A Comparison of Clear Cell Sarcoma to Jaw and Salivary Tumors Bearing EWS Fusions.

OBJECTIVE: To review tumors identified as "clear cell sarcoma" in order to determine similarities to the rare EWS fusion positive jaw and salivary gland tumors clear cell odontogenic carcinoma (CCOC) and clear cell carcinoma of the salivary gland (CCC). METHODS: PubMed was used to collect all reports of clear cell sarcoma (CCS). Search parameters were "clear cell sarcoma" and "CCS." References in the publications were screened and cross-referenced. Data extracted included demographic characteristics, presenting signs and symptoms, radiographic findings, histological and immunohistochemical features and known molecular/genetic aberrations. RESULTS: Clear cell sarcoma has several similarities to CCOC and CCC. All three tumor types have similar histologic appearances including the presence of clear cells, as well as similar genetic profiles in that all harbor an EWSR1-CREB family fusions. Additionally, these tumors appear in soft tissue as well as bone, and can have a prolonged clinical course. CCS can appear anywhere in the body, including the head and neck region. All three tumors appear to have a predilection to women, although CCS may have a slight younger age of onset as compared to CCOC and CCC (3rd vs 5th decade of life, respectively). CONCLUSION: Gaining a better understanding of the similarities and differences between these three tumors may lead to a better understanding of each one.

Unlocking the potential of organoids in cancer treatment and translational research: An application of cytologic techniques.

Patient-derived organoid models hold promise for advancing clinical cancer research, including diagnosis and personalized and precision medicine approaches, and cytology, in particular, plays a pivotal role in this process. These three-dimensional multicellular structures are heterogeneous, potentially maintain the cancer phenotype, and conserve the genomic, transcriptomic, and epigenomic patterns of the parental tumors. To ensure that only tumor tissue is used for organoid development, cytologic validation is necessary before initiating the process of organoid generation. Here, we explore the technology of tumor organoids and discuss the fundamental application of cytology as a simple and cost-effective approach toward organoid development. We also underscore the potential application of organoid development in drug efficacy studies for lung cancer and head and neck tumors. Additionally, we stress the importance of using fine-needle aspiration to generate tumoroids.

Temporomandibular Joint Fibrocartilage Contains CD105 Positive Mouse Mesenchymal Stem/Progenitor Cells with Increased Chondrogenic Potential.

Objective: A specific type of mesenchymal stem/progenitor cells (MSPCs), CD105+ is reported to aid in cartilage regeneration through TGF-ß/Smad2-signalling. The purpose of this study was to identify and characterize CD105+ MSPCs in temporomandibular joint (TMJ) cartilage. Materials and Methods: MSPCs were isolated from mouse TMJ condyle explants and evaluated for their clonogenicity and pluripotential abilities. MSPC were examined for CD105 antigen using immunohistochemistry and flow cytometry. Results: Immunohistochemistry revealed presence of CD105+ MSPCs in the proliferative zone of condyle's cartilage. Only 0.2% of isolated MSPCs exhibited CD105, along with the stem cell surface markers CD44 and Sca-1. In CD105+ MSPCs, intracellular immunostaining revealed significantly higher (p < 0.05) protein levels of collagen type 1, 2, proteoglycan 4. Ability for chondrogenic differentiation was found to be significantly higher (p < 0.05) after 4 weeks compared to CD105- cells, using alcian blue staining. CD105+ cells were found to resemble an early MSPC subgroup with significantly higher gene expression of biglycan, proteoglycan 4, collagen type 2, Gli2, Sox5 (p < 0.001) and Sox9 (p < 0.05). In contrast, significantly lower levels of Runx2 (p < 0.05), Osterix, Trps1, Col10a1 (p < 0.01), Ihh (p < 0.001) related to chondrocyte senescence and commitment to osteogenic lineage, were observed compared to CD105- cells. Conclusion: The study showed the existence of a CD105+ MSPC subgroup within TMJ fibrocartilage that may be activated to aid in fibrocartilage repair.

Chondrogenic differentiation of mouse CD105+ stem/progenitor cells on amino-group-functionalized biosilica-hydrogel scaffolds.

