Fractures of the naso-orbito-ethmoid (NOE) complex require precise three-dimensional bony reconstruction for optimal functional and aesthetic outcomes. Intraoperative cone-beam computed tomography (CBCT) enables real-time visualization of fracture reduction and subsequent correction, potentially reducing functional and aesthetic sequelae. We aimed to assess the impact of intraoperative CBCT on outcomes in surgically treated NOE fractures. This retrospective case series included 43 subjects (34 men and 9 women) aged 16 years or older who had undergone surgical treatment for NOE complex fractures between February 2015 and November 2020 at the Department of Maxillofacial Surgery of a Swiss university hospital with intraoperative CBCT or postoperative CT scans. Postoperative patient dissatisfaction with aesthetic or functional outcomes, the need for secondary surgical revision, and radiographic signs of imperfect fracture reduction were assessed. The analyses encompassed descriptive statistics, Fisher tests, and Spearman correlation analyses, with statistical significance set at p < .05. Intraoperative CBCT was performed in 38 subjects, with 10 (23.3

BACKGROUND:Intraoperative cone-beam computed tomography (CBCT) during open reduction and internal fixation of zygomaticomaxillary complex (ZMC) fractures may facilitate the re-establishment of a complex 3-dimensional anatomy. PURPOSE:This study was conducted to measure the occurrence of malpositions after ZMC fracture reduction and intraoperative revision rates after conducting intraoperative CBCT. STUDY DESIGN, SETTING, SAMPLE:This retrospective case series included subjects treated for ZMC fractures with intraoperative CBCT at the Department of Maxillofacial Surgery of the University Hospital Zurich (Switzerland) over a 5-year period (January 2015 to December 2019). The exclusion criteria were a history of facial fracture and incomplete data. PREDICTOR VARIABLE:Not applicable. MAIN OUTCOME VARIABLES:The primary outcome variable was malpositioning after ZMC fracture reduction on intraoperative 3-dimensional imaging. Further variables-including intraoperative revisions of ZMC malpositions, osteosynthesis material revisions, and intraoperative assessments of orbital reconstruction-were analyzed. COVARIATES:Demographic (age and sex) and clinical (associated with facial fractures) characteristics were assessed. ANALYSES:The analyses included Spearman's rank correlations, mosaic plots, χ2 tests, and Fisher's exact tests. The confidence level for hypothesis testing was set at P < .05. RESULTS:The sample included 337 subjects, and 589 intraoperative CBCT scans were obtained. ZMC malposition after reduction was observed in 154 (45.7%) subjects; the most common malpositions were caudal displacement, underprojection, and inward rotation of the ZMC. Intraoperative revisions were conducted in 150 (44.5%) subjects: 105 (31.2%) subjects exhibited a ZMC malposition, 13 (3.9%) subjects needed revisions of the osteosynthesis material placement, and 32 (9.5%) subjects required intraoperative orbital floor reconstruction. No secondary revision surgeries were required, excluding 25 secondary orbital floor reconstructions. Preoperative and intraoperative radiographic findings did not correlate regarding indications for orbital floor reconstruction. CONCLUSION AND RELEVANCE:The 44.5% intraoperative revision rate underscores the challenges of ZMC fracture surgery. Clinical evaluation of fracture reduction at the latero-orbital rim is recommended to identify caudal displacements, and intraoperative CBCT helps identify candidates for primary orbital floor reconstruction. This technique may enhance quality control and precision, thereby potentially improving patient outcomes.

