{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T19:10:01Z","timestamp":1787685001652,"version":"build-2784847793"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007797","name":"University of Helsinki","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007797","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Oral Maxillofac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Preoperative virtual planning and osteosynthesis with patient-specific implants (PSIs) have become a quotidian approach to many maxillofacial elective surgery setups. When a process is well-organized, a similar approach can be harnessed to serve the needs of exact primary reconstructions, especially in midfacial trauma cases. PSI osteosynthesis of the mandible is, however, more challenging because a mirror technique of the facial sides is often unreliable due to inherent lack of symmetry, and movement of the mandible increases the risk of loosening of the osteosynthesis. The purpose of this study was to present clinical results of the Helsinki protocol concept of utilizing PSIs in the primary surgery of unilateral mandibular subcondylar fractures as the first publication on the subject.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center study of a new Helsinki protocol is presented for surgical treatment of subcondylar mandibular fractures using patient-specific, titanium-milled repositator plates. Ten patients with dislocated subcondylar mandibular fractures received surgery and osteosynthesis with PSI via a retromandibular approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinical and radiological outcomes were excellent; none of the patients had fixation-related major complications or developed postoperative malocclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Study results show that the Helsinki protocol, treating mandibular condylar fractures primarily with PSI plates, is a viable treatment option.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10006-025-01338-2","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T09:03:54Z","timestamp":1737709434000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Primary surgery of subcondylar mandibular fracture using patient-specific implant: the Helsinki protocol"],"prefix":"10.1007","volume":"29","author":[{"given":"Mikko","family":"Saloniemi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malla","family":"Salli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valtteri","family":"Lehtinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Sn\u00e4ll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"key":"1338_CR1","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1097\/SCS.0b013e31822e5f20","volume":"22","author":"B Van Den Bergh","year":"2019","unstructured":"Van Den Bergh B, Van Es C, Forouzanfar T (2019) Analysis of mandibular fractures. J Craniofac Surg 22:1631\u20131634. https:\/\/doi.org\/10.1097\/SCS.0b013e31822e5f20","journal-title":"J Craniofac Surg"},{"key":"1338_CR2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.ijom.2009.10.005","volume":"39","author":"F De Matos","year":"2010","unstructured":"De Matos F, Arnez M, Sverzut C, Trivellato A (2010) A retrospective study of mandibular fracture in a 40-month period. Int J Oral Maxillofac Surg 39:10\u201315. https:\/\/doi.org\/10.1016\/j.ijom.2009.10.005","journal-title":"Int J Oral Maxillofac Surg"},{"key":"1338_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12041394","volume":"12","author":"M Kozakiewicz","year":"2023","unstructured":"Kozakiewicz M, Walczyk A (2023) Current frequency of mandibular condylar process fractures. J Clin Med 12. https:\/\/doi.org\/10.3390\/jcm12041394","journal-title":"J Clin Med"},{"key":"1338_CR4","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/s0300-9785(77)80009-4","volume":"6","author":"L Lindahl","year":"1977","unstructured":"Lindahl L (1977) Condylar fractures of the mandible. Int J Surg 6:12\u201321. https:\/\/doi.org\/10.1016\/s0300-9785(77)80009-4","journal-title":"Int J Surg"},{"key":"1338_CR5","doi-asserted-by":"publisher","first-page":"398E","DOI":"10.1097\/PRS.0000000000008294","volume":"148","author":"A Gibstein","year":"2021","unstructured":"Gibstein A, Chen K, Nakfoor B, Gargano F, Bradley J (2021) Mandibular subcondylar fracture: improved functional outcomes in selected patients with Open Treatment. Plast Reconstr Surg 148:398E-406E. https:\/\/doi.org\/10.1097\/PRS.0000000000008294","journal-title":"Plast Reconstr Surg"},{"key":"1338_CR6","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1002\/ohn.185","volume":"168","author":"M Shikara","year":"2023","unstructured":"Shikara M, Bridgham K, Ludeman E, Vakharia K, Justicz N (2023) Current management of Subcondylar fractures: a systematic review. Otolaryngol Head Neck Surg 168:956\u2013969. https:\/\/doi.org\/10.1002\/ohn.185","journal-title":"Otolaryngol Head Neck Surg"},{"key":"1338_CR7","doi-asserted-by":"publisher","unstructured":"Ellis E, Mcfadden D, Simon P, Throckmorton G (2000) Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 58:950\u2013958. https:\/\/doi.org\/10.1053\/joms.2000.8734","DOI":"10.1053\/joms.2000.8734"},{"key":"1338_CR8","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.jcms.2017.10.024","volume":"46","author":"E Al-Moraissi","year":"2018","unstructured":"Al-Moraissi