Search Results (122)

Purpose: Ganglion cysts of the temporomandibular joint (TMJ) are uncommon periarticular lesions and may be diagnostically challenging because symptoms are often nonspecific. When these lesions arise posterior to the joint, they can produce otologic complaints through dynamic narrowing of the external auditory canal (EAC). Herein, we report on a histologically confirmed TMJ ganglion cyst causing position-dependent hearing loss and review the relevant literature. Case description: A 72-year-old woman presented with a 3-year history of bilateral preauricular pain, left-sided tinnitus, left aural fullness, and near-complete hearing loss in the left ear when the mandible was closed in occlusion. Clinical examination showed marked narrowing of the left EAC with mandibular closure. Magnetic resonance imaging demonstrated bilateral anterior disc displacement with reduction and a posterior meniscal cyst associated with the left TMJ. The lesion was excised using a preauricular approach. Results: Intraoperatively, the cyst was adherent to the posterior aspect of the TMJ disc and retrodiscal tissues and was noted to obstruct the EAC in the closed-mouth position. Gross examination showed a cystic structure measuring 2.4 × 2.1 × 1.0 cm which contained gelatinous material, while histopathology confirmed that the structure was a ganglion cyst. The patient’s hearing improved substantially by 4 months after surgery and had returned to normal 2 years later, with no clinical evidence of recurrence. Conclusions: Posterior TMJ ganglion cysts should be considered in patients with fluctuating otologic symptoms that vary with mandibular movement. MRI is valuable for diagnosis and surgical planning, and open excision can provide durable symptom resolution. Full article

Advanced cases of unilateral condylar hyperplasia might need combined joint reconstruction and orthognathic surgery. This report illustrates the feasibility of integrating digital planning, patient-specific prosthesis design, and orthognathic correction within a single-stage surgical workflow. A 23-year-old female patient presented with skeletal Class III malocclusion, facial asymmetry, and mandibular midline deviation due to left condylar hyperplasia. After preoperative orthodontic alignment, virtual surgical planning was carried out using specialised software to simulate resection of the hyperplastic condyle, with concurrent total TMJ replacement, contralateral sagittal split ramus osteotomy, and Le Fort I osteotomy. Based on this plan, patient-specific prosthetic components, surgical guides, and fixation plates were designed and manufactured. Surgery was performed according to the digital plan using a combined intraoral and extraoral approach. At 3-month follow-up, clinical and radiological assessments showed stable prosthesis positioning, improved occlusal relationships, restoration of facial symmetry, and high patient-reported satisfaction. However, given the single-case design and short follow-up, these findings should be considered preliminary, and further studies are necessary to evaluate long-term functional outcomes and reproducibility. Full article

Background/Objectives: Unilateral condylar hyperplasia is an idiopathic condition that causes facial asymmetry and occlusal problems. Currently, traditional treatment protocol is the combination of orthognathic and extra-oral condylectomy surgery via pre-auricular incision, which can create aesthetic problems with additional risks of facial nerve damage. The purpose of this study was to report management of condylar hyperplasia patients through minimally invasive condylectomy that was planned via virtual methods. Methods: The custom-made cutting guides were produced, and unilateral condylectomy operations were performed via intra-oral approach. Orthognathic surgery with/without genioplasty operations were either done with condylectomy in one session or in an additional session. Results: Custom-made cutting guides produced by virtual methods provided easy operations without any need for additional extra-oral incisions. Planned osteotomies were transferred successfully from the virtual surgical plan and resections of the excess bone tissues were performed using novel piezo surgery devices. The bones were fixed to their pre-planned position using 3D-printed titanium plates. The patients healed without any complications. Results of this innovative virtually guided protocol tested showed functional and esthetic results without any extra-oral scars with no facial nerve damage. Conclusions: Combination of intra-oral condylectomy with orthognathic surgery using 3D-printed titanium cutting guides seems to be an advantageous approach with successful results in terms of aesthetics and function for management of mandibular condylar hyperplasia patients; however, there is an urgent need in the scientific literature for further clinical research with a larger number of subjects. Full article