Previous finite element analyses (FEA) have shown promising results for using two titanium screws in treating mandibular condylar head fractures but limited mechanical stability of a two-screw osteosynthesis with magnesium screws. Given the potential benefits of magnesium screws in terms of biocompatibility and resorption, this study aimed to compare two- and three-screw osteosynthesis solutions for a right condylar head fracture (AO CMF type p) with magnesium screws with a FEA. A previously validated finite element model simulating a 350 N bite on the contralateral molars was used to analyze von Mises stress within the screws, fragment deformation, and fracture displacement. All screws were modeled with uniform geometric specifications mirroring the design of Medartis MODUS® Mandible Hexadrive cortical screws. The three-screw configuration demonstrated lower values for all three parameters compared to the two-screw scenario. There was a 30

Temporary, sudden, shooting and recurrent unilateral facial pain in the supply area of one or more trigeminal nerve branches characterises trigeminal neuralgia. Innocuous stimuli trigger the pain, e.g. chewing, speaking or brushing teeth. In some patients, paroxysms superimpose on continuous pain. In aetiological terms, idiopathic, classic (due to neurovascular compression) and secondary trigeminal neuralgia (e.g. due to multiple sclerosis, brainstem ischaemia and space-occupying lesions) are defined. Many drugs may be efficacious, with carbamazepine being first-choice therapy. However, non-pharmacological and invasive procedures may also help. To reach the correct diagnosis and determine the best therapeutic measures, adequate pain characterisation and interdisciplinary collaboration are essential. We hereby present our experience of an interdisciplinary approach for the diagnosis and treatment of trigeminal neuralgia.

This retrospective study aimed to assess the effects of the use of intraoperative three-dimensional (3D) imaging on outcomes in surgical treatment of nasal fractures. Furthermore, we investigated whether the use of intraoperative imaging improves outcomes and decreases the frequency of corrective surgeries compared to published literature. This retrospective descriptive study included patients who underwent operative treatment for nasal fractures with the use of intraoperative 3D imaging between January 2015 and January 2020 at a University Hospital. The primary outcome measure was patient satisfaction, which was assessed through patient charts about subjective esthetic problems and nasal obstruction. The secondary outcome measures were the number of intraoperative images and necessity of intra- and postoperative revisions. All the outcomes were evaluated using regression analysis. Of the 172 patients, secondary rhinoplasty and intraoperative revision were performed in 10 (6 %) and 93 (54 %) patients, respectively. Postoperatively, 19 (11 %) and 12 (7 %) patients complained of subjective esthetic problems and nasal obstruction, respectively. The intraoperative revision rate in patients undergoing surgical treatment of nasal fractures with intraoperative 3D imaging was >50 %. However, the incidence of postoperative secondary revision, nasal obstruction, and subjective esthetic problems was lower than that reported in the literature not having an intraoperative imaging. Our findings suggest that prompt quality control of the operative result enables immediate correction and prevents postoperative revision.

This study compared the biomechanical behavior of titanium, magnesium, and polylactic acid screws for two-screw osteosynthesis of mandibular condylar head fractures using finite element analysis. Von Mises stress distribution, fracture displacement, and fragment deformation were evaluated. Titanium screws performed the best in terms of carrying the highest load, resulting in the least fracture displacement and fragment deformation. Magnesium screws showed intermediate results, while PLA screws were found to be unsuitable with stress values exceeding their tensile strength. These findings suggest that magnesium alloys could be considered a suitable alternative to titanium screws in mandibular condylar head osteosynthesis.

Titanium screws are commonly used for osteosynthesis of mandibular condylar head fractures. Evidence suggests that the insertion of three screws may result in better fracture stability. Two screws only, on the other hand, could reduce adverse effects, mainly bone resorption. This study aimed to investigate the biomechanical differences in mandibular condylar head osteosynthesis with two versus three titanium screws using finite element analysis. A finite element model of the mandible with a right type P condylar head fracture fixed with two or three titanium screws was analyzed in ANSYS Mechanical. The geometry of the model assembly was constructed in ANSYS Spaceclaim. Biomechanical load boundary conditions were obtained from a validated musculoskeletal model in AnyBody Modeling System™. The preprocessing of the finite element model and mapping of the obtained boundary conditions was done in docq VIT. Fracture displacement, fragment deformation, von Mises stress distribution, and reaction forces within the screws were evaluated in ANSYS for three different loading scenarios. Finite element analysis showed similar results when comparing osteosynthesis with two versus three titanium screws for all three loading scenarios. Contralateral molar loading resulted in the highest stress on both the fracture and the screws with the maximum von Mises stress being found at the condylar neck. Stress concentration within the screws was found in the fracture gap and was higher in the lateral fragment. In all scenarios, maximum von Mises stress values were smaller when forces were distributed among three screws. However, stability was also adequate when two screws were used. Mandibular condylar head osteosynthesis with two titanium screws appears to provide sufficient fracture stability. Further clinical studies are needed to clarify the implications of these results.

Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.

Background: The aim of the study was to assess, whether there is a difference in aesthetic and functional patient satisfaction between closed nasal reductions with intraoperative Cone-Beam Computed Tomography (CBCT) and without using intraoperative medical imaging. Methods: A monocentric, retrospective cohort study of 43 patients (20 patients treated with intraoperative CBCT and 23 patients treated without intraoperative imaging) was conducted. Subjective postoperative aesthetic and functional aspects of the nose were assessed. Additionally, questions comparing the aesthetics and function of the nose before and after the accident and on the desire of revision surgery were asked. Results: Both the SCHNOS-C and total SCHNOS score in the non-CBCT group were higher than the respective scores of the CBCT-group. The comparison of SCHNOS-C between male subjects of the two groups showed no statistical significance. The comparison of SCHNOS-C between male and female subjects over both groups showed significantly higher scores for female subjects. Conclusions: Patients undergoing surgery with intraoperative CBCT imaging showed better aesthetical outcomes than patients, treated without intraoperative imaging. However, the difference showed no clinical importance, so that both strategies appear to have comparable outcomes regarding postoperative aesthetics and function of the nose. Gender instead of the different strategies could contribute to the demonstrated differences. Female subjects seem to be less satisfied with the aesthetics of their nose postoperatively, potentially being more sensitive to remaining nasal deformities after surgery.

Secondary orbital reconstructions mostly affect defects in the area of the orbital floor or the medial wall, because these structures are most susceptible to fractures due to fragility. These defects may cause an increase of the orbital volume and a dislocation of the orbital content; furthermore, an altered globe position may arise (Fig. 1). Clinically, enophthalmos and/or hypoglobus develops (Figs. 2 and 3). As part of primary trauma diagnostics, swelling of the soft tissue in the affected eye socket may compensate this increase in volume for a short time.

Purpose: Patient-specific implants (PSIs) are known to yield reliable outcomes in orbital wall fracture reconstruction (high precision, smoother operating techniques, and shorter surgical duration). This study analyzed the surgical error and clinical and esthetic outcomes of orbital reconstructions with PSIs. Methods: This ambispective cohort study enrolled patients who underwent orbital reconstruction using PSIs between October 2016 and January 2018. The study end points were surgical error, indication and duration of surgery, long-term sequelae, revision surgeries, and surgical complications. Surgical error was analyzed by superimposing the postoperative implant position onto the preoperative virtual plan. Both qualitative (heat map) and quantitative (distance) measurements were obtained. Results: Three patients were enrolled prospectively, and 23 were enrolled retrospectively. Indications for surgery were defect size (25 patients), diplopia (10 patients), impaired eye motility (4 patients), and significant enophthalmos (6 patients). At the last patient visit, there were 5 cases of diplopia, 1 case of exophthalmos, and 6 cases of slight enophthalmos of incremental degree. In terms of surgical error, a mean distance of 0.6 mm (95% confidence interval, 0.49 to 0.76), with a mean maximal distance of 3.4 mm (95% confidence interval, 2.79 to 4.02), was noted. No revision surgery was necessary. Lid malposition complications were not observed. However, 1 case each of symblepharon and scleral show were observed. No time-saving component was observed. Conclusions: PSI use in orbital reconstruction guarantees a preplanned 3-dimensional anatomical shape with a mean surgical error of just 0.6 mm. Our clinical results were similar to those of other protocols; however, warranting a complex 3-dimensional anatomical shape also in large orbital fractures with a low mean surgical error is feasible by using PSIs. (C) 2020 American Association of Oral and Maxillofacial Surgeons