E, Louvrier A, Colletti G, Wolford L, Biglioli F, Ragaey M, Meyer C, Ellis E (2018) Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. J Craniomaxillofac Surg 46:398\u2013412. https:\/\/doi.org\/10.1016\/j.jcms.2017.10.024","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR9","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1016\/j.jcms.2018.04.015","volume":"46","author":"E Al-Moraissi","year":"2018","unstructured":"Al-Moraissi E, Ellis E, Neff A (2018) Does encountering the facial nerve during surgical management of mandibular condylar process fractures increase the risk of facial nerve weakness? A systematic review and meta-regression analysis. J Craniomaxillofac Surg 46:1223\u20131231. https:\/\/doi.org\/10.1016\/j.jcms.2018.04.015","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR10","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/j.jcms.2021.04.008","volume":"49","author":"M Nikunen","year":"2021","unstructured":"Nikunen M, Rajantie H, Marttila E, Sn\u00e4ll J (2021) Implant malposition and revision surgery in primary orbital fracture reconstructions. J Craniomaxillofac Surg 49:837\u2013844. https:\/\/doi.org\/10.1016\/j.jcms.2021.04.008","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR11","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.jcms.2022.09.006","volume":"50","author":"V Lehtinen","year":"2022","unstructured":"Lehtinen V, Salli M, Py\u00f6tsi\u00e4 K, Toivari M, Sn\u00e4ll J (2022) Primary reconstruction of combined orbital and zygomatic complex fractures with patient-specific milled titanium implants \u2013 A retrospective study. J Craniomaxillofac Surg 50:756\u2013764. https:\/\/doi.org\/10.1016\/j.jcms.2022.09.006","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13005-020-00236-0","volume":"16","author":"T Pavlychuk","year":"2020","unstructured":"Pavlychuk T, Chernogorskyi D, Chepurnyi Y, Neff A, Kopchak A (2020) Biomechanical evaluation of type p condylar head osteosynthesis using conventional small-fragment screws reinforced by a patient specific two-component plate. Head Face Med 16:1\u201314. https:\/\/doi.org\/10.1186\/s13005-020-00236-0","journal-title":"Head Face Med"},{"key":"1338_CR13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205\u2013213. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","journal-title":"Ann Surg"},{"key":"1338_CR14","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1016\/j.jcms.2015.04.019","volume":"43","author":"D Dalla Torre","year":"2015","unstructured":"Dalla Torre D, Burtscher D, Widmann G, Pichler A, Rasse M, Puelacher W (2015) Surgical treatment of mandibular condyle fractures using the retromandibular anterior transparotid approach and a triangular-positioned double miniplate osteosynthesis technique: a clinical and radiological evaluation of 124 fractures. J Craniomaxillofac Surg 43:944\u2013949. https:\/\/doi.org\/10.1016\/j.jcms.2015.04.019","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR15","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.ijom.2013.08.008","volume":"43","author":"T Kanno","year":"2014","unstructured":"Kanno T, Sukegawa S, Tatsumi H, Nariai Y, Ishibashi H, Furuki Y, Sekine J (2014) The retromandibular transparotid approach for reduction and rigid internal fixation using two locking miniplates in mandibular condylar neck fractures. Int J Oral Maxillofac Surg 43:177\u2013184. https:\/\/doi.org\/10.1016\/j.ijom.2013.08.008","journal-title":"Int J Oral Maxillofac Surg"},{"key":"1338_CR16","doi-asserted-by":"publisher","unstructured":"Darwich M, Albogha M, Abdelmajeed A, Darwich K (2016) Assessment of the Biomechanical Performance of 5 Plating Techniques in Fixation of Mandibular Subcondylar Fracture Using Finite Element Analysis. J Oral Maxillofac Surg 74. https:\/\/doi.org\/10.1016\/j.joms.2015.11.021","DOI":"10.1016\/j.joms.2015.11.021"},{"key":"1338_CR17","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.jcms.2017.12.020","volume":"46","author":"M Albogha","year":"2018","unstructured":"Albogha M, Mori Y, Takahashi I (2018) Three-dimensional titanium miniplates for fixation of subcondylar mandibular fractures: comparison of five designs using patient-specific finite element analysis. J Craniomaxillofac Surg 46:391\u2013397. https:\/\/doi.org\/10.1016\/j.jcms.2017.12.020","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR18","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1016\/j.ijom.2014.07.011","volume":"43","author":"G De Jesus","year":"2014","unstructured":"De Jesus G, Vaz L, Gabrielli M, Passeri L, Oliveira T, Noritomi P, J\u00fcrgens P (2014) Finite element evaluation of three methods of stable fixation of condyle base fractures. Int J Oral Maxillofac Surg 43:1251\u20131256. https:\/\/doi.org\/10.1016\/j.ijom.2014.07.011","journal-title":"Int J Oral Maxillofac Surg"},{"key":"1338_CR19","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.jcms.2019.01.033","volume":"47","author":"S Sukegawa","year":"2019","unstructured":"Sukegawa S, Kanno T, Masui M, Sukegawa-Takahashi Y, Kishimoto T, Sato A, Furuki Y (2019) Which fixation methods are better between three-dimensional anatomical plate and two miniplates for the mandibular subcondylar fracture open treatment? J Craniomaxillofac Surg 