OBJECTIVES: Mesenchymal stem/progenitor cells (MSPCs) are critical for tissue regeneration. Moreover, the CD105 antigen identifies early MSPCs with increased chondrogenic differentiation ability. We hypothesized that amine-(NH2)-functionalized biosilica incorporating hydrogel scaffolds, seeded with mCoSPCs105+ would contribute to creating tissue-engineered scaffolds, capable of de novo cartilage synthesis. MATERIALS AND METHODS: Scaffolds were characterized by water uptake, lysozyme degradation, axial compression, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Differentiation stimulus of scaffold functionalization was evaluated using Alcian blue staining. Cartilage-forming abilities of mCoSPCs105+ were evaluated using Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunohistochemistry. RESULTS: Biosilica particle incorporation into scaffolds resulted in increased water uptake capacity and compression force withstanding abilities. Amine-(NH2)-group functionalization of biosilica led to significantly increased stem cell differentiation potential, by Alcian blue staining, in the first 3 weeks. Scaffold attachment and viable cell proliferation were observed for 6 weeks under chondrogenic differentiation. Downregulation of Runx2, an increase of Col10a1, Ihh, and maintenance of Sox9, was seen under these culture conditions. mCoSPCs105+ gene expression pattern was defined by the significant upregulation of Col1a1, Col2a1, Prg4, and Agc-1 over 6 weeks of incubation compared to the unsorted control. Immunostaining of cell-seeded scaffolds revealed significantly higher secretion of proteins relevant to cartilage extracellular matrix. CONCLUSION: The preselecting of CD105+ phenotype in MSPCs may enhance tissue regeneration of fibrocartilage and biosilica nanoparticles may be a beneficial additive in tissue engineering of scaffolds.

Detection of EWSR1 fusions in CCOC by targeted RNA-seq.

OBJECTIVE: To describe the application of a targeted RNA sequencing assay to detect fusion transcripts in formalin-fixed paraffin-embedded (FFPE), non-decalcified samples of clear cell odontogenic carcinoma (CCOC) and related tumors, and to add to knowledge of the genetic drivers of CCOC. STUDY DESIGN: Five FFPE tissues, including intraosseous CCOC (n = 3), clear cell carcinoma of the salivary gland (CCC, n = 1), and Ewing sarcoma (ES, n = 1), were analyzed by targeted RNA-seq to detect fusions. RESULTS: The 3 intraosseous CCOC samples harbored EWSR1 translocations: EWSR1-ATF1 (n = 2) and EWSR1-CREM (n = 1); the CCC sample contained an EWSR1-ATF1 fusion; and the ES sample contained an EWSR1-FLI1 fusion detected by RNA-seq. CONCLUSIONS: These results demonstrate that targeted RNA-seq is a valuable tool to detect fusions in FFPE samples of rare tumors such as CCOC and CCC. The results also confirm the observations that CCOC is driven by fusions between EWSR1 and CREB family transcription factors, including ATF1 and CREM. To our knowledge, this is the second report of CCOC with an EWSR1-CREM translocation.

Increased Osteogenic Activity of Dynamic Cultured Composite Bone Scaffolds: Characterization and In Vitro Study.

PURPOSE: The purpose of this study was to develop and characterize beta-tricalcium phosphate (ß-TCP)/polycaprolactone (PCL) scaffolds, with 2 different ratios (50/50% and 65/35%), using 3-dimensionally (3D) printed dissolvable molds, and to evaluate cellular growth and osteogenic differentiation of both groups seeded with porcine bone marrow stem cells (pBMSCs) under dynamic culture in vitro. MATERIALS AND METHODS: Two different groups of scaffolds were produced: group 1 (n = 40) with a ratio (wt%) of 50/50% and group 2 (n = 40) with 65/35% of ß-TCP/PCL. Physicochemical, morphological, and mechanical characterization of the scaffolds were performed. Scaffolds were seeded with pBMSCs and differentiated osteogenically in dynamic culture. Cell density, distribution, and viability were assessed. Osteogenic differentiation was examined through alkaline phosphatase (ALP) staining, immunofluorescence, and photospectrometry. RESULTS: Osteogenic differentiated constructs showed homogenous and viable cell distribution. Cell density was significantly higher (P < .05) for 65/35% scaffolds at 10 days postseeding, whereas at 6 weeks, cell number equalized for both groups. ALP activity increased over time and was significantly higher (P < .05) for 65/35% scaffolds at 14 days postseeding. CONCLUSIONS: The mechanical properties of the developed 65/35% scaffolds were within the range of natural trabecular bone. Moreover, the 65/35% scaffolds showed biological advantages, such as higher cell growth and higher ALP activity.

A Meta-Analysis and Systematic Review of the Incidences of Complications Following Facial Thread-Lifting.

