Background: The recent increase in computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted surgery has warranted a thorough evaluation of the accuracy of virtual plan execution. Mandibular reconstructions with a fibula free flap were evaluated by comparing the fibular segments postoperatively with the virtual surgical plans. Methods: This study included computed tomography data for 20 patients (11 males; mean age 61.3 years, range 47–74) that received a mandibular reconstruction with a fibula free flap. Linear distances (superior and inferior borders) of 41 fibula segments and intercoronoid distances were measured. Results: The mean difference was 3.11 ± 2.80 mm for superior borders (range 0.02–12.20 mm), and 2.75 ± 2.61 mm for inferior borders (range 0.22–13.58 mm). The mean intercoronoid difference was 3.57 ± 1.80 mm (range 0.91–6.11 mm). Conclusion: This study confirmed the presumed accuracy regarding the use of fibular and mandibular cutting guides. CAD/CAM is an attractive technique which enhances efficiency and assurance during surgery and preoperative planning.

Previous reports have suggested a possible association between tumour necrosis factor alpha (TNF-a) inhibitors, used in the treatment of immune-mediated inflammatory diseases, and medication-related osteonecrosis of the jaw (MRONJ). However, a comprehensive assessment of the frequency and severity of MRONJ caused by these agents is lacking. The aim of this cohort study was to investigate the occurrence of MRONJ in a population of patients with inflammatory bowel disease (IBD) treated with TNF-a inhibitors at a tertiary care medical centre. A total of 2701 IBD patients under current or former treatment with TNF-a inhibitors were identified in an IBD registry covering the period 1994-2018. These patients were cross-matched with all patients diagnosed with MRONJ. This resulted in three patients with a definite diagnosis of MRONJ, without concomitant treatment with bisphosphonates. All three patients required surgical treatment with sequestrectomy. Mucosal healing occurred at 4-15 months and one patient developed recurrence. In conclusion, this study identified and described anti-TNFa-related MRONJ occurring in a large cohort of IBD patients, and reported the severity and treatment strategies used.

Orthognathic surgery involving the mandible can lead to remodelling of the temporomandibular joint (TMJ). Cone beam computed tomography (CBCT) provides an easily accessible three-dimensional (3D) approach to study this entity. A systematic review of the literature was performed with the aim of identifying condylar remodelling analysis protocols using CBCT-derived 3D models. The search yielded 10 eligible studies. The systematic review identified three pillars of a condylar remodelling analysis protocol that were retrievable from each of the included studies:(1) registration, (2) segmentation, and (3) analysis. The studies lacked consensus on how these pillars should be transferred to their respective protocol. Through critical assessment, criteria for a universal condylar remodelling analysis are suggested: (1) performance of a regional voxel-based registration of baseline and postoperative CBCT scans using an anatomical region not prone to postoperative changes, (2) application of a (semi-)automated 3D segmentation algorithm, (3) performance of a combination of both volumetric and surface-based 3D condylar analysis, and (4) extensive validation of each step of the protocol. The homogenization of condylar remodelling analysis protocols and their incorporation into virtual planning software suites raises the potential for the inclusion of larger numbers of patients in future prospective studies in order to gain evidence-based data.

La myosite ossifiante traumatique (MOT) du muscle temporal est une pathologie extrêmement rare. Une limitation de l’ouverture buccale est le symptôme clé. Les examens d’imagerie sont très utiles au diagnostic, le CT-scanner de la face étant l’examen le plus performant pour la détection de la MOT. Le meilleur traitement est la résection chirurgicale complète. Les cas de myosite ossifiante traumatique dans la région de la tête et du cou sont rares. Les atteintes au niveau du muscle temporal sont encore plus rares. Nous présentons ici le cas d’une ossification isolée du muscle temporal gauche après un polytraumatisme. L’intérêt de l’observation clinique du cas présenté est donc de documenter la littérature. Le diagnostic différentiel et les signes pathognomoniques présents sur les examens d’imagerie seront également détaillés.