case_images: PMC10663213_01
case_images: Panels (A-I) represent the diagnostic images associated with case 1. (A) Perioperative CT, 3-D reconstruction of the skull of the patient demonstrates comminuted fractures of the left ramus and the coronoid process. (B) Immediate postoperative CT, 3-D reconstruction of the skull of the patient demonstrates the left caudal mandibulectomy. (C) Twenty-week postoperative CT, 3-D reconstruction image of the skull demonstrates the newly modeled and remodeled left mandibular head of the condylar process, the condylar process, and a portion of the coronoid process. (D-F) Twenty-week postoperative CT demonstrates the transverse, parasagittal and dorsal planes of the skull at the level of the TMJ, highlighting the newly formed left mandibular head of the condylar process and the condylar process. The transverse dimensions of the left mandibular head of the condylar process and the condylar process are comparatively smaller in relation to contralateral structures. The medial pole of the mandibular head is not evident. The left TMJ is positioned rostrally on the cranial base when compared to the right side. The articular portion of the left glenoid fossa is rostrally positioned on the cranial base. Panel (G) (rostral view) and (H) (ventral view) are volume rendered images. There is asymmetry of the mandibles with the left mandible being smaller than the right mandible (transverse, vertical, and rostrocaudal). The osseous and dental midlines of the mandible are shifted to the left. The occlusal plane is elevated on the left side. (I) The shape of the maxilla has not significantly changed when comparing the preoperative study and the 20-week postoperative study.
case_images: fvets-10-1288938-g001.jpg
case_images: PMC10663213_01_fvets-10-1288938-g001.jpg
case_images: fig1
case_images: Conventional CT imaging of the head (Figure 1) revealed several injuries: (A) A left condylar process fracture with lateral displacement. (B) A comminuted fracture of the left ramus with medial displacement of a bone fragment containing the angular process. (C) An oblique fracture separating the coronoid process from the ramus. (D) Avulsion of the developing mineralized tooth structures of the left mandibular second molar tooth. (E) fracture of the left caudal maxilla. (F) A temporal bone fracture resulting in lateral displacement of the zygomatic arch. (G) A separation of the zygomaticotemporal suture and (H) a fracture of the temporal process of the zygomatic bone. TMJ disc (Figure 1B). The left mandibular second molar was extracted (Figure 1B). For the purpose of promoting functional occlusion, orthodontic buttons with elastomeric chains were placed on the deciduous canine teeth (Figure 1B). Following surgical treatment, we conducted a conventional CT scan of the head (Figure 1B). Conventional CT imaging of the head (Figures 1C-I) revealed several findings: (A) Shifting of the mandible to the left and a shorter rostrocaudal dimension on the left mandible. (B) Reduced left mandibular lateral development. (C) Decreased vertical dimensions on the left, including the ramus, condylar process, and the mandibular body region (molar, premolar, canine, and incisor). (D) Evidence of bone bridging between the ramus, condylar process, and the coronoid process. (E) A lateral step deformity extending from the ramus to the condylar process and the angular process, resulting in lateral cantilevering of the condylar process. (F) Depression of the left orbit compared to the right. (G) Regrowth of the left mandibular head of the condylar process with smaller overall dimensions, particularly the medial pole, while the lateral half maintained a relatively normal shape. (H) Both the mandibular head of the condylar process and the condylar process exhibited an outer cortex and internal cancellous bone. (I) Non-union of the fracture of the left zygomatic arch. (J) The left TMJ was positioned rostroventrally on the skull base compared to the right, with an unattached retroarticular process.
case_images: PMC10663213_02
case_images: Panels (A-F) represent the diagnostic images associated with case 2. (A) Perioperative CT, 3-D reconstruction of the skull of the patient demonstrates the comminuted fracture of the right mandibular head of the condylar process, ramus and coronoid process. (B) Immediate postoperative CT, 3-D reconstruction of the skull demonstrating the condylectomy. (C) Five-week postoperative CT, 3-D reconstruction of the skull demonstrating the newly modeled and remodeled right mandibular condylar process. (D-F) Five-week postoperative CT demonstrates the transverse, parasagittal and dorsal plane of the skull at the level of the TMJ, highlighting the right mandibular head of the condylar process and non-union of the left mandibular head of the condylar process.