Purpose: Decision making in the management of condylar head fractures remains difficult due to its dependency on multiple factors like fracture type, degree of dislocation, patient's age and dental condition. As open reduction and internal fixation (ORIF) of condylar head fractures (CHFs) becomes more popular, the question of osteosynthesis removal is controversial. So far, information on volumetric changes after ORIF are available for a short-term period (<6 months) only. This study, therefore, was performed to assess bone resorption after condylar head fractures and to follow-up intermediate-term (>1 year) remodelling after removal of metallic osteosynthesis material. Furthermore clinical outcome was measured using Helkimo Index and put in relation with bone resorption. Materials and Methods: A retrospective analysis of 19 patients who underwent open reduction and internal fixation of condylar head fractures at the University Hospital of Zurich between January 2016 and April 2018 using intraoperative cone-beam computed tomography repositioning control was conducted. The bone resorption on the condylar head was measured in the course after removal of osteosynthesis material by segmenting and superimposing of the postoperative 3D radiologic follow-up exam (T2) over the initial intraoperative cone-beam computed tomography (T1) using iPlan-CMF software. Complementary Helkimo index was assessed to put resorption rate in relation to clinical outcome. Results: A total of 19 patients fulfilled the inclusion criteria. The mean follow-up time was 15.6 months and the mean bone resorption on the condylar head was -0.348cm(3) or -15.29% of segmented condylar head. There was no correlation of clinical outcome and bone resorption. Conclusions: Helkimo index showed satisfying results; therefore, ORIF of condylar head fracture proves as a feasible treatment option. The mean bone resorption rate of -15.29% in the intermediate-term follow-up time (mean 15.6 months) is comparable to findings of other studies with short-term follow-up time (< 6 months). Thus, postinterventional remodeling activity and resorption seems highest in the first 4 to 6 postoperative months with little further resorption. In prevention of negative sequelae of protruding implants, timing of osteosynthesis material removal after this period of high bone remodeling activity is recommended. The resorption rate showed no correlation to clinical outcome. (C) 2021 The American Association of Oral and Maxillofacial Surgeons.

Purpose: Concomitant ophthalmic injuries are common in patients with facial fractures, though frequency varies widely in the literature. Major ophthalmic injuries can have drastic consequences for patients, and permanent visual impairment cannot be prevented in all cases. This study analyzed the frequency and distribution pattern of associated ophthalmic injuries in patients who received operative treatment for fractures of the midface. Material and Methods: The clinical information system was searched for patients with midface fractures that were treated operatively between December 2014 and November 2017. Demographic, fracture-related, and ophthalmic data were assessed and statistically analyzed. Results: This study included 282 patients. The most common fracture types were zygomaticomaxillary complex fractures and orbital floor fractures. Falls and violence were the most common causes of fractures (43.3% and 24.5%, respectively). Chemosis and subconjunctival bleeding were the most common associated eye injuries. The most prevalent long-term eye injury was diplopia, which was identified in 18.4% of cases preoperatively. Postoperative diplopia persisted in 36 cases (12.8%) at 3-month follow-up. Optic neuropathy, enophthalmos, exophthalmos, and retrobulbar hematomas were identified infrequently. Conclusion: Minor ophthalmic injuries, including chemosis and subconjunctival bleeding, are more frequently associated with midface trauma. These minor injuries tend to heal quickly and without sequela. Major ophthalmic injuries, including retinal detachment, optic neuropathy, and retrobulbar hematomas, are identified less frequently. Special attention should be paid to patients with diplopia, as this condition may persist and have long-term occupational consequences. Therefore, close interdisciplinary collaboration is essential when treating patients with fractures of the midface to prevent permanent visual impairment.

