Craniomaxillofacial Trauma & Reconstruction

1 pages, 59 KiB

Open AccessEditorial

by Srinivas M. Susarla, Rui Fernandes and Sat Parmar

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 173; https://doi.org/10.1177/19433875211015634 - 4 May 2021

Cited by 2 | Viewed by 40

It has been over a year since the start of the COVID-19 pandemic; our daily lives have changed in innumerable ways, many of which are likely permanent.[...] Full article

5 pages, 223 KiB

Open AccessArticle

Reduction of Opioid Prescriptions in Maxillofacial Trauma Following North Carolina STOP Act

by Caitrin Curtis, Joshua Scarcella, Chelsea Viscardi, Arthur Samia, Richard Zeri and Yifan Guo

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 231-235; https://doi.org/10.1177/1943387520980572 - 14 Dec 2020

Cited by 4 | Viewed by 34

Abstract

Study Design: Retrospective cohort study. Objective: On January 1, 2018, the Strengthen Opioid Misuse Prevention (STOP) Act was implemented to increase oversight over opioid prescriptions in North Carolina. The aim of this study is to evaluate the legislation’s efficacy in reducing opioid prescriptions [...] Read more.

Study Design: Retrospective cohort study. Objective: On January 1, 2018, the Strengthen Opioid Misuse Prevention (STOP) Act was implemented to increase oversight over opioid prescriptions in North Carolina. The aim of this study is to evaluate the legislation