case_images: fvets-10-1288938-g002.jpg
case_images: PMC10663213_02_fvets-10-1288938-g002.jpg
case_images: fig2
case_images: Chihuahua mix dog presented with maxillofacial injuries sustained in a vehicular accident. CBCT imaging of the head (Figure 2) revealed several injuries: (A) A right ramus fracture, resulting in lateral condylar process luxation and lateral displacement of the fractured condylar process. (B) A fracture involving both the left and right mandibles, crossing the separated symphysis in a lateroventral direction, involving the alveoli of the left and right permanent mandibular canine teeth and (C) Dorsocaudal luxation of the left TMJ, which included a comminuted fracture of the left mandibular head of the condylar process and a ramus fracture resulting in lateral displacement of the left coronoid process. Surgical intervention involved a right condylectomy and excision of the displaced mandibular head of the condylar process, while preserving the TMJ disc (Figure 2B). A postoperative CBCT scan of the head was performed following surgical treatment (Figure 2B). CBCT imaging of the head (Figures 2C-F) revealed several findings: (A) Healing of the right coronoid process fracture, which had fused with the ramus. (B) Regrowth of the right mandibular head of the condylar process with a smooth and corticated articular surface, situated in a shallow fossa. (C) A relatively larger left TMJ space compared to the right. (D) Non-union of the untreated left condylar fracture, resulting in irregular positioning of the proximal segment of the mandibular head of the condylar process within the fossa.
case_images: PMC10663213_03
case_images: Panels (A-F) represent the diagnostic images associated with case 3. (A) Perioperative CT, 3-D reconstruction of the skull of the patient demonstrates a comminuted fracture of the right mandibular head of the condylar process, ramus, zygomatic arch, and coronoid process with significant displacement of the fragments. (B) Four-week postoperative CT, 3-D reconstruction of the skull demonstrates the newly modeled and remodeled mandibular head of the condylar process and the condylar process. (C-E) Four-week postoperative CT demonstrates the transverse, parasagittal and dorsal plane of the skull at the level of the TMJ, highlighting the newly modeled and remodeled right mandibular head of the condylar process, and condylar process. The transverse dimension of the right mandibular head of the condylar process, and condylar process are comparatively smaller in relation to the contralateral structures. The lateral dimensions of the right mandibular head of the condylar process are smaller than the left mandibular head of the condylar process. Panels (F,G) are rostral views of the skull pre-surgery and 4 weeks post-surgery. The osseous and dental midlines of the mandible are shifted to the right after 4 weeks. There is a right sided caudal cross-bite and an open bite on the left side. The occlusal plane on the right side is elevated. Panels (H,I) are volume rendered images pre- and 4 weeks post-surgery. The rostrocaudal dimensions of the right mandible are comparatively less than the left mandible. The right TMJ is positioned rostrally on the cranial base compared to the left.
case_images: fvets-10-1288938-g003.jpg
case_images: PMC10663213_03_fvets-10-1288938-g003.jpg
case_images: fig3
case_images: CBCT scan of the head (Figures 3A,F,H) revealed several injuries: (A) A comminuted right ramus fracture involving the mandibular head of the condylar process and coronoid process, with significant displacement. (B) A comminuted right zygomatic arch fracture, with significant displacement. (C) Soft tissue swelling along the right side of the face, and isolated areas of gas attenuation in the soft tissues lateral to the right maxilla and mandible, indicative of air emphysema in the traumatized tissues. CBCT imaging of the head (Figures 3B-E,G,I) revealed several findings: (A) Horizontal mandibular drift to the right side. (B)
case_images: PMC10663213_04
case_images: Panels (A-F) represent the diagnostic images associated with case 4. (A) Perioperative CT, 3-D reconstruction of the skull of the patient demonstrates fractures of the right mandibular head of the condylar process, ramus, and the zygomatic arch. (B) Immediate postoperative CT, 3-D reconstruction of the skull demonstrates the removal of the fractured portion of the mandibular head of the condylar process, and internal fixation of the right ramus and coronoid process with a titanium miniplate and locking screw construct. (C) Eight-week postoperative CT, 3-D reconstruction of the skull demonstrating the newly modeled and remodeled right mandibular head of the condylar process. (D-F) Five-week postoperative CT demonstrates the transverse, parasagittal and dorsal plane of the skull at the level of the TMJ, highlighting the right mandibular head and condylar process. The right and left TMJs are relatively symmetric. There is flattening of the articular surface of the right mandibular head of the condylar process.
case_images: fvets-10-1288938-g004.jpg
case_images: PMC10663213_04_fvets-10-1288938-g004.jpg
case_images: fig4
case_images: Conventional CT imaging of the head (Figure 4) revealed several injuries: (A) Comminuted fractures of the right mandibular head, condylar process, ramus, and coronoid process. (B) Displacement of the lateral fragment of the right mandibular head in a rostrolateral direction. (C) A segmental, minimally displaced fracture of the right zygomatic arch extending into the squamous portion of the temporal bone. A postoperative conventional CT of the head was performed following surgical treatment (Figure 4B).