BACKGROUND: Facial thread-lifting (FTL) has gained more popularity, but the incidences of complications following FTL remain controversial. We aimed to perform a meta-analysis and systematic review to estimate the incidences of complications and to compare the short- and long-term satisfaction rates following FTL. METHODS: We searched PubMed, Web of Science, Embase and Cochrane library for eligible studies. The primary outcome was the incidences of complications following FTL. The secondary outcome was the satisfaction rate immediately and 6-month after FTL. The pooled incidences of complications and 95% confidence intervals were estimated using random-effects models. RESULTS: A total of 26 studies were included in this meta-analysis. Swelling was the most commonly reported complication with a pooled incidence of 35%, followed by skin dimpling (10%), paresthesia (6%), thread visibility/palpability (4%), infection (2%), and thread extrusion (2%). Absorbable threads were associated with a significantly lower risk of paresthesia (3.1% vs. 11.7%) and thread extrusion (1.6% vs. 7.6%) than non-absorbable threads. Patients older than 50 years had a significantly higher risk of dimpling (16% vs. 5.6%) and infection (5.9% vs. 0.7%) than their younger counterparts. In addition, the pooled long-term satisfaction rate was significantly decreased compared to it immediately after FTL (88% vs. 98%). CONCLUSION: Non-absorbable threads and older age of patients are associated with higher risks of complications. Therefore, we recommend a judicious use of non-absorbable threads and FLT in older patients. Furthermore, it should be discussed with patients preoperatively that the rejuvenation effect of FTL may not maintain in the long-term. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Induction, Treatment, and Prevention of Temporomandibular Joint Ankylosis-A Systematic Review of Comparative Animal Studies.

PURPOSE: Several animal models of temporomandibular joint ankylosis (TMJA) have been described for more than the past 2 decades. The aim of this study was 2-fold: 1) to compile and summarize the evidence of animal studies that compare different forms to induce, treat (disease already established), or prevent (after trauma) TMJA; and 2) to address the following focused question: what is the quality of reporting in these studies? MATERIALS AND METHODS: A systematic review was conducted. Animal studies conducted up to October 2019 comparing at least 2 procedures to induce, treat (disease already established), or prevent (after trauma) TMJA were considered. Compliance with the Animal Research Reporting In Vivo Experiments guidelines was checked for all studies. Studies evaluating treatment of TMJA or preventive measures also were evaluated using the SYstematic Review Center for Laboratory animal Experimentation's risk of bias tool for animal studies. RESULTS: A total of 24 studies were included. The studies were evaluated for feasibility regarding data synthesis, and a meta-analysis was not suitable because of methodological differences, mainly regarding the animal model chosen and surgical procedures performed to induce TMJA. In 17 articles, authors aimed to investigate different procedures to induce TMJA (fibrous, fibro-osseous, or bony). In 7 articles, different treatment or preventive strategies were compared. The sheep was the most used animal in models of TMJA. Only 25% (6 of 24) of studies reported some step to minimize bias (ie, blinding of investigators, randomization procedures, or allocation concealment). Approximately 54% (13 of 24) of articles clearly commented on study limitations and potential sources of bias. Further animal studies on TMJA should consider improving their reporting standards to increase their validity and improve the reproducibility of animal experiments.

Do Graduating Oral-Maxillofacial Surgery Residents Feel Confident in Practicing the Full Scope of the Specialty?

PURPOSE: Laskin (2008) suggested that the core of oral and maxillofacial surgery could be divided into 3 levels: 1) areas of expertise, such as oral pathology, oral medicine, dentoalveolar surgery, preprosthetic surgery, and maxillofacial traumatology; 2) areas of competence, including orthognathic surgery, temporomandibular joint surgery, and local reconstructive surgery; and 3) areas of familiarity that include cleft lip and palate surgery, craniofacial surgery, regional reconstructive surgery, oncologic surgery, and cosmetic surgery. The purpose of this study is to assess residents' confidence in practicing the full scope of oral-maxillofacial surgery and their perception of gaps existing in their training. The investigators hypothesized that graduating residents' confidence in practicing the full scope of oral-maxillofacial surgery falls within the suggested levels by Laskin. METHODS: The investigators implemented a cross-sectional study. A questionnaire was designed, and a link to a Partners REDCap (Nashville, TN) survey was electronically mailed to 252 chief residents in the final month (July 2018) of their program. The questionnaire included resident demographic characteristics, program demographic characteristics, and residents' perceived preparedness, level of proficiency, comfort, and experience for each area. RESULTS: The sample was composed of 78 graduating residents, with a response rate of 31%. Analyses included univariate statistics and a Wilcoxon signed rank test. Significance was set at P < .05. There was no significant difference between orthognathic surgery and each area in the expertise category, and in some cases, a significantly higher perception of ability in orthognathic surgery (P < .05). There was a significantly lower perception of training in oral medicine than each area in the expertise category (P < .05), suggesting a deficit in oral medicine training. CONCLUSIONS: Residents perceived that their training in orthognathic surgery was at the level of expertise, higher than expected. They also perceived a training deficit in oral medicine. Training proficiency in dentoalveolar surgery was found to be at a level higher than any other area.

