean age 21.8 years) who underwent BSSO + Le Fort I osteotomy and 12 patients (male/female = 6:6, mean age 19.8 years) who underwent BSSO-only. The position of the bilateral condylar head in both surgery groups was adjusted continuously during the 12 months after the operation. Immediately and 12 months after surgery, both sides of the condylar long axis in the BSSO with Le Fort I osteotomy group and the BSSO-only surgery group rotated inward, tilted forward, and tilted inward. In the BSSO with Le Fort I osteotomy group, the rotation and tilt angle changes of the condylar long axis on both sides were stable 6 months after surgery. Conclusions The addition of Le Fort I osteotomy did not significantly change the rotation and tilt direction of the condylar long axis and could accelerate the stability of the condylar long axis after BSSO surgery.

AIM Evaluation of size of the condyle in various vertical and anteroposterior skeletal conditions with the help of cone-beam computed tomography (CBCT). METHODS AND MATERIALS In this study, 266 study participants were included consisting of 112 males and 144 females. The study participants were categorized as class I when -1° ≤ A point-nasion-B point angle (ANB) < 4°, class II when ANB ≥ 4°, and class III when ANB < -1°. The study participants were categorized as hypodivergent when the mandibular plane (MP) ≤ 23°, normodivergent when 23° < MP < 30°, and hyperdivergent when MP ≥ 30°. CBCT images were obtained for each subject and measurement of length, width, and height of the condyle was carried out. The data were collected and analysis of covariance test (ANCOVA) was used for statistical analysis. Statistical significance was adjusted at p ≤ 0.05. RESULTS The size of the condyle was smaller in females. The length of the condyle was similar in different anteroposterior and vertical positions with no significant difference. The width of the condyle and the height of the condyle were greatest in class III anteroposterior condition while they were lowest in class I condition. The width and height of the condyle were greatest in hypodivergent condition while they were lowest in hyperdivergent condition. CONCLUSION It was concluded that the height and width of the condyle vary considerably in different vertical and anteroposterior skeletal patterns and the size of the condyle was smaller in women as compared with men. CLINICAL SIGNIFICANCE The position of the condyle and its morphology are important features that constitute an important part of orthodontic treatment planning. The skeletal pattern of the patient has also an important effect on the diagnosis, planning of treatment, and prognosis in the orthodontic treatment.

Background The pathogenesis of traumatic temporomandibular joint (TMJ) bony ankylosis remains unknown. This study aimed to explore the pathogenesis of traumatic TMJ bony ankylosis in a rat model. Methods Twenty-four 3-week-old male Sprague–Dawley rats were used in this study. Excision of the whole disc, the fibrocartilage damage of the condyle and glenoid fossa, and narrowed joint space were performed in the left TMJ of the operation group to induce TMJ bony ankylosis (experimental side). The right TMJ underwent a sham operation (sham side). The control group did not undergo any operations. At 1, 4, and 8 weeks postoperatively, rats of the operation group were sacrificed and TMJ complexes were evaluated by gross observation, Micro-CT, histological examinations, and immunofluorescence microscopy. Total RNA of TMJ complexes in the operation group were analyzed using RNA-seq. Results Gross observations revealed TMJ bony ankylosis on the experimental side. Micro-CT analysis demonstrated that compared to the sham side, the experimental side showed a larger volume of growth, and a considerable calcified bone callus formation in the narrowed joint space and on the rougher articular surfaces. Histological examinations indicated that endochondral ossification was observed on the experimental side, but not on the sham side. RNA-seq analysis and immunofluorescence revealed that Matrix metallopeptidase 13 (MMP13) and Runt-related transcription factor 2 (RUNX2) genes of endochondral ossification were significantly more downregulated on the experimental side than on the sham side. The primary pathways related to endochondral ossification were Parathyroid hormone synthesis, secretion and action, Relaxin signaling pathway, and IL-17 signaling pathway. Conclusions The present study provided an innovative and reliable rat model of TMJ bony ankylosis by compound trauma and narrowed joint space. Furthermore, we demonstrated the downregulation of MMP13 and RUNX2 in the process of endochondral ossification in TMJ bony ankylosis.

Summary Objective To observe and analyze the interaction between excessive mechanical stress (MS) and decreased sex hormones on Temporomandibular Joint Osteoarthritis (TMJ-OA), and to discover TMJ-OA disease susceptibility genes by molecular biological analysis to elucidate part of the mechanism of TMJ-OA onset. Design For experimental groups, orchiectomy (ORX) or ovariectomy (OVX) was performed on sexually mature 8-week-old mice. A metal plate was attached to the posterior surface of the maxillary incisors to apply excessive MS on mandibular condyles. Male mice were divided into control, ORX, MS, and ORX + MS groups, while female mice were divided into control, OVX, MS, and OVX + MS groups. Mandibular condyles were evaluated by histology and molecular biology. Results Histomorphometric analysis of the TMJ in ORX + MS and OVX + MS groups revealed the thinnest chondrocyte layers, highest modified Mankin scores, and significant increases in the number of osteoclasts. Gene expression analysis indicated upregulation of Angptl7 and Car1 genes in the mandibular condyles of mice subjected to the combined effects of excessive MS and reduced sex hormones. In vitro analysis suggested that cartilage-like cells overexpressing Angptl7 enhanced calcification, and osteoblast-like cells overexpression Car1 suppressed cell proliferation and calcification. Conclusions A severe TMJ-OA mouse model was successfully developed by applying excessive MS on the mandibular condyle of male and female mice with reduced sex hormones. Disease-susceptibility genes Angptl7 and Car1 were newly discovered in the experimental groups, suggesting their involvement in the onset mechanism of TMJ-OA.

Patients with Osteogenesis Imperfecta (OI) present extra-skeletal manifestations, including important orodental and craniofacial features as dentinogenesis imperfecta, dental agenesis, failure of maxilla growth and hypotonia of masticatory muscles. These features may compromise vital functions speech and mastication. Studies have demonstrated that cyclic pamidronate infusion, the standard therapy for patients with moderate to severe OI, influences the histomorphometric pattern of different body bones. The present study aimed to investigate the condyle trabecular bone pattern in OI patients. We used fractal dimension (FD) analysis on dental panoramic radiographic images to characterize the mandibular condyle trabecular bone in adolescents diagnosed with OI and treated with pamidronate. Imaging exam of 33 adolescents of both sexes, aged between 12 and 17 years, were analyzed and compared with 99 age- and sex-matched healthy adolescents. FD in patients was significantly lower (1.23 ± 0.15) than in healthy controls (1.29 ± 0.11; p < 0.01). Type of OI, age at treatment onset, and the duration of therapy were variables that showed a statistically significant effect on the FD results. This study demonstrated that the bone architecture of mandibular condyles may be altered in pediatric patients with moderate and severe forms of OI. Also, pamidronate treatment seems to have a positive effect on condyle trabecular bone in these patients. This is supported by our finding that FD values were positively influenced by the length of cyclic pamidronate treatment at the time of imaging, as well as by the age of the individual at treatment onset.