Purpose: Reconstruction of symmetry after zygomaticomaxillary complex (ZMC) fractures is essential for esthetic appearance as well as function. Therefore, this study aimed to analyze whether bony facial symmetry in patients surgically treated for unilateral ZMC fractures via intraoperative imaging differs from that of healthy individuals. Patients and Methods: Retrospective and cross-sectional radiographic measurements of patients treated for unilateral ZMC fractures via intraoperative cone beam computed tomography (CBCT) were performed to evaluate the postoperative ZMC symmetry. The same number of healthy individuals without any history of midfacial trauma matched for age and gender served as the control group. Asymmetry of the ZMC was determined by measuring bilateral differences in the malar eminence position on CBCT. In addition, demographic statistics, etiology, and fracture type were analyzed. Results: Analysis of 57 surgically treated patients and 57 healthy individuals with a mean age of 29 years was performed. No significant difference in the symmetry of the malar eminence position was observed between healthy individuals and patients treated for a unilateral ZMC fracture (P = .890). In one third of patients, corrections were needed after intraoperative CBCT control. Conclusions: The results of this study indicate that, on average, a ZMC asymmetry of 1.6mm is observed in healthy individuals. Furthermore, the use of intraoperative CBCT for the treatment of dislocated ZMC fractures helps to achieve precise anatomic, symmetrical repositioning and is suggested to improve the quality of care. (C) 2019 American Association of Oral and Maxillofacial Surgeons

Purpose: Early operative reconstruction using titanium mesh is a technique often used for preventing sequelae after an orbital fracture. We sought to examine the utility of patient-specific molding of the mesh with a biomodel via virtual mirroring of the nonaffected side. Methods: We retrospectively assessed the clinical and radiological outcomes of orbital fracture reconstruction using a customized titanium mesh shaped on 3D-printed biomodels in 34 unilateral orbital fracture cases. Preoperative virtual orbital reconstruction images, using the mirroring technique, were superimposed on postoperative 3D images, and clinical data from patient charts were analyzed. Orbital reconstructions were rated, and the intention to revise results intraoperatively, or during inpatient or outpatient phases, was assessed by 2 consultants and 2 residents. Results: We found that most fractures arose from falls of <3 meters or from interpersonal violence. Ophthalmic injuries included subconjunctival bleeding, ocular contusion, enophthalmos, and diplopia. Long-term sequelae at last followup were diplopia (8.8%) and mild enophthalmos (11.8%). Conclusion: Interrater reliabilities regarding consultants' intention to revise results were substantial to almost perfect at any time point. Therefore, using the mirroring technique for the virtual reconstruction of a fractured orbit and a 3D-printed biomodel to customize commercial titanium implants yields good and reliable results, enhances surgical precision, and decreases the need for intraoperative revision, as well as long-term sequelae of orbital fractures. (C) 2020 American Association of Oral and Maxillofacial Surgeons