Impact of Zika virus on the human type I interferon osteoimmune response.

BACKGROUND: The developing field of osteoimmunology supports importance of an interferon (IFN) response pathway in osteoblasts. Clarifying osteoblast-IFN interactions is important because IFN is used as salvage anti-tumor therapy but systemic toxicity is high with variable clinical results. In addition, osteoblast response to systemic bursts and disruptions of IFN pathways induced by viral infection may influence bone remodeling. ZIKA virus (ZIKV) infection impacts bone development in humans and IFN response in vitro. Consistently, initial evidence of permissivity to ZIKV has been reported in human osteoblasts. HYPOTHESIS: Osteoblast-like Saos-2 cells are permissive to ZIKV and responsive to IFN. METHODS: Multiple approaches were used to assess whether Saos-2 cells are permissive to ZIKV infection and exhibit IFN-mediated ZIKV suppression. Proteomic methods were used to evaluate impact of ZIKV and IFN on Saos-2 cells. RESULTS: Evidence is presented confirming Saos-2 cells are permissive to ZIKV and support IFN-mediated suppression of ZIKV. ZIKV and IFN differentially impact the Saos-2 proteome, exemplified by HELZ2 protein which is upregulated by IFN but non responsive to ZIKV. Both ZIKV and IFN suppress proteins associated with microcephaly/pseudo-TORCH syndrome (BI1, KI20A and UBP18), and ZIKV induces potential entry factor PLVAP. CONCLUSIONS: Transient ZIKV infection influences osteoimmune state, and IFN and ZIKV activate distinct proteomes in Saos-2 cells, which could inform therapeutic, engineered, disruptions.

Diagnosis and Treatment of Pediatric Primary Jaw Lesions at Massachusetts General Hospital.

PURPOSE: To review the demographic data, presenting symptoms, location, radiographic findings, treatment, and prognosis of pediatric jaw lesions in children treated at a single academic institution. PATIENTS AND METHODS: A retrospective medical record review was undertaken of patients younger than 18 years who presented to the Massachusetts General Hospital for Children between 2006 and 2018 with a primary jaw lesion. RESULTS: About 164 patients were identified. The most common lesions were giant cell tumors (n = 25), odontogenic keratocysts (n = 24), simple bone cysts (n = 19), odontomas (n = 17), fibrous dysplasia (n = 11), and dentigerous cysts (n = 11). Fifty-one patients (30.7%) were asymptomatic. About 94% were referred by their dentist, outside oral and maxillofacial surgeon or orthodontist. Most common presenting symptoms were swelling (66.9%), pain (32.5%), tooth mobility (17.5%), and neurosensory change (6.6%). Mandibular location was most common (72.3%). Radiographically, most were well-circumscribed radiolucencies with mean size of 2.9 cm (range, 0.7 to 15.6). Treatment varied from excisional biopsy to wide composite resection. Mean follow-up time was 38 months (range, 1 to 204). Recurrence was found in 21%. CONCLUSIONS: Pediatric jaw lesions are often asymptomatic and discovered incidentally by dental practitioners on routine examination. Clinical features (age, gender, location, and radiographic appearance) can help narrow the differential and expedite treatment. It is important that clinicians involved in the care of children be familiar with the wide differential diagnosis and management considerations of primary jaw lesions.

Facial dog bites treated at the Massachusetts General Hospital over a 20-year period.