Summary Objective This study aimed to evaluate the mandibular skeletal asymmetry in pre-orthodontic patients with the unilateral posterior dental crossbite (UPCB). Materials and methods Using a retrospective design, 30 pre-orthodontic patients with a UPCB, (16 on the right side, 14 on the left side), 18 females and 12 males were selected (mean age: 21.2 ± 4.92 years), along with 30 controls matched by age and sex with cl I occlusal relationship (mean age: 21.9 ± 4.80 years). The patients were from an Orthodontic Department of Dental Faculty of Hamadan University of Medical Sciences and a private office from 2009 to 2013. In the UPCB group, at least one molar tooth was in the crossbite position. All the patients had initial CBCT 1 and pre-orthodontic study models. 10 linear and 3 angular measurements were performed to evaluate the mandibular skeletal asymmetry. repeated measure-ANCOVA 2 by controlling the effect of age and sex, T-test and paired-samples t-test were used for comparisons. Measurement's reliability was measured with ICC 3 test. Results There was a positional deviation of mandible to the crossbite side 95% CI 4 (0.166 - 1.087). The intergroup analysis showed that Corpus Length (P ≤ 0.014), Ramus Angle in frontal view (P ≤ 0.046), and Condylar-Width in axial view (P ≤ 0.029) in the crossbite side of the case group were significantly smaller than the control group. In the subjects with UPCB, mandibular condylar width was smaller in the crossbite side (17.31 ± 2.50) relative to the non-crossbite side (18.06 ± 2.18). Conclusions The adults with dental UPCB, in addition to deviation to crossbite side, may show smaller condylar head and Corpus length in crossbite side relative to the control group.

We compared mandibular condyle positions as determined by magnetic resonance imaging (MRI) and a mechanical device, the condylar position indicator (CPI). Both methods assessed 3 mandibular positions in 10 asymptomatic males and 10 asymptomatic females, aged 23 to 37 years, free from temporomandibular disorders: maximum intercuspation, bimanually manipulated centric relation, and the unguided neuromuscular position. Bite registrations were obtained for bimanual operator guidance and neuromuscular position. 3 T MRI scans of both temporomandibular joints produced 3D data of the most superior condylar points in all 3 mandibular positions. Using mounted plaster casts and the same bite registrations, an electronic CPI displayed 3D data of its condylar spheres in these positions. The results showed interclass correlation coefficients ranging from 0.03 to 0.66 (95% confidence intervals from 0 to 0.8) and significantly different condyle positions between both methods (p = 0.0012, p

Background Subcondylar fractures represent 25 to 35 percent of all mandibular fractures, yet the treatment paradigm has remained controversial. Closed treatment relies on the plasticity of the condyle head during recovery, whereas open treatment is challenging and risks facial nerve injury. Perioperative, functional, and patient-reported outcomes were measured to compare methods of open versus closed treatment of subcondylar fractures. Methods Selected displaced subcondylar fracture cases with open (open reduction and internal fixation of subcondylar fracture with maxillomandibular fixation) versus closed (maxillomandibular fixation) treatment were compared (n = 60). Demographics, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded. Results Open versus closed groups had similar demographics and perioperative data, except the open group had longer operating room time (76.39 minutes versus 56.15 minutes). In long-term follow-up, open-treated patients had fewer symptoms (9 percent versus 67 percent), less chin deviation (0 percent versus 40 percent), a less restricted mouth opening (3mm versus 5mm), and better functional scores (1.92 versus 0.861). Transient facial nerve weakness was seen in 6 percent of open cases. Conclusion For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters. Clinical question/level of evidence Therapeutic, II.

This study aimed to elucidate whether the stability of an unsintered hydroxyapatite particles/poly- l -lactide (uHA/PLLA) system is comparable with that of titanium, according to different load-bearing areas of the mandible. The study included patients who underwent open reduction and internal fixation of the mandibular body, angle, or subcondylar fracture. The stability of uHA/PLLA systems was compared between the immediate and 6-month postoperative time points using three-dimensional cone-beam CT image analysis. The positional changes of each landmark were measured in three-dimensional (3D) coordinate systems using simulation software. Among 36 patients, there were more displacements of the landmarks between the immediate and 6-month postoperative time points after subcondylar fracture reduction than after body or angle fracture reductions. Strong upward displacements of the landmarks after subcondylar fracture reduction were found in the lateral pole [mean (SD) = 1.75 (3.16), p-value = 0.003] and medial pole [mean (SD) = 1.64 (2.50), p-value = 0.024], but not in the center. Subgroup analyses revealed similar unstable results in males on the condylar landmarks after subcondylar fracture reduction. There were tendencies for lateral displacement of the coronoid process in the body fracture group [mean (SD) = 0.8 (0.83)] and angle fracture group [mean (SD) = 0.75 (0.58)] postoperatively (p-value = 0.01). This study concluded that bioresorbable osteosynthesis can be recommended for body or angle fractures, while the indication for subcondylar fractures is less clear.

Condylar hyperplasia is (CH) a mandibular malformation that involves a change in the size and morphology of the condylar neck and head. The CH is an abnormality that usually occurs unilaterally and affects equally both men and women. Its etiology is controversial in its own right. Under this condition, mandibular growth occurs in all the 3 planes of space, but more predominantly in one of them. Treatment protocols are variable, but one of the best treatment choices is high condylectomy. Compared to the past, the change in the treatment protocol, as well as the innovations in both surgical and orthodontic technology, allowed a simplification of the therapeutic path, reduced patient discomfort and ensured more stable long-term postsurgical results.The authors present a case of a 40-year-old female patient with relapsed of unilateral CH, treated surgically for the second time and with orthodontic treatment with clear aligners. The clear aligners orthodontic treatment is now considered one the best treatment orthodontic options. In this case, considering the relapse of the hyperplasia and the need of a new orthodontic treatment we decide to use this technique to reduce patient discomfort and teeth force appliance.