Background: The medial pterygoid muscle (MPM) is frequently implicated in pain and dysfunction in patients with temporomandibular disorders (TMDs), owing to its functional complexity, susceptibility to overload, and rich neuromuscular control. Paradoxically, in patients rehabilitated with tubero-pterygoid implants, whose apices often penetrate or traverse the MPM attachment, no pain, trismus, or TMD-related symptoms are typically observed. Objective: The aim of this study was to evaluate the impact of implant penetration into the medial pterygoid muscle using CBCT and clinical examination after surgery and during follow-up visits. Methods: A retrospective observational study was conducted on 56 patients receiving a total of 116 tubero-pterygoid implants protruding beyond the pterygoid process of the sphenoid bone. Patients were divided into two groups according to implant penetration depth (<2 mm and >2 mm), with a minimum follow-up period of 12 months. Clinical outcomes related to pain, muscle disorders, and TMD symptoms were assessed. Results: Throughout the observation period, all patients remained free of pain, muscular disorders, and signs or symptoms of TMD, regardless of the degree of muscular penetration. Statistical analysis revealed no association between penetration depth and adverse clinical outcomes. Conclusions: The combined clinical and statistical evidence indicates that transmuscular penetration of the MPM by tubero-pterygoid implants is safe and well tolerated. These findings challenge traditional assumptions regarding MPM sensitivity and provide important guidance for surgical planning and maxillary rehabilitation strategies. Full article

Background/Objectives: One key objective in temporomandibular joint replacement is to precisely position the implant according to the virtual surgical plan, utilizing drilling and osteotomy guides for accuracy. However, implementing this process can be challenging, as—even though the drilling and osteotomy guides should only fit in one position—there often are still multiple potential positions for both guides and implants on smooth bony surfaces. Even minor deviations in the implant’s placement can affect wear, influence biomechanical behavior, and lead to adverse outcomes. Intraoperative navigation has emerged to verify the alignment of implants with the preoperatively planned ideal position. While the use of navigation systems in TMJ surgery is well documented for certain procedures, its application in TMJ replacement cases has been limited. Methods: In this study, two methods to improve the accuracy of TMJ replacement are introduced: a new marker-based navigation workflow and the use of orientation screws in two patients. Results: Unlike conventional navigation methods, the marker-based system provides a more intuitive method for assessing the 3D orientation of the TMJ implant concerning the planned position, enhancing surgical accuracy. The addition of a guiding screw provides a reference point to enhance the accuracy of guide placement. Conclusions: The accurate placement of the prosthesis largely relies on the precise positioning of the guides. Even slight inaccuracies in the position of the TMJ prosthesis, resulting from suboptimal guide placement, can lead to significant negative clinical outcomes. Marker-based navigation and the use of guiding screws may potentially improve the precision of TMJ replacement procedures. Full article

Background/Objectives: Mandibular counterclockwise (CCW) autorotation following maxillary repositioning is a common biomechanical consequence of bimaxillary orthognathic surgery. However, its effect on temporomandibular joint (TMJ) morphology remains controversial. This study aimed to evaluate whether condyle-centered CCW mandibular autorotation influences postoperative TMJ spaces and condylar morphology using cone-beam computed tomography (CBCT). Methods: A total of 24 patients who underwent combined Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were included in this retrospective analysis. Patients were divided into two groups based on virtual surgical planning: those with condyle-centered CCW autorotation (4–7°) and those without autorotation. Preoperative and one-year postoperative CBCT images were analyzed. Sagittal and coronal joint spaces, condylar dimensions, and glenoid fossa thickness were measured. Intra- and intergroup comparisons were performed using nonparametric statistical tests (α = 0.05). Results: Both groups demonstrated significant postoperative reductions in condylar height, width, and depth, reflecting adaptive bone remodeling. Joint space changes were limited overall. A significant intergroup difference was observed only in the change in the right superior joint space (p = 0.024), which decreased in the non-autorotation group but was preserved or slightly increased in the autorotation group. No other joint space or fossa parameter showed significant between-group differences. Conclusions: Condyle-centered CCW mandibular autorotation during bimaxillary orthognathic surgery does not induce adverse TMJ morphological changes beyond physiological adaptation. Preservation of the superior joint space suggests that autorotation may contribute to maintaining a more favorable condyle–fossa relationship. Incorporating controlled mandibular autorotation into surgical planning may support TMJ biomechanical balance and postoperative joint stability. Full article