OBJECTIVE: The aim of this study was to identify risk factors associated with facial dog bites and discuss prevention strategies. STUDY DESIGN: This is a retrospective analysis of facial dog bites treated at the Massachusetts General Hospital (MGH) from 1997to 2018. Patients were identified through the Research Patient Data Registry. The predictor variables included demographic characteristics, circumstantial information regarding the injury, and dog characteristics. Other study variables were wound and treatment specifics and follow-up. Descriptive and bivariate statistics were computed. RESULTS: In total, 321 patients were identified (mean age 29.5 years; range 0.7-81 years). There were 141 males and 180 females. The majority of patients were adults (age > 18 years; n = 223 [69.5%]). Most dogs (n = 281 [87.5%]) were known (P < .00001), and provocation was recorded in 207 cases (64.5%; P < .00001). Bites were preceded by the following behaviors: playing with the dog, feeding the dog, and placing the face close to the dog. Pitbulls led in the number of bites (n = 26 [8.5%]). Location on the face was predominantly the middle or lower third (n = 299 [93.1%]). CONCLUSIONS: The results of this study suggest that education of dog owners, parents, and children should focus on avoidance of known provoking behaviors. This may help decrease the incidence of these devastating injuries.

Benign Pediatric Jaw Lesions at Massachusetts General Hospital Over 13 Years.

PURPOSE: To the best of our knowledge, no study has reported pediatric jaw lesions according to the latest World Health Organization (WHO) classification of head and neck tumors. We reviewed the spectrum of benign pediatric jaw lesions treated at the Massachusetts General Hospital during a 13-year period according to the 2017 WHO classification. PATIENTS AND METHODS: We implemented a retrospective cohort study of patients younger than 18 years old with benign bony lesions. The primary predictor variable was the histopathologic diagnosis, grouped into odontogenic tumors (OTs), non-OTs, and odontogenic cysts. The primary outcome variables were the incidence of recurrence and the interval to recurrence. Other outcome variables included symptoms, radiographic findings, and treatment modalities. Descriptive statistics were computed. Kaplan-Meier analyses and Cox regressions were performed. RESULTS: The sample included 131 patients (58 males and 73 females; mean age, 12.6 ± 3.7 years) with 14 pathologic diagnoses. These were grouped as follows: non-OTs (n = 67), OTs (n = 36), and odontogenic cysts (n = 28). Odontogenic cysts were predominantly radiolucent, unilocular, and well-circumscribed cysts compared with the OTs and non-OTs (P < .05). Enucleation was the most commonly performed surgical procedure (72.5%). Adjuvant nonoperative procedures included cryotherapy for 10 patients, interferon therapy for 9 patients, and chemotherapy with denosumab for 3 patients to treat aggressive tumors. The overall incidence of recurrence was 0.77/100 person-years. The Cox hazard ratio of non-OTs/OTs was 3.1 (P = .13) and cysts/OTs was 4.3 (P = .075). Neither the incidence of recurrence nor the interval to recurrence among the 3 groups showed significant differences. A high incidence of recurrence was noted for aggressive central giant cell tumors (39.1%) and odontogenic keratocysts (40%) during a median follow-up of 3 years. CONCLUSIONS: Although pediatric jaw lesions are uncommon, symptoms such as swelling could indicate potential pathologic findings and require panoramic examination. Management of pediatric jaw lesions should consider the biologic behavior of the lesion, maxillofacial development, and growth. Enucleation combined with pharmacologic therapy is a promising strategy for the management of aggressive central giant cell tumors in children.

Platform for ergonomic intraoral photodynamic therapy using low-cost, modular 3D-printed components: Design, comfort and clinical evaluation.

Oral cancer prevalence is increasing at an alarming rate worldwide, especially in developing countries which lack the medical infrastructure to manage it. For example, the oral cancer burden in India has been identified as a public health crisis. The high expense and logistical barriers to obtaining treatment with surgery, radiotherapy and chemotherapy often result in progression to unmanageable late stage disease with high morbidity. Even when curative, these approaches can be cosmetically and functionally disfiguring with extensive side effects. An alternate effective therapy for oral cancer is a light based spatially-targeted cytotoxic therapy called photodynamic therapy (PDT). Despite excellent healing of the oral mucosa in PDT, a lack of robust enabling technology for intraoral light delivery has limited its broader implementation. Leveraging advances in 3D printing, we have developed an intraoral light delivery system consisting of modular 3D printed light applicators with pre-calibrated dosimetry and mouth props that can be utilized to perform PDT in conscious subjects without the need of extensive infrastructure or manual positioning of an optical fiber. To evaluate the stability of the light applicators, we utilized an endoscope in lieu of the optical fiber to monitor motion in the fiducial markers. Here we showcase the stability (less than 2 mm deviation in both horizontal and vertical axis) and ergonomics of our applicators in delivering light precisely to the target location in ten healthy volunteers. We also demonstrate in five subjects with T1N0M0 oral lesions that our applicators coupled with a low-cost fiber coupled LED-based light source served as a complete platform for intraoral light delivery achieving complete tumor response with no residual disease at initial histopathology follow up in these patients. Overall, our approach potentiates PDT as a viable therapeutic option for early stage oral lesions that can be delivered in low resource settings.