After high fractures of the mandibular condyle, the insufficient blood supply to the condyle often leads to poor bone and cartilage repair ability and poor clinical outcome. Parathyroid hormone (PTH) can promote the bone formation and mineralization of mandibular fracture, but its effects on cartilage healing after the free reduction and internal fixation of high fractures of the mandibular condyle are unknown. In this study, a rabbit model of free reduction and internal fixation of high fractures of the mandibular condyle was established, and the effects and mechanisms of PTH on condylar cartilage healing were explored. Forty-eight specific-pathogen-free (SPF) grade rabbits were randomly divided into two groups. In the experimental group, PTH was injected subcutaneously at 20 µg/kg (PTH (1–34)) every other day, and in the control group, PTH was replaced with 1 ml saline. The healing cartilages were assessed at postoperative days 7, 14, 21, and 28. Observation of gross specimens, hematoxylin eosin staining and Safranin O/fast green staining found that every-other-day subcutaneous injection of PTH at 20 µg/kg promoted healing of condylar cartilage and subchondral osteogenesis in the fracture site. Immunohistochemistry and polymerase chain reaction showed that PTH significantly upregulated the chondrogenic genes Sox9 and Col2a1 in the cartilage fracture site within 7–21 postoperative days in the experimental group than those in the control group, while it downregulated the cartilage inflammation gene matrix metalloproteinase-13 and chondrocyte terminal differentiation gene ColX. In summary, exogenous PTH can stimulate the formation of cartilage matrix by triggering Sox9 expression at the early stage of cartilage healing, and it provides a potential therapeutic protocol for high fractures of the mandibular condyle.

This study proposes a deep learning model for cortical bone segmentation in the mandibular condyle head using cone-beam computed tomography (CBCT) and an automated method for measuring cortical thickness with a color display based on the segmentation results. In total, 12,800 CBCT images from 25 normal subjects, manually labeled by an oral radiologist, served as the gold-standard. The segmentation model combined a modified U-Net and a convolutional neural network for target region classification. Model performance was evaluated using intersection over union (IoU) and the Hausdorff distance in comparison with the gold standard. The second automated model measured the cortical thickness based on a three-dimensional (3D) model rendered from the segmentation results and presented a color visualization of the measurements. The IoU and Hausdorff distance showed high accuracy (0.870 and 0.928 for marrow bone and 0.734 and 1.247 for cortical bone, respectively). A visual comparison of the 3D color maps showed a similar trend to the gold standard. This algorithm for automatic segmentation of the mandibular condyle head and visualization of the measured cortical thickness as a 3D-rendered model with a color map may contribute to the automated quantification of bone thickness changes of the temporomandibular joint complex on CBCT.

This study aimed to characterize samples from patients diagnosed with TMJ ankylosis, using both clinical and histological data. Both clinical and histological analyses of retrieved tissue samples from patients with primary TMJ ankyloses were performed retrospectively (1980–2012). All patients had been subjected to primary arthroplasty. Our study analyzed connective tissue differentiation, ossification patterns, and bone resorption, using histology and immunohistochemistry. Fifteen case records, with a sex ratio of 4:1 (men:woman) and a median age of 8 years, were collected. Six patient samples reported a previous inflammatory event. Histologically, 15 samples exhibited fibrous tissue. Among these, 13 displayed bone at different stages of maturity (fibrous/bony ankylosis). Eleven samples showed aberrant cartilage, characterized by hypertrophic chondrocyte-like cells at the bone/cartilage interface. Four samples revealed inflammatory infiltrate; in one case, this was organized as a lymphoid follicle. Eleven samples showed bone resorption by attached osteoclasts. Interestingly, non-attached osteoclasts were detected, suggesting locally impaired bone remodeling. An association between the presence of mature/lamellar bone and the presence of osteoclasts was observed (p = 0.03). No association was found between previous history of either trauma or infection and the histological type of ankylosis (p = 0.74). There was no association between the histological presence of inflammation or infection and the type of ankylosis (p = 0.63 and p = 0.87, respectively). Retrieved TMJ ankylosis tissues displayed both aberrant ossification and reduced focal bone resorption, suggesting a dysregulated healing response.

Purpose This study was conducted to elucidate volumetric data of mandibular condyles of orthognathic patients by analyzing cone beam computed tomography images based upon semiautomatic segmentation. Methods Cone beam computed tomography images of 87 patients with malocclusions were analyzed in this retrospective study. Patients were between 17 and 53 years old and diagnosed with Angle class I, II, or III malocclusion. By using the validated open-source software “ITK-SNAP,” the volumetric measurements of 174 mandibular condyles were performed. Volumetric analysis was performed according to intra-subject side differences by paired Student t test. In accordance to inter-subject side, gender, age and type of malocclusion differences bivariate analysis and ANOVA were applied. Results The mean volume for the right condyle was 1.378 ± 0.447 cm3, with a maximum of 2.379 cm3 and a minimum of 0.121 cm3. The mean volume for the left side was 1.435 ± 0.474 cm3, with a maximum of 3.264 cm3 and a minimum of 0.109 cm3. Bivariate analysis indicated a highly significant inter-subject difference between the volume of the left and right mandibular condyles (p p p Conclusion The fact that shape and volume of mandibular condyles show a high susceptibility to pathological alterations and particularly malocclusions makes a precise knowledge about volumetric changes indispensable. Our results show that significant inter-subject differences in condyle volume could be found with respect to the side and gender. Larger volumes could be assessed for the left condyle and for male patients.

Purpose Our current understanding of unilateral condylar hyperplasia (UCH) was put forth by Obwegeser. He hypothesized that UCH is 2 separate conditions: hemimandibular hyperplasia and hemimandibular elongation. This hypothesis was based on the following 3 assumptions: 1) the direction of overgrowth, in UCH, is bimodal—vertical or horizontal, with rare cases growing obliquely; 2) UCH can expand a hemimandible with and without significant condylar enlargement; and 3) there is an association between the condylar expansion and the direction of overgrowth—minimal expansion resulting in horizontal growth and significant enlargement causing vertical displacement. The purpose of this study was to test these assumptions. Patients and Methods We analyzed the computed tomography scans of 40 patients with UCH. First, we used a Silverman Cluster analysis to determine how the direction of overgrowth is distributed in the UCH population. Next, we evaluated the relationship between hemimandibular overgrowth and condylar enlargement to confirm that overgrowth can occur independently of condylar expansion. Finally, we assessed the relationship between the degree of condylar enlargement and the direction of overgrowth to ascertain if condylar expansion determines the direction of growth. Results Our first investigation demonstrates that the general impression that UCH is bimodal is wrong. The growth vectors in UCH are unimodally distributed, with the vast majority of cases growing diagonally. Our second investigation confirms the observation that UCH can expand a hemimandible with and without significant condylar enlargement. Our last investigation determined that in UCH, there is no association between the degree of condylar expansion and the direction of the overgrowth. Conclusions The results of this study disprove the idea that UCH is 2 different conditions: hemimandibular hyperplasia and hemimandibular elongation. It also provides new insights about the pathophysiology of UCH.