Free AccessBruxismus und kraniomandibuläre DysfunktionMichael BlumerMichael Blumer Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital ZürichSearch for more papers by this authorPublished Online:September 15, 2020https://doi.org/10.1024/1661-8157/a003533PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreBruxismus und kraniomandibuläre Dysfunktion (CMD) sind häufige Beschwerdebilder. Die Prävalenz des Bruxismus beträgt etwa 6–20 %. An einer CMD mit Symptomen leiden etwa 5 % der Bevölkerung, wobei die Prävalenz von asymptomatischen Fällen mit CMD noch deutlich höher liegen dürfte. Bruxismus und CMD können längere Zeit symptomlos bleiben und erst nach Jahren Beschwerden verursachen. Bei CMD wird zudem eine Chronifizierung befürchtet, was das Therapieregime deutlich erschwert und den Therapieerfolg schmälern kann. Siehe dazu auch den Beitrag von Vavrina & Vavrina in diesem Heft [1]. So wird aktuell eine frühzeitige Diagnosestellung von Parafunktionen und CMD angestrebt, um die Chronifizierung und mögliche Folgeerkrankungen zu verhindern. Nach Diagnosestellung ist insbesondere eine umfassende Information der Patientin/des Patienten elementar, um das Krankheitsverständnis bei diesem heterogenen Symptomkomplex sicherzustellen. Dies kann sehr zeitaufwendig und durch Sprachbarrieren kompliziert sein. Es können mehrere Sitzungen notwendig sein, um dieses Ziel zu erreichen.Eine weitere Schwierigkeit besteht darin, dass der Patientin/dem Patienten nicht eine «einzige» richtige Behandlung präsentiert werden kann. Eine zielführende Therapie gestaltet sich vielmehr multimodal und individuell auf jede Patientin/jeden Patienten zugeschnitten. Regelmässige Recalls mit Evaluation des Therapiefortschritts sind unerlässlich.Je nach Ursache der Parafunktion oder CMD findet eine Vielzahl von konservativen Therapiemethoden Anwendung, z.B. Relaxationstraining, Progressive Muskelentspannung, Biofeedbackübungen, kognitive oder operante Verhaltenstherapie, Selbstbeobachtung, Heimübungen zur Verbesserung der Mundöffnung oder Lockerung der Kaumuskulatur, topische oder systemische Begleitmedikation, Physiotherapie, Schienentherapie bis hin zu Veränderungen der okklusalen Verhältnisse oder Hypnose.Bei ausbleibender Besserung von überwiegend arthrogen bedingten Beschwerden können gemäss Stufenprinzip therapeutische Injektionen ins Kiefergelenk oder eine Botulinumtherapie der Kaumuskulatur oder eine minimalinvasive diagnostische wie auch therapeutische Arthroskopie des Kiefergelenks folgen. Und schliesslich, bei Ausbleiben einer Beschwerdebesserung nach dieser ganzen Kaskade, kann eine offene Kiefergelenkchirurgie notwendig werden.Diese Bandbreite an unterschiedlichsten Therapieansätzen zeigt die Komplexität der Krankheitsbilder. Zudem müssen andere Kopf- und Gesichtsschmerzen sicher ausgeschlossen werden. Daher müssen für eine erfolgreiche Therapie die Kompetenzen einer Vielzahl an Fachdisziplinen interprofessionell zusammengeführt werden. Universitäre Zentren, wie beispielsweise das Zentrum für Kopf-, Gesichts- und Kiefergelenkschmerzen (ZKGS) am Universitätsspital Zürich, bieten mit ihren integrierten Konzepten nicht nur eine patientenzentrierte Behandlung nach den neuesten wissenschaftlichen Erkenntnissen, sondern stellen zudem die so wichtige Aus- und Weiterbildung des ärztlichen, therapeutischen und pflegerischen Personals sicher und entwickeln die Behandlungsmethoden von morgen.Bibliografie Vavrina J, Vavrina J: Bruxismus: Einteilung, Diagnostik und Behandlung. Praxis. 2020;109:973–978. First citation in articleLink, Google ScholarDr. med. Dr. med. dent. Michael Blumer, Oberarzt, Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091 Zürich, michael.blumer@usz.chFiguresReferencesRelatedDetails Volume 109Issue 12September 2020ISSN: 1661-8157eISSN: 1661-8165 InformationPraxis (2020), 109, pp. 937-937 https://doi.org/10.1024/1661-8157/a003533.© 2020Hogrefe AGPDF download