Minimally Invasive Endoscopic Oral and Maxillofacial Surgery.

Advances in technology and specialized instrumentation allow surgeons to study, refine, and modify minimally invasive surgery (MIS) to replace standard operations. This has occurred across many surgical specialties. The benefits of MIS include less swelling, less pain, shorter hospital stay, and faster return to daily activities. Oral and maxillofacial endoscopic techniques are used for access to the ramus condyle unit, maxillary sinus, zygoma, orbit, temporomandibular joint, and salivary ductal system. Although endoscopic techniques are also used in facial cosmetic surgery, this discussion focuses on noncosmetic procedures.

Implant Therapy in Alveolar Cleft Sites.

Dental implant therapy in the non-cleft patient is familiar to most oral and maxillofacial surgeons. Understanding the differences in surgical treatment planning in the cleft patient versus the non-cleft patient is the key to highly functional and esthetic long-term outcomes. CBCT and computer-assisted planning, as well as improved technology in grafting and implant materials, result in excellent outcomes. Communication with the restorative team remains of paramount importance in planning treatment.

The Regenerative Applicability of Bioactive Glass and Beta-Tricalcium Phosphate in Bone Tissue Engineering: A Transformation Perspective.

The conventional applicability of biomaterials in the field of bone tissue engineering takes into consideration several key parameters to achieve desired results for prospective translational use. Hence, several engineering strategies have been developed to model in the regenerative parameters of different forms of biomaterials, including bioactive glass and ß-tricalcium phosphate. This review examines the different ways these two materials are transformed and assembled with other regenerative factors to improve their application for bone tissue engineering. We discuss the role of the engineering strategy used and the regenerative responses and mechanisms associated with them.

Long-Term Stability of Condylectomy and Costochondral Graft Reconstruction for Treatment of Idiopathic Condylar Resorption.

PURPOSE: To assess and update long-term outcomes of endoscopic condylectomy and costochondral graft (CCG) reconstruction for treatment of active idiopathic condylar resorption (ICR). PATIENTS AND METHODS: This study is a continuation of a retrospective cohort study of patients with active ICR who underwent bilateral condylectomies and CCG reconstruction from 1999 to 2016. Predictor variables were demographic and operative factors. The primary outcome variable was occlusal stability, as defined by normal overbite (1 to 4 mm) at latest follow-up. Overbite; overjet; the angle formed by the sella, nasion, and B point (SNB); mandibular plane angle; and ramus-and-condyle unit height were measured. Time points were preoperative (T0) and immediate (T1), 1 year (T2), 2 years (T3), 3 to 5 years (T4), and at least 5 years (T5) postoperative. Descriptive and bivariate statistics were computed. A Firth logistic regression model was used to identify variables associated with occlusal instability. RESULTS: Twenty-six patients (25 female; mean age, 23.1 yr) who underwent bilateral endoscopic condylectomies and CCG reconstruction were included: 14 from the original cohort and 12 additional patients for the present analysis. Median follow-up was 3.65 years (range, 1.11 to 17.1 yr). Preoperatively, all patients had a Class II malocclusion with a mean overjet of 6.89 mm (range, 1.2 to 17.1 mm) and a mean anterior open bite of -2.12 mm (range, -0.4 to -7.9 mm). Normal overbite (1 to 4 mm) and overjet (2 to 4 mm) were achieved postoperatively in all patients. There were no significant changes in overjet, overbite, SNB, mandibular plane angle, and ramus-and-condyle unit height from T1 to T4. At latest follow-up, 88.5% of patients had a normal overbite. Three patients developed an anterior open bite postoperatively: 1 at 2 years (0.1 mm; preoperative, -3.4), 1 at 9 years (-0.8 mm; preoperative -7.9), and 1 at 11 years (-1.3 mm; preoperative -1.1). Subjects at T5 (n = 9 of 26) had mean overjet and overbite of 3.48 and 1.56 mm, respectively. Non-white race and follow-up time were significant predictors of occlusal instability in the regression model. CONCLUSIONS: Stable and predictable long-term outcomes can be achieved using endoscopic condylectomy and CCG reconstruction for treatment of active ICR.