Background/Objectives: Subcondylar mandibular fractures represent a challenging subset of maxillofacial trauma due to their proximity to the temporomandibular joint and the facial nerve. The retromandibular approach can be performed through either an anteroparotid or a transparotid route, but comparative clinical data remain limited. This study aimed to evaluate clinical outcomes, complication profiles, and operative parameters associated with the retromandibular anteroparotid versus transparotid approach for open reduction and internal fixation (ORIF) of subcondylar fractures. Methods: A retrospective analysis was conducted on 80 consecutive patients treated for subcondylar mandibular fractures at the Department of Maxillofacial Surgery, Umberto I General Hospital, Sapienza University of Rome, between 2018 and 2025. All patients underwent ORIF via a retromandibular approach (anteroparotid or transparotid) with a minimum follow-up of 6 months. Demographic data, trauma etiology, fracture morphology (classified as simple or complex), associated fractures, surgical approach, fixation details, operative time, hospital stay, and postoperative complications were collected. Facial nerve function was clinically assessed and graded using the House–Brackmann scale. Associations between fracture type, surgical approach, number of plates, and complications were evaluated using Chi-square or Fisher’s exact tests, while operative time was compared using one-way ANOVA and Kruskal–Wallis tests (p < 0.05). Results: The cohort had a mean age of 41.9 years and was predominantly male (67.5%). The anteroparotid route was used in 54 patients (67.5%) and the transparotid route in 26 (32.5%). Overall, 10 patients (12.5%) developed postoperative complications, including transient facial nerve weakness, malocclusion, visible scarring, and sialocele. All cases of sialocele occurred in the transparotid subgroup, whereas no salivary complications were observed after the anteroparotid approach. No permanent facial nerve deficits, temporomandibular joint ankylosis, or long-term facial asymmetry were recorded at 6 months. No significant association was found between surgical approach and overall complication rate, but complex fracture patterns were significantly associated with increased operative time. Conclusions: The retromandibular approach is a safe and effective option for ORIF of subcondylar mandibular fractures. Both anteroparotid and transparotid routes provided reliable exposure and stable fixation with low complication rates. The anteroparotid route appears to minimize parotid-related complications, such as sialocele, while maintaining comparable functional outcomes. These findings support the retromandibular anteroparotid approach as a valuable alternative in the surgical management of subcondylar fractures. Full article

Objectives: Telemedicine has rapidly expanded in oral and maxillofacial surgery (OMFS), especially during the COVID-19 pandemic, but its specific roles and limitations across the care pathway remain unclear. This narrative review aimed to map telemedicine modalities and indications in OMFS, summarize reported outcomes, and identify priorities for future research. Methods: A narrative synthesis was undertaken after a systematic search of medical and engineering databases to 10 October 2025. Studies applying telemedicine, telehealth, telepresence or teleradiology to OMFS practice were eligible, including trials, observational cohorts, technical reports and surveys. Data were extracted in duplicate and organized thematically; heterogeneity precluded meta-analysis. Results: Fifty studies met the inclusion criteria. Telemedicine was mainly used for preoperative consultation and triage, postoperative follow-up, trauma teleradiology and tele-expertise, oncologic and oral medicine follow-up, temporomandibular disorders, and education or humanitarian work. In low-risk outpatient and postoperative settings, remote consultations showed high concordance with in-person plans, similar complication or reattendance rates, reduced travel, and high satisfaction. In trauma networks, telemedicine supported timely triage and reduced unnecessary inter-hospital transfers. Evidence in oral oncology and complex mucosal disease was more cautious, favouring hybrid models and escalation to face-to-face assessment. Data on cost-effectiveness and impacts on equity were limited. Conclusions: Telemedicine in OMFS has moved from niche innovation to a pragmatic adjunct across the clinical pathway. Current evidence supports its use for selected pre- and postoperative care and trauma triage within risk-stratified hybrid models, while underscoring the need for stronger comparative and implementation studies, clear governance on equity and data protection, and alignment with wider digital and AI-enabled health systems. Full article

Background/Objectives: The aim of this study is to evaluate pretreatment osseous changes in the temporomandibular joint (TMJ) in orthognathic surgery patients using cone-beam computed tomography (CBCT) and to determine the distribution of the findings according to sagittal skeletal malocclusion groups. Methods: CBCT images of 103 patients (206 condyles) were retrospectively analyzed. Patients were classified as Class I, II, and III based on ANB angles. Condylar morphology was assessed for flattening, sclerosis, erosion, osteophyte formation, and subchondral bone cysts. All evaluations were performed by a single investigator (κ = 0.87). Group differences were analyzed using the chi-square test with Bonferroni correction (p < 0.05). Results: The most frequent alteration was flattening (29.6%), followed by sclerosis (11.2%), erosion (10.7%), osteophyte formation (8.3%), and subchondral bone cysts (4.4%). No significant sex-related differences were found (p > 0.05). A significant difference was observed only in sclerosis (p = 0.049), which was more prevalent in Class I than Class III. Flattening predominated in all groups, while erosion and osteophytes were more common in Class II, and sclerosis was more frequent in Class I. Conclusions: This study demonstrated that condylar flattening was the most common morphological alteration in orthognathic patients across all skeletal malocclusion groups. The higher prevalence of sclerosis in Class I compared with Class III suggests that mandibular positioning may influence adaptive and degenerative remodeling processes of the TMJ. This study emphasizes the importance of CBCT evaluation for detecting osseous changes in TMJ before orthognathic surgery and demonstrates that pre-existing alterations may impact surgical stability and postoperative functional outcomes. Full article