Statement of problem Programming semiadjustable and fully adjustable articulators involves time-consuming clinical steps which can be avoided if an accurate radiographic method can accurately determine the condylar guidance angles. Purpose The purpose of this clinical study was to compare the sagittal condylar guidance in dentate individuals as determined by a clinical method, protrusive interocclusal record, and a radiographic method, cone beam computed tomography. If the methods show a correlation, then cone beam computed tomography can be used as a time-saving method of programming an articulator for patients requiring a cone beam computed tomography scan. Material and methods A total of 40 participants (20 men and 20 women) within the 20 to 40 years age group were enrolled according to the inclusion and exclusion criteria. Cone beam computed tomography scans were obtained, and by using an appropriate software program, the sagittal condylar guidance was measured for both sides. A protrusive interocclusal record was obtained by using polyvinyl siloxane material. The maxillary cast of each participant was mounted on a semiadjustable articulator with a facebow transfer, and the mandibular cast was mounted with a maximum intercuspal record. The protrusive record was then transferred to the articulator for programming. Results The right and left sagittal condylar guidance values obtained from both the protrusive interocclusal record and cone beam computed tomography method were comparable, with no significant differences (P>.05). The difference in condylar inclination values for both sexes obtained from both methods for both sides were not statistically different (P>.05). With increasing age, condylar inclination values obtained from both methods tended to decrease. The values for sagittal condylar guidance obtained from both methods (protrusive interocclusal record and cone beam computed tomography) were comparable and correlated. Conclusions Cone beam computed tomography measurement involves stable bony landmarks and can be standardized, whereas clinical methods are time consuming and can provide inaccurate results because of the instability of the materials used to register the maxillomandibular relationship. Thus, cone beam computed tomography can be used to obtain the sagittal horizontal guidance for programming semiadjustable and fully adjustable articulators for patients requiring a cone beam computed tomography scan.

Introduction This study evaluated whether presurgical characteristics, the magnitude of mandibular advancement, and changes in mandibular plane angle are correlated with long-term stability and postsurgical condylar remodeling and adaptations using 3-dimensional imaging. Methods Forty-two patients underwent bilateral sagittal split osteotomies for mandibular advancement using rigid fixation. Cone-beam computed tomography (CBCT) scans were acquired before surgery (T1), immediately after surgery (T2), and at long-term follow-up (T3). The average follow-up period was 5.3 ± 1.7 years after surgery. Anatomic landmark identification on the cone-beam computed tomographies and subsequent quantification of the changes from T1 to T2 and T2 to T3 were performed in ITK-SNAP (version 2.4; itksnap.org) and 3DSlicer (version 4.7; http://www.slicer.org ) software. Surgical displacements, mandibular plane angle changes, and skeletal stability were measured relative to cranial base superimposition, whereas condylar remodeling was measured relative to regional condylar registration. Partial correlation coefficients were used to assess relationships between clinical and surgical variables, condylar remodeling, and long-term surgical relapse while controlling for variability in the length of follow-up. Results B-point relapsed more than 2 mm posteriorly in 55% of the patients. The only variables strongly associated with the posterior movement of B-point long-term were mesial yaw of the condyle during surgery (P ≤0.01) and the length of follow-up from T2 to T3 (P ≤ 0.01). There was no relationship between the magnitude of advancement or presurgical mandibular plane angle and relapse or condylar resorption. Condylar resorption was strongly associated with relapse of B-point in the posterior direction (P ≤0.01) and clockwise rotation of the mandibular plane long-term (P ≤0.01). Twenty-nine percent of subjects showed resorption of more than 2 mm in the inferior direction at the lateral pole, and 17% of the subjects showed resorption of more than 2 mm in the inferior direction at condylion. Compared with male subjects, females exhibited significantly greater condylar remodeling (P ≤0.01) and slightly greater relapse at B-point (P ≤0.05). Conclusions Surgical relapse at B-point may occur slowly over time and is primarily due to condylar resorption in mandibular advancement patients. Mesial yaw of the condyle during surgery may lead to condylar resorption postsurgically. In addition, females are at greater risk of condylar resorption postsurgically.

Background Condylar guidance can be determined using the clinical and radiographic methods. The present study was conducted to determine condylar guidance using the protrusive interocclusal wax method, panoramic radiographs, and lateral cephalogram. Aims The aim of the study was to compare the correlation between sagittal condylar guidance with protrusive interocclusal method, panoramic radiographs, and lateral cephalogram. Materials and methods The present study was conducted on 82 dentulous subjects (males 41, females 41). In all subjects, interocclusal registration values and condylar guidance values were measured using panoramic radiographs and lateral cephalograms. Results The mean ± SD protrusive interocclusal registration value on the left side was 34.01 ± 1.2 mm and 34.08 ± 1.4 mm on the right side. The panoramic radiographs showed 35.12 ± 1.6 mm on the left side and 35.16 ± 1.7 mm on the right side. The mean ± SD protrusive interocclusal registration values on the left side was 34.01 ± 1.2 mm on the left side and 34.08 ± 1.4 mm on the right side. Lateral cephalogram showed 34.35 ± 1.3 mm on the left side and 34.67 ± 1.6 mm on the right side. There was a significant difference between the methods (p Conclusion Sagittal condylar guidance can be evaluated using protrusive interocclusal method. Along with it, other methods such as panoramic radiographs and lateral cephalogram may also be used for recording condylar guidance. Clinical significance Lateral cephalogram and panoramic radiographs may be reliable in determining condylar guidance, which can be used in orthodontic treatment planning.

To evaluate the post-operative condylar bone remodeling after the treatment of Yang’s arthroscopic surgery. Consecutive cases from Jan 2017 to May 2018 that received Yang’s arthroscopic surgery were included in this study, the TMJ MRI examinations were performed preoperatively and postoperatively (follow up for 1 year or more), and condylar bone remodeling was estimated. A total of 229 patients (29 male and 200 female) were included in the study, 161 patients had new bone formation, and the average age was 17.5 ± 2.1a. There was no new bone formation in 68 patients with an average age of 24.5 ± 0.7a. The percentage of new bone formation patients in 10–15 years of age was 94.33% and decreases as the age increases. In the position of new bone formation, the posterior slope of condyle was the most (129 joints), the second was the top of condyle (54 joints), the third was around condyle (33 joints), only 25 joints had new bone on the anterior slope of condyle. After TMJ arthroscopic surgery, the condyle has the ability to form new bone, and the younger the age, the stronger the ability of new bone formation. The formation of new bone was most in posterior slope and least in anterior slope of condyle.

Diabetes mellitus (DM) is associated with a broad range of complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Therefore, predicting DM from head and neck images is a challenge for clinicians. The purpose of this study was to assess the mandibular condylar bone marrow in DM patients using computed tomography (CT) texture analysis. This retrospective study included 16 DM and age and sex matched 16 control patients (11 men, 5 women; mean age, 56.8 ± 14.4 years; range 31–78 years). Patients with Type I DM, prior history of taking bisphosphonates, osteoarthritis of the temporomandibular joint, and CT images with metal artifacts were excluded from this study. Bilateral mandibular condylar bone marrow was manually contoured on axial CT images. The presence or absence of DM is the primary predictor variable. Texture features of the region of interest was the outcome variable, that were analyzed using an open-access software, MaZda Ver.3.3. For each group, 20 features out of 279 parameters were selected with Fisher, probability of error and average correlation coefficient methods in MaZda. Bivariate statistics were computed with the Mann–Whitney U test and the P value was set at .05. One histogram feature, 15 Gy level co-occurrence matrix features, and four gray level run length matrix features showed differences between the DM patients and non-DM patients (P

Importance: Mandibular condyle reconstruction with vascularized free flaps can re-establish form and function after resection. However, no reports have been published regarding the postoperative an...