47:771\u2013777. https:\/\/doi.org\/10.1016\/j.jcms.2019.01.033","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR20","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.jormas.2021.06.011","volume":"123","author":"P Liokatis","year":"2022","unstructured":"Liokatis P, Tzortzinis G, Gerasimidis S, Smolka W (2022) Finite element analysis of different titanium miniplates: evaluation of three-dimensional designs applied on condylar neck fractures. J Stomatol Oral Maxillofac Surg 123:184\u2013190. https:\/\/doi.org\/10.1016\/j.jormas.2021.06.011","journal-title":"J Stomatol Oral Maxillofac Surg"},{"key":"1338_CR21","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1590\/s0102-86502012000600011","volume":"27","author":"F Costa","year":"2012","unstructured":"Costa F, Bezerra M, Ribeiro T, Puchain E, Saboia V, Soares E (2012) Biomechanical analysis of titanium plate systems in mandibular condyle fractures. A systematized literature review. Acta Cir Bras 27:424\u2013429. https:\/\/doi.org\/10.1590\/s0102-86502012000600011","journal-title":"Acta Cir Bras"},{"key":"1338_CR22","doi-asserted-by":"publisher","first-page":"2522.e1","DOI":"10.1016\/j.joms.2019.07.012","volume":"77","author":"H Marwan","year":"2019","unstructured":"Marwan H, Sawatari Y (2019) What Is the most stable fixation technique for mandibular condyle fracture? J Oral Maxillofac Surg 77:2522.e1-2522.12. https:\/\/doi.org\/10.1016\/j.joms.2019.07.012","journal-title":"J Oral Maxillofac Surg"},{"key":"1338_CR23","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.aanat.2017.10.007","volume":"216","author":"I Garc\u00eda-Guerrero","year":"2018","unstructured":"Garc\u00eda-Guerrero I, Ram\u00edrez J, de Diego R, Mart\u00ednez-Gonz\u00e1lez M, Lancho J (2018) Complications in the treatment of mandibular condylar fractures: surgical versus conservative treatment. Ann Anat 216:60\u201368. https:\/\/doi.org\/10.1016\/j.aanat.2017.10.007","journal-title":"Ann Anat"},{"key":"1338_CR24","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.jcms.2012.02.012","volume":"40","author":"J Handschel","year":"2012","unstructured":"Handschel J, R\u00fcggeberg T, Depprich R, Schwarz F, Meyer U, K\u00fcbler N, Naujoks C (2012) Comparison of various approaches for the treatment of fractures of the mandibular condylar process. J Craniomaxillofac Surg 40:397\u2013401. https:\/\/doi.org\/10.1016\/j.jcms.2012.02.012","journal-title":"J Craniomaxillofac Surg"},{"key":"1338_CR25","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1097\/TA.0b013e31823b8b9f","volume":"72","author":"D Amanatullah","year":"2012","unstructured":"Amanatullah D, Khan S, Curtiss S, Wolinsky P (2012) Effect of divergent screw fixation in vertical medial malleolus fractures. J Trauma Acute Care Surg 72:751\u2013754. https:\/\/doi.org\/10.1097\/TA.0b013e31823b8b9f","journal-title":"J Trauma Acute Care Surg"},{"key":"1338_CR26","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s10195-023-00714-6","volume":"24","author":"F Aykanat","year":"2023","unstructured":"Aykanat F, Kose O, Guneri B, Celik H, Cakar A, Tasatan E, Ulmeanu M (2023) Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis. J Orthop Traumatol 24:30. https:\/\/doi.org\/10.1186\/s10195-023-00714-6","journal-title":"J Orthop Traumatol"},{"key":"1338_CR27","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s13018-017-0641-9","volume":"12","author":"X Shi","year":"2017","unstructured":"Shi X, Pan T, Wu D, Cai N, Chen R, Li B, Zhang R, Zhou C, Pan J (2017) Effect of different orientations of screw fixation for radial head fractures: a biomechanical comparison. J Orthop Surg Res 12:143. https:\/\/doi.org\/10.1186\/s13018-017-0641-9","journal-title":"J Orthop Surg Res"}],"container-title":["Oral and Maxillofacial Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10006-025-01338-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10006-025-01338-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10006-025-01338-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T02:12:09Z","timestamp":1765159929000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10006-025-01338-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,24]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1338"],"URL":"https:\/\/doi.org\/10.1007\/s10006-025-01338-2","relation":{},"ISSN":["1865-1569"],"issn-type":[{"value":"1865-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,24]]},"assertion":[{"value":"15 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The authors have no conflict of financial or non-financial interest related to the study. All authors contributed to the study conception and design, material preparation, data collection and analysis. The first draft of the manuscript was written by M.S., all authors commented on previous versions and approved the final version of the manuscript. No generative or nongenerative artificial Intelligence -assisted technologies were used to produce the submitted work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study is a retrospective cohort study. The internal board of the Head and Neck Centre, Helsinki University Hospital, Helsinki, Finland approved the study protocol.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was waived by the internal board due to the retrospective nature of the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number\u00a0"}}],"article-number":"46"}}