Virtual Surgical Planning for Temporomandibular Joint Ankylosis: A Case Comparison of Dolphin Imaging® and Meshmixer®-Based Guides

This study compares the performance of surgical guides generated using Dolphin Imaging® (Dolphin Imaging and Management Solutions, Chatsworth, CA, USA) and Autodesk Meshmixer® (Autodesk Inc., San Rafael, CA, USA) in virtual surgical planning (VSP) for temporomandibular joint (TMJ) ankylosis. The purpose was to assess their accuracy, intraoperative adaptation, and clinical feasibility as a cost-effective alternative. A computed tomography (CT) scan of a 51-year-old male with post-traumatic TMJ and zygomatic-coronoid ankylosis was processed independently by two professionals using the respective software. Both guides were designed based on identical CT data and anatomical landmarks and subsequently 3D-printed using stereolithography. Intraoperative evaluation demonstrated excellent adaptation and precision for both guides, with no notable differences in fit. Osteotomies were executed as planned, resulting in an improvement in maximum interincisal distance from 9 mm preoperatively to 29 mm postoperatively. The patient remained recurrence-free after 19 months of follow-up. Meshmixer® proved to be a viable and accurate alternative to Dolphin Imaging®, providing comparable clinical outcomes without the associated financial cost of commercial software. These findings suggest that open-source tools can enhance the accessibility of high-precision VSP, particularly in resource-limited environments. Further studies with larger samples are warranted to confirm these results. This study demonstrates that open-source tools such as Meshmixer® can achieve surgical accuracy comparable to commercial software for oral surgeries, offering a practical and affordable alternative for surgeons, especially in institutions or regions with limited financial resources, without compromising clinical outcomes. • Compared Dolphin Imaging® and Meshmixer® for TMJ ankylosis VSP guides • Both guides showed excellent intraoperative fit and osteotomy accuracy • Meshmixer® achieved outcomes comparable to commercial software at no cost • Mouth opening improved from 9 mm to 24 mm with no recurrence at 19 months • Open-source VSP may expand access to precision surgery in low-resource settings