This study aims to show our institute’s experience in the treatment of HH and its associated facial deformities in adults and growing adolescents and to investigate condylar remodeling and volumetric changes and long-term stability of orthognathic surgery in adults. The study included consecutive patients with clinical and radiological features of HH who underwent high condylectomy with or without simultaneous orthognathic surgery from 2013 to 2018. The clinical outcomes were assessed based on functional activities, TMJ pain, and recurrence. Postoperative 3D condylar remodeling and orthognathic stability were evaluated with the use of ITK-Snap and 3D Slicer. Thirteen patients (8 females and 5 males) with a mean age of 26.3 ± 5.79 years (range; 13–34 years) were included with facial asymmetry as the chief complaint. The patients were followed up for a minimum of 12 months and a maximum of 4 years (mean; 16.85 ± 10.04). There were no postoperative complications, and all patients achieved a satisfactory functional and aesthetic outcome using a one-stage surgical procedure. There was no incidence of recurrence or further asymmetries, with long-term stability at the selected points showing a mean difference of less than ±1 mm. The affected condylar volume was significantly reduced following high condylectomy, with mean changes between T1 and T2 of −144. 80 mm3 (p = .012). However, the contralateral condylar volume remained stable, with a mean change of 2.54 mm3 (p = .881). One-stage high condylectomy and orthognathic surgery is a viable measure for the treatment of HH and associated deformities in adults. High condylectomy in early adolescence could result in termination of the disease, and aesthetic improvement with further constant orthodontist-surgeon follow-up is required.

Background The purpose of this study was to examine injury patterns in pediatric mandibular condylar fractures and to propose and evaluate the validity of an institutional treatment algorithm for such fractures. Methods A retrospective chart review was conducted on pediatric patients who presented to the authors' institution with isolated mandibular condylar fractures between 1990 and 2016. Patients were categorized by dentition, and information regarding demographics, injury characteristics, management, and complications was compiled. Results Forty-three patients with 50 mandibular condylar fractures were identified. Twelve patients (27.9 percent) had deciduous dentition, 15 (34.9 percent) had mixed dentition, and 16 (37.2 percent) had permanent dentition. The most common fracture pattern in all groups was diacapitular [n = 30 (60 percent)]; however, older groups showed higher rates of condylar base fractures and bilateral fractures (p = 0.029 and p = 0.011, respectively). Thirty-one patients (72.1 percent) were treated with nonoperative management, 10 (23.2 percent) with closed treatment and mandibulomaxillary fixation, and two (4.7 percent) with open treatment and mandibulomaxillary fixation; nonoperative treatment was more common in younger patients (p = 0.008). Management for 10 patients (23.2 percent) was nonadherent to the treatment algorithm. Eight patients had complications (18.6 percent). Common complications included temporomandibular joint ankylosis (n = 2) and malocclusion (n = 2). Although complications were seen in all groups, adherence to the algorithm was associated with an 81.8 percent reduction in odds of complications (p = 0.032). Conclusions Nonoperative management has a low complication rate in deciduous children. Children with permanent/mixed dentition may undergo closed treatment and mandibulomaxillary fixation if they have malocclusion/contralateral open bite, significant condylar dislocation, and ramus height loss greater than 2 mm. Clinical question/level of evidence Therapeutic, III.

Purpose The use of rigid versus semi-rigid intermaxillary fixation (IMF) following subcondylar fractures is controversial. This study aims to investigate whether the “dynamic” elastic fixation technique improves the outcomes, compared to the rigid fixation technique for the treatment of displaced subcondylar fractures in adults. Materials and Methods This nonblinded randomized clinical trial was performed on adult patients with unilateral displaced mandibular subcondylar fractures. Patients were randomly allocated into two groups (n = 17). The primary predictor variable was wire versus elastic IMF. Changes in primary (mouth opening) and secondary (other clinical and radiological) outcomes were recorded. Data were analyzed with the t test and Mann-Whitney test with SPSS software version 20. P-value Results In this study 34 patients (with mean age of 33.03 ± 1.79, 23.5% females & 76.5% males) in two groups (Elastics & Wire) followed up to 6 months. The Elastics group showed significant improvement in mouth opening (primary outcome) after 1 month of follow-up, but the differences were not significant at the end of the study. In terms of secondary outcomes, the ramus height shortening compared to the opposite side revealed favorable improvement in the Elastics group in the period of study. The differences between the two groups in the lateral movement and protrusive movement were significant in favor of the Elastics group. The differences in pain, fracture displacement, and midline deviation between study groups were not significant at the end of the study. Just 1 case with malocclusion was observed in the Wire group. Patients were more satisfied with dynamic nonrigid IMF with elastics. Conclusions The results of this study showed that using the dynamic IMF technique is more tolerable, and patients have better functional and clinical outcomes during and at the end treatment.

Background: Growth and development of dentocraniofacial complex occurs during various stage of development of dentition with TMJ as one of its centres of growth. The condition of temporomandibular joint can be visible from its condylar head form; therefore, it is crucial to recognize the normal morphology of condylar head during different stages of development of dentition. Aims: The aim of the study is to view the morphological appearance of condylar head during primary dentition, mixed dentition and permenant dentition. Subject and Methods: 400 panoramic images of 194 boys and 296 girls were collected and were divided into three groups bases on the stage of dentition. Shape of the condylar head were determined by tracing the print out of the panoramic image on an X ray viewer. Results: The study showed that during primary dentition stage shape of the conylar head was dominated by round shape and as growth and development occurs the condylar head shape changes to convex. Conclusion: The study describes the normal morphology of mandibular condyles in a child population attending The dentition status as well as growth of craniofacial has a significant role in determining condylar morphology.

Treatment of skeletal Class II patients with dual bite and idiopathic condylar resorption (ICR) is challenging for orthodontists because of the unstable position of the mandible as well as skeletal relapse attributed to improper seating of the mandibular condyles. This case report describes the successful treatment of an 18-year-old Mongolian man diagnosed with centric relation–maximum intercuspation discrepancy and ICR. After making a definitive diagnosis from verified centric relation using bilateral manipulation, orthodontic treatment was initiated followed by three-dimensional computer-aided design/computer-aided manufacturing prebent titanium plate–guided sagittal split ramus osteotomy and genioplasty. Postoperative 3D superimposition demonstrated that this surgical guide approach provided accurate repositioning of the condyles, which were well positioned in the fossae. Complete orthodontic and surgical treatment time was 24 months. The patient's facial appearance and occlusion improved significantly, and a stable result was obtained with a 1-year follow-up.