PURPOSE:This study analyzed the radiologic outcomes of patients with unilateral mandibular condylar fractures treated with open reduction-internal fixation (ORIF) through a transoral approach. PATIENTS AND METHODS:In this retrospective study, the radiologic images of 40 patients who underwent open reduction-internal fixation through a transoral approach were presented to 2 independent examiners. All patients underwent the surgical procedure between January 2015 and December 2016 at the Department of Cranio-Maxillofacial Surgery at UniversitätsSpital Zürich and were included in a previous functional outcome study. The surgical results were analyzed and graded as poor, acceptable, or good. The examiners declared whether they would have made any intraoperative revisions if the radiologic information had been available. Finally, the examiners estimated the required duration of elastic intermaxillary fixation (IMF) from the radiologic images, which was compared with the actual duration. RESULTS:Fracture reduction was classified as good in 33 cases (82.5%), acceptable in 5 cases, and poor in 2 cases by one examiner and as good in 32 cases (80%), acceptable in 6 cases, and poor in 2 cases by the other examiner. The inter-rater reliability was determined to be good (Cohen κ = 0.92). Correct osteosynthesis placement was found in 19 cases by one examiner and in 21 cases by the other examiner, with good inter-rater reliability (κ = 0.8). Moderate inter-rater reliability (κ = 0.4) was found for the required duration of elastic IMF. Furthermore, the estimated elastic IMF duration matched the actual duration in fewer than half of the cases. CONCLUSIONS:It is feasible to achieve reliably good radiologic results when operating on condylar process fractures by a transoral approach with endoscopic assistance and angled instruments. Intraoperative 3-dimensional imaging enables instant quality control and prompts surgical revision if needed.

Zusammenfassung. Das Gesicht ist ein entscheidender Teil der individuellen Personlichkeit und erfullt gleichzeitig vielfaltige Aufgaben. Asthetik und Funktion bilden hier eine einzigartige Einheit. Die Formierung des Fachgebiets der Mund-, Kiefer- und Gesichtschirurgie begann in den ersten Jahrzehnten des letzten Jahrhunderts. Es umfasst die Pravention, Diagnose, Therapie und Rehabilitation von Erkrankungen, Verletzungen, Fehlbildungen und Formveranderungen der komplexen Strukturen des Gesichts, der Mundhohle, der Kiefer und der Zahne. Inzwischen ist die Mund-, Kiefer- und Gesichtschirurgie im 21. Jahrhundert angekommen. Die heutige Mund-, Kiefer- und Gesichtschirurgie ist ein Bindeglied zwischen der Medizin und der Zahnmedizin und ein Protagonist in der Implementierung digitaler Arbeitsablaufe in die klinische Versorgung. Individuelle Losungen mit patientenspezifischen Implantaten sind die Regel, computerassistierte Techniken unterstutzen den Operateur bei der Planung und Durchfuhrung der chirurgischen E...

OBJECTIVE:The aim of this clinical study was to analyze the accuracy of computer-guided implant surgery.MATERIALS AND METHODS:Assisted by computed tomography (CT)-based planning software and navigational templates, 16 patients successfully received 26 dental implants. Each implant parameter (a-d) was calculated based on superimposed preoperative and postoperative cone beam CT scans: (a) deviation at entry point; (b) deviation at apex; (c) angular deviation; and (d) depth deviation.RESULTS:Mean central deviation at implant entry point and apex was 0.91 mm (standard error [SE] = 0.11 mm; 95% confidence interval [CI]: 0.69-1.13) and 1.22 mm (SE = 0.11 mm; 95% CI: 0.99-1.45), respectively. Mean angulation deviation was 4.11 degrees (SE = 0.52 degrees; 95% CI: 3.04-5.17) and the average depth deviation was 0.65 mm (SE = 0.11 mm; 95% CI: 0.42-0.87). For the total number of implants placed, the maximum error was 2.34 mm at entry point, 2.71 mm at apex, 9.44 degrees in angular deviation, and 2.00 mm in depth deviation.CONCLUSION:Great accuracy was reached even in advanced cases with prior bone augmentation and complex traumas. This leads to the conclusion that particularly in advanced cases, computer-guided implantation can be beneficial.