The main role of panoramic radiography lies in its rapid screening capability and its ability to detect and identify bone lesions, pathologies, and tooth-bearing structures. Since panoramic radiographs are widely used, they provide a good view of the jaw bones, maxillary sinus, and temporomandibular area. However, their major limitation is the reduced ability to accurately assess bone conditions, particularly in evaluating cortical integrity or identifying subtle, nondisplaced, or greenstick-type fracture lines. Other limitations include the presence of artifacts, image distortion, magnification variability, and high sensitivity to patient and film positioning, all of which can compromise image quality and diagnostic confidence. This 2D imaging method is still used worldwide, especially by dentists; however, this type of radiograph can be unpredictable due to structural superimposition and reduced ability to clearly establish, measure, and verify the precise dimensions, boundaries, and areas occupied by selected lesions. Many patients undergo panoramic imaging to assess possible mandibular fractures after trauma or following the removal of cysts, tumors, or impacted teeth. In most cases, the occurrence of a fracture without displacement can be misjudged, omitted, or underestimated. In such cases, either cone-beam computed tomography is performed or a detailed clinical examination before or during surgery, followed by intraoperative assessment, helps identify a possible fracture line, bone bending, mandibular instability, or the potential need for simultaneous prophylactic plating during dental procedures or the use of maxillomandibular fixation. This paper presents the author’s own experience regarding the limitations of panoramic radiographs in estimating bone condition and detecting fracture lines. Therefore, it is essential to highlight the role of prophylactic (preventive) mandibular plating (PMP) or fixation and to clarify when it should be considered. Full article

Background: Maxillofacial trauma can impair crucial functions of the stomatognathic system. Mandibular condyle fractures, in particular, often lead to temporomandibular joint (TMJ) dysfunction. Methods: This study evaluated the effectiveness of open rigid internal fixation (ORIF) in restoring TMJ function, using the Helkimo Index to compare pre- and post-operative outcomes. Results: A total of 395 patients who underwent ORIF for condylar fractures were analyzed (302 males, 93 females). TMJ function improved significantly from baseline to 6-month follow-up (p < 0.001), with a mean reduction of 2.18 grades on the Helkimo Index. Higher post-operative Helkimo grades (2–3) occurred more frequently during warm months than during cold months (p < 0.05). Low body mass index (BMI) was associated with a greater risk of post-surgical TMJ dysfunction (p < 0.001). TMJ function correlated with facial nerve recovery: patients with poorer pre-operative TMJ function showed additionally slower facial nerve recovery during the first five months after surgery. Age, gender, place of residence, injury characteristics, comorbidities, delay of surgery, duration of surgery, surgical approach, fixing material and laboratory blood tests showed no significant association with post-operative TMJ function. Residual TMJ dysfunction was observed in 3% of treated patients (Di = 3). Conclusions: ORIF, combined with appropriate post-operative physiotherapy, effectively restores TMJ function after condylar fractures—including severe injuries. Simple clinical indices such as the Helkimo Index reliably capture functional improvement. Full article

Background/Objectives: This study aims to evaluate the functional characteristics of the temporomandibular joint (TMJ) in patients diagnosed with juvenile idiopathic arthritis (JIA). Specifically, it seeks to determine the prevalence of TMJ involvement and its impact on clinical symptoms and functional limitations. Methods: A total of 40 patients diagnosed with JIA according to the International League of Associations for Rheumatology criteria were included. Exclusion criteria encompassed systemic diseases unrelated to JIA, prior craniofacial surgery, and trauma. Participants were divided into two groups: those with TMJ arthritis (n = 23) and those without (n = 17). Clinical assessments were conducted using the Helkimo anamnestic index (Ai) and dysfunction index (Di) to evaluate TMJ-related symptoms. Results: The Ai revealed that most patients reported no or only mild subjective symptoms. Overall Di distributions did not differ significantly between groups, although mandibular mobility was more impaired in the TMJ arthritis group. A moderate correlation (r = 0.4) was observed between Ai and Di. Conclusions: This pilot study indicates that impaired mandibular mobility may suggest TMJ involvement in JIA. Given the study’s limitations, such as being a single-center study with a small sample size and using a CBCT-based classification, further multicenter studies utilizing validated pediatric protocols are necessary to reinforce these preliminary findings. Full article