Thalassemia is the most common hereditary blood disorder across the world. This study aimed to identify some mandibular features of thalassaemic patients and compare them with unaffected counterparts.This retrospective case-control study was carried out on lateral cephalograms of 60 subjects (26 males, 34 females) with class II malocclusion and age range of 11 to 15 years. The control group consisted of 60 non-thalassaemic subjects with class II malocclusion and similar chronological age, gender and vertical facial dimension. Based on the Jarabak index, the case and control subjects were classified into hyperdivergent, normodivergent and hypodivergent growth patterns. Four linear (ramus height, ramus width, mandibular depth, and antegonial notch depth) and 3 angular (symphyseal angle, gonial angle, and mandibular arc angle) cephalometric parameters were measured to represent mandibular morphology. The data were analysed using Chi-square test and Student's t-test.No significant difference was found in linear measurements between thalassaemic patients and controls. The symphysis angle was significantly greater and the mandibular arc angle was significantly smaller in the total thalassaemic sample than the control individuals (P0.001 and P=0.004, respectively). The difference in symphysis angle was significant in both hyperdivergent and normodivergent subjects (P=0.004 and P=0.002, respectively), whereas the difference in mandibular arc angle was only significant in the normodivergent subgroup P=0.001).The smaller mandibular arc angle in the thalassaemic sample suggests a more superior than posterior growth direction of condyles compared with healthy individuals. The difference in symphyseal angle represents inherent differences in chin morphology between thalassaemic subjects and controls.

The aim of this study was to investigate the clinical characteristics of disc perforation (DP) of temporomandibular joint (TMJ) at different ages. METHODS：Patients with TMJ disc perforation admitted to the Department of Trauma and Temporomandibular Joint Surgery Stomatological Hospital of Wuhan University, from April 2012 to May 2021 were included in this study. They were divided into 6 groups according to different ages. Clinical and CBCT radiographic features were analyzed. Clinical features included maximal interincisal opening, pain, clicking，and occlusal changes. Imaging features included condylar absorption flattening, hyperplasia or osteophyte formation, sclerosis, subchondral cysts, depression defects, and blurred anterior slope. The clinical and imaging characteristics of patients in different age groups were statistically analyzed. SPSS 26.0 software was used for statistical analysis, and Chi-square test was used to compare the distribution of clinical symptoms and imaging features in patients of different ages.A total of 368 patients were collected, including 24 males, with an average age of 27.63±15.90 years. There were 344 females with an average age of 32.61±15.61 years. The incidence of pain was 21.31%, occlusal change was 50.82%, and condylar absorption flat was 50.82% in the 10-19 age group. The incidence of pain in 20-29 age group was 31.06%, occlusal change was 53.42%, and condylar absorption flattening was 45.34%. In 50-59 age group, the incidence of pain was 83.33%, occlusal changes were 2.38%, and hyperplasia or osteophyte formation was 47.62%. In age group ≥60 years old, the incidence of pain was 82.86%, occlusal changes were 2.86%, and hyperplasia or osteophyte formation was 60%.In terms of clinical features, patients under 40 years old are more likely to have occlusal changes, while patients over 40 years old are most likely to have joint pain. Radiographically, patients under 40 years old are mainly characterized by bone loss in the condyle, while patients over 40 years old are mainly characterized by condylar hyperplasia.

To investigate the effectiveness of disc reduction and anchorage in treatment of diacapitular condylar fracture with disc displacement.Between June 2019 and June 2021, 20 patients (27 sides) with diacapitular condylar fractures with disc displacement were treated with disc reduction and anchorage combined with internal fixation. There were 15 males and 5 females with a median age of 40 years (range, 8-65 years). The fractures were caused by falling from height in 3 cases, traffic accident in 3 cases, and falling in 14 cases. Among them, there were 13 cases of unilateral fracture and 7 cases of bilateral fractures. Five sides were type A fractures and 22 sides were type B. There were 14 simple diacapitular condylar fractures, 12 diacapitular condylar fractures combined with mandibular chin fractures, and 1 diacapitular condylar fracture combined with mandibular angle fracture. The maximum opening was 5-20 mm (mean, 9.7 mm). The time from injury to operation was 4-20 days, with an average of 11.6 days. The postoperative imaging examination was performed to evaluate the reduction of fracture and disc. The maximum opening at 6 months after operation was recorded, and the clinical dysfunction index (Di) of Helkimo index was used to evaluate the temporomandibular joint function.All incisions healed by first intention. All 20 patients were followed up 6-10 months (mean, 8 months). Postoperative imaging examination showed that 27 fractures were well reduced, of which 26 were anatomically reduced and 1 was basically reduced; the reduction of the temporomandibular joint disc was excellent in 25 sides, good in 1 side, and poor in 1 side, and the effective rate of disc reduction and anchorage was 96.3%. The occlusion relationship of the patient was stable and basically reached the pre-injury level, the incision scar was hidden, and the mouth opening significantly improved when compared with the preoperative level. The maximum mouth opening was 32-40 mm (mean, 36.8 mm) at 6 months after operation. Maximum opening was more than 35 mm in 17 cases. At last follow-up, joint function reached Di 0 grade in 8 sides, DiⅠ grade in 18 sides, and DiⅡ grade in 1 side. After operation, 2 cases of opening deviation, 1 case of joint click, and 2 cases of temporary disappearance of frontal striae on affected side occurred, which recovered to normal after symptomatic treatment.For diacapitular condylar fractures with disc displacement, it is necessary to adopt disc reduction and anchorage at the same time of fracture reduction and internal fixation, which can achieve good clinical results.探讨关节盘复位锚固术治疗下颌骨髁突囊内骨折伴关节盘移位的临床疗效。.2019年6月—2021年6月，采用关节盘复位锚固术联合骨折内固定术治疗下颌骨髁突囊内骨折伴关节盘移位20例（27侧）。男15例，女5例；年龄8～65岁，中位年龄40岁。致伤原因：高空坠落伤3例，交通事故伤 3例，摔伤14例。其中，单侧骨折13例，双侧骨折7 例；骨折分型：A型5侧，B型22侧。单纯髁突囊内骨折14侧，髁突囊内骨折伴下颌颏部骨折12侧、下颌角骨折1例。最大开口度5～20 mm，平均9.7 mm。受伤至手术时间4～20 d，平均11.6 d。术后影像学检查评价骨折复位及关节盘复位情况。记录患者术后6个月最大开口度，通过Helkimo指数中的临床功能障碍指数（clinical dysfunction index，Di）评价颞下颌关节功能。.术后切口均Ⅰ期愈合。20例患者均获随访，随访时间6～10个月，平均8个月。术后影像学复查示26侧骨折达解剖复位、1侧达基本复位；关节盘复位达优25侧、良1侧、差1侧，关节盘复位锚固术有效率达96.3%。患者咬合关系稳定程度基本达到伤前水平，切口瘢痕隐蔽。开口度较术前明显改善，术后6个月最大开口度达32～40 mm，平均36.8 mm；17例最大开口度≥35 mm。末次随访时，关节功能评价Di 0级 8侧、DiⅠ级18侧、DiⅡ级1侧。术后出现2例开口偏斜、1例关节弹响、2例暂时性患侧额纹消失，经对症处理后恢复正常。.对于伴有关节盘移位的下颌骨髁突囊内骨折，骨折复位内固定同时采用关节盘复位锚固术，可获得较好临床效果。.

