3-D Morphological Condylar Changes Post-Oncological Mandibular Reconstruction: Comparison of Surgical Techniques

Background: Mandibular reconstruction, with temporomandibular joint (TMJ) involvement, is a challenging procedure where precise evaluation of condylar displacement is critical for assessing functional and aesthetic outcomes. The complexity of this evaluation stems from anatomical variability, surgical techniques, and post-surgical changes, making consistent and reliable assessments difficult. This study assessed condylar displacement following mandibular reconstruction using a standardized protocol for reproducibility. Methods: A retrospective analysis of patients treated at AOU Careggi, Florence (2019–2023), was conducted, with preoperative, immediate postoperative, and long-term CT scans analyzed across four groups: customized microvascular bone flaps, conventional bone flaps, customized plate implants, and soft tissue-only reconstructions. Results: Customized bone flaps and plate implants minimized condylar displacement, while conventional bone flaps had initial misalignment, stabilizing over time. Soft tissue-only reconstructions led to complete condylar resorption after two years. Conclusion: The study introduced a standardized protocol for assessing condylar shifts, highlighting the advantages of CAD/CAM-based techniques in preserving TMJ integrity, and suggesting further research for refining reconstructive strategies.