Background/Objectives: Orthognathic surgery represents a surgical modality for the correction of craniofacial skeletal deformities. These procedures help achieve stable occlusion and improve facial symmetry, which in turn enhances functional outcomes and overall quality of life. However, to date, no consensus has been reached regarding whether orthognathic surgery also induces changes in the relationship of articular surfaces within the temporomandibular joints (TMJs). The primary objective of this study was to conduct a systematic review of research evaluating joint space dimensions based on CBCT imaging performed before and after orthognathic surgery. Methods: A comprehensive literature search was carried out across four electronic databases: PubMed, Web of Science, Cochrane Library, and Scopus. Two independent reviewers screened titles and abstracts according to predefined inclusion criteria. Eligible studies were subjected to critical appraisal, and relevant data were systematically extracted and summarized in tabular form. Results: Fourteen studies published between 2010 and 2024 met the inclusion criteria. In all studies, CBCT-based joint space measurements were conducted at least twice once preoperatively and once postoperatively, across a total of 527 patients included in the review. Conclusions: The synthesized evidence suggests that orthognathic surgery produces measurable modifications in the spatial relationship of TMJ articular surfaces. Nonetheless, the clinical relevance of these alterations appears to be modulated by several variables, including the surgical technique employed and the patient’s individual adaptive capacity. Full article

Introduction: Evidence on orthodontic interventions for temporomandibular disorders (TMD) is fragmented and inconclusive, creating a gap in guidance for clinical decision-making. This study addresses that gap by evaluating current knowledge on these interventions. Methods: A PRISMA-ScR scoping review was conducted with a systematic search of PubMed, Scopus, and Web of Science (2018–2023). Eligible studies were peer-reviewed, English-language, human studies examining TMD treatment and/or etiology. Three independent reviewers screened records and extracted data and a fourth reviewer performed random audits. Results: Of 899 records, 10 studies met inclusion criteria (non-surgical, n = 7: 4 case reports, 2 prospective, 1 longitudinal; combined orthodontic–surgical, n = 3: 1 case report, 2 longitudinal; participant ages 15–71 years). Diagnostics included imaging, clinical examination, occlusal analysis, and questionnaires, although few used RDC/TMD or DC/TMD criteria. Non-surgical orthodontic modalities (fixed appliances, camouflage, TADs, stabilization splints) showed mixed results, with several studies reporting short-term symptom improvement, while others found no effect on TMD onset or progression. Combined orthodontic–surgical approaches (e.g., bilateral sagittal split osteotomy, Le Fort I) also showed variable outcomes. Conclusions: Low-to-moderate quality evidence suggests that orthodontic-surgical interventions may alleviate TMD symptoms in select patients; however, heterogeneity and limited use of standardized diagnostics constrain the certainty of these findings. Future research should prioritize DC/TMD-based diagnostics, core outcomes, comparative designs, and ≥12–24 months of follow-up to identify prognostic factors and responsive subgroups. Full article

Background: Orthognathic surgery using the Surgery-First approach (SFA) has gained increasing attention not only for its functional and aesthetic benefits but also for its potential psychological impact. Aim: This study aimed to evaluate the effects of SFA on the psychological well-being of patients with dentofacial anomalies and temporomandibular disorders (TMD), using validated tools for assessing anxiety (GAD-7), depression (PHQ-9), and pain catastrophizing (PCS). Materials and methods: A longitudinal observational study was conducted on 27 patients treated between 2022 and 2025. TMD was assessed using the DC/TMD clinical criteria. Psychological status was evaluated preoperatively and 6 months postoperatively using the GAD-7, PHQ-9, and PCS standardized questionnaires. Results: Significant reductions were observed in all three domains: GAD-7 scores dropped from 13.8 to 4.1 (p < 0.001), PHQ-9 from 15.5 to 5.3 (p < 0.001), and PCS from 26.2 to 12.7 (p < 0.001). These are raw total scores; corresponding normalized mean scores (per item) decreased from 2.78 to 1.08 for GAD-7, from 3.00 to 0.36 for PHQ-9, and from 1.22 to 1.06 for PCS. The greatest improvements were seen in Class III patients with TMD. Psychological scores did not significantly predict persistent TMD. Conclusions: These findings support the psychological benefits of SFA and underline the importance of integrating psychological screening into orthognathic treatment planning. Full article