Background. Panoramic radiograph is the first and most commonly advised radiograph for screening of temporomandibular joints/condyles. Different shapes of the mandible have been discussed by various authors with no consensus for a definite classification for condyle shape. This study was conducted with the objective to observe various shapes of condyles, symmetry of bilateral condyles, and variations of condyle shapes among males and females. Materials and Methods. This cross-sectional study was conducted on digital panoramic radiographs available at a tertiary center of Lalitpur from 25.12.2020 to 20.06.2021 after ethical approval from the institutional review board (reference no. 077/078/27). Panoramic radiographs were selected on the basis of inclusion and exclusion criteria, and various shapes of condyles were noted on HP 15 inch flat LED monitor ( 1280 × 1024 ). The collected data was analyzed using SPSS (chi-square test: a p value of < 0.05 was considered significant). Intra- and interobserver agreement was observed for condylar shapes. Results. Among the selected 850 panoramic radiographs (1700 condyles), most of them, i.e., 1343 (79%), were round/oval, followed by flattened, i.e., 149 (8.76%), diamond/angled, i.e., 93 (5.47%), crooked finger shaped, i.e., 28 (1.6%), and mixed, i.e., 46 (2.7%), and the least common shape observed was bifid, i.e., 40 (2.3%) (18 (2.1%) left condyle and 22 (2.6%) right condyle). Conclusions. Six different types of condyle shapes were noted: type I, oval; type II, flat; type III, diamond; type IV, mixed; type V, bifid; and type VI, crooked finger among the study population of Lalitpur.

Orthodontic treatment carried out with clear aligners has become a method that is preferred by patients. In this study, the effect following orthodontic treatment with clear aligners and with conventional brackets, on the mandibular condyle trabecular bone formation is aimed to be examined.Thirty two individuals (16 females and 16 males) with a mean age of 16.80 ± 3,10 years who received orthodontic treatment with clear aligners and conventional brackets were included in the study. Individuals included in the study from the archive data were divided into two groups according to treatment types. The mandibular condyle bone quality in the panoramic images taken from the patients before orthodontic treatment (T0) and after orthodontic treatment (T1) has been compared retrospectively. This examination is carried out via the fractal analysis method.The mandibular condyle bone density in individuals that have undergone orthodontic treatment with clear aligners, has been reduced following orthodontic treatment. In individuals that have undergone orthodontic treatment with conventional brackets however the mandibular condyle bone density has increased following treatment (T0) in comparison to before being treated (T1). The mandibular condyle bone density change according to different treatment groups has been found to be statistically different.Orthodontic treatment with clear aligners provides several advantages to patients. However, besides determining the effectiveness of the treatment, complications must also be examined. Application of clear aligners in orthodontic treatment may cause a decrease in bone density in the mandibular condyle. When evaluating orthodontic treatments carried out with clear aligners, the change of the mandibular condyle head bone should be taken into consideration.

Objective: To investigate the size and morphology of the temporomandibular joint (TMJ) articular disc and condyle in young asymptomatic adults by using magnetic resonance imaging (MRI) and to provide a reference for clinical diagnosis and scientific study of temporomandibular disorders (TMD). Methods: Overall, 93 undergraduate volunteers without TMD were enrolled from the freshmen pool at the Qingdao University. All participants underwent MRI of the oblique sagittal and oblique coronal TMJ planes. The articular disc and condyle were subsequently measured, and their morphology was evaluated. The obtained data were then grouped and analyzed statistically. Finally, intragroup correlation coefficient (ICC) was used to evaluate the interobserver measurement reliability. Results: We totally received 186 TMJ imaging samples. Based on our analysis, disc’s anterior band in young asymptomatic adult females were thicker than males of the same age (p = 0.024). Moreover, the media-lateral dimensions of the condylar head of adult females were shorter than males of equal age (P＜0.001). The bilateral articular disc morphology was the same in 72.4% of subjects while the condylar morphology was the same in 63.4% of participants. Finally, using measurement reliability assessment, we demonstrated that our conclusions are reliable (ICC ≥0.7). Conclusion: The thickness of the anterior band of the disc and the media-lateral dimensions of the condylar head were gender-related. Additionally, the morphology of the bilateral articular disc and condyle was different among the subset of young asymptomatic adults.

This study aimed to quantify mandibular ramus height and condylar distances asymmetry indexes in adult patients with different vertical facial growth pattern using Cone Beam computed tomography (CBCT). An observational cross-sectional study was conducted by using CBCT of 159 patients (mean age 26.36 ± 5.32 years). Vistadent 3D® software was used to determine the facial pattern in 3 groups (N = 53): hypodivergent, normodivergent and hyperdivergent—by Ricketts VERT index. Mandibular ramus height and the condylar linear distance in relation to the median sagittal plane were evaluated. The asymmetry index was calculated considering the right and left sides. Data were analyzed by generalized linear models and Tukey post-hoc test (α = 0.05). Significantly lower values were found for the left and right mandibular ramus height in the hyperdivergent skeletal pattern (P 0.05). Asymmetry indexes (mandibular ramus height and condylar distance) were similar, and no statistically significant differences were found among the skeletal patterns. In most subjects, the severity of mandibular ramus height asymmetry varied from light to not clinically significant independently of the facial type. The findings suggest that vertical facial growth pattern not affected the asymmetry index of mandibular ramus height and the intercondylar distance. The results also demonstrated significantly shorter mandibular ramus height for the hyperdivergent skeletal pattern individuals.

The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.

Obesity is the main cause of type 2 diabetes mellitus (T2DM). Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for this obesity-related health problem. However, the adverse effects of T2DM on bone tissue persist or even aggravate after this surgical procedure. As studies on the mandibular condyle bone are scarce, the aim of the present study was to assess its compositional characteristics in T2DM and RYGB conditions. Thirty-two male C57BL/6 mice at 8 weeks of age were randomly assigned to receive either a high-fat or low-fat diet. After 14 weeks of high-fat diet intake, seven obese mice were subjected to RYGB surgery. All animals were euthanized at the age of 30 weeks. Mandibular bones were removed and the trabecular condyle region was assessed using Raman spectroscopy. A decreased mineralization was observed for both T2DM and RYGB condyle bones when compared to controls, with elevated carbonate substitutions for the RYGB group. No compositional differences in crystallinity and presence of advanced glycation end products were found between the groups, with the exception of an increased presence of N-carboxymethyl-lysine in RYGB bone compared to their T2DM counterpart. Site-specific measurements revealed a non-uniform bone composition, with increasing mineralization and carbonate substitutions towards the centre of the mandibular condyle. T2DM and RYGB surgery affect the mandibular condyle bone quality, as investigated at compositional level. Assessment of bone structural properties and remodelling should be carried out to further explore the effects of T2DM and RYGB surgery on this skeleton area. Electronic supplementary material The online version of this article (10.1007/s00223-020-00732-0) contains supplementary material, which is available to authorized users.

Morphology of glenoid fossa might help the clinician in the diagnosis, establishing more biological treatment modalities and treatment response between patients with different skeletal malocclusions. This study aimed to assess the glenoid fossa morphology in different sagittal facial types using CBCT. The CBCT images of 64 patients with normal vertical growth patterns were classified into class I, class II, and class III based on the skeletal sagittal analysis. Depth, width, and angle of glenoid fossa were measured and assessed on CBCT images. One-way analysis of variance (ANOVA) and Tukey post-hoc test were used to compare mean values among the groups. There was a significant statistical difference in means of glenoid fossa' width between groups with skeletal class III and skeletal class I (P value: 0.038). However, no significant statistical differences were found in angle(P value = 0.18) and depth (P value = 0.40) of glenoid fossa among 3 groups. This study showed the glenoid fossa in class I patients was wider than class III patients. There were no statistically significant differences in the angle and depth of glenoid fossa in patients with a different sagittal skeletal pattern.

Background Facial asymmetry from unilateral condylar hyperplasia (UCH) may be definitively treated in the presence of active disease (with high condylectomy and concurrent orthognathic surgery) or after waiting for disease inactivity (orthognathic surgery alone). There is currently no consensus on the standard of care. In this study, we sought to compare functional and esthetic outcomes, as well as treatment duration, between these 2 management options. Methods Patients who underwent treatment for UCH were identified through retrospective review. Pre- and postoperative 3-dimensional (3D) images were obtained. Short- and long-term operative outcomes of those treated during the active (group 1) were compared to those treated in the inactive phase (group 2). Total treatment time, operative time, and length of hospital stay were evaluated. Facial asymmetry was also assessed by laypersons using a Likert scale. Results Fifteen patients (mean 25.6 years, range 14-56) were included: 6 in group 1 and 9 in group 2. All surgical outcomes were statistically independent of procedure type. Treatment time was significantly longer in the group 2 (P = 0.03). Both groups demonstrated significant improvement in facial asymmetry scores postoperatively with no significant difference in pre- or postoperative asymmetry between groups (P = 0.64). Conclusions In patients with active UCH, high condylectomy and orthognathic surgery is a procedure that restores facial symmetry and improves jaw function while halting mandibular growth. Good esthetic and functional outcomes, as well as reduced treatment time and disease burden, support the use of this treatment option for this population.

The aim of this study was to evaluate temporomandibular joint (TMJ) condyle and glenoid fossa morphology with measurements on Computed Tomography (CT) and volumetric analysis using InVesalius software program. 250 condyles in 125 patients (mean age: 40.64) was evaluated on CT. Length, width, and height of the condyle, condylar volume, the thickness of glenoid fossa (TGF), condyle surface area, anterior space (AS), superior space (SS), and posterior space (PS) were measured in this study. Two left and right sides of the jaw have been measured. Linear measurements were performed with the image analysis program (Image J, 1.4 v version, National Institutes of Health, Bethesda, MD). Volume and surface area measurements were performed with InVesalius software (CTI, Campinas, SaoPaulo, Brazil). To compare the dimensions of the condyle between males and females, there was only a significant difference in left AS and SS and no significant difference was found between males and females in other measured factors. There was a significant difference between the age groups and left SS. A significant difference was also found between the age groups and condylar height, condyle surface area, and condylar volume on both right and left sides. Evaluation of condylar morphology is important to assess the TMJ anomalies and bony changes. This study showed no significant differences between gender and all measured factors except in the left AS and SS. However, age factor had a major effect on the morphology.

The Notch pathway is critical for the development of the extracellular matrix in cartilage by regulating both anabolic and catabolic cellular activities. Similarly, Notch signaling plays a biphasic role in adult cartilage health and osteoarthritis by maintaining homeostasis and contributing to degeneration, respectively. The temporomandibular joint (TMJ) is the synovial joint of the craniofacial complex and is subject to injury and osteoarthritis. While Notch has been studied in axial skeletal joints, little is known about the role of Notch in TMJ development and disease. We identified fibrocartilage stem cells (FCSCs) localized within the TMJ condyle superficial zone niche that regenerate cartilage and repair joint injury. Here we investigate the role of Notch in regulating TMJ development and FCSC fate. Using a Notch reporter mouse, we discovered FCSCs localized within the TMJ superficial niche exhibit Notch activity during TMJ morphogenesis. We further showed that constitutively activating Notch promotes FCSC differentiation toward both cartilage and bone lineages, but inhibits adipogenesis. Using a TNF-α–induced TMJ inflammatory arthritis mouse model, we found that the expression of Notch receptors and ligands are upregulated and coupled with cells undergoing cartilage to bone transdifferentiation, which may contribute to TMJ pathogenesis. We also discovered that global Notch inhibition reduces osteogenic and chondrogenic differentiation of FCSCs. Together, these findings suggest that Notch is critical for FCSC fate specification and TMJ homeostasis, and reveal that inhibition of the Notch pathway may be a new therapeutic target for treating TMJ osteoarthritis.

Endoscopically assisted open reduction and internal fixation has cumulate advantages over both open and closed techniques. Even though, this approach had not become popular. The study intended to summarize the outcomes and complications from the first 12 consecutive cases of sub condylar fractures that treated by endoscope and trans-buccal trocar. All patients experienced improvement in mouth opening. No postoperative malocclusion was noticed. The learning curve was assessed subjectively regarding the use of the endoscope and objectively by operating time reduction. The significant decrease in operating time and the ease of handling the endoscope were already noticed after the 5th operation. The mean time for endoscopically assisted open reduction and internal fixation in our study was 180 minutes, which was the same as for external approaches open reduction and internal fixation for sub-condylar fracture cases. No special designed instruments except an endoscope and a trans-buccal trocar were used. We can conclude that the learning curve for this technique is not as steep as it was thought to be, and it can be mastered after a relatively small number of operations. There is no difference in mean operation time comparing to external approaches. No need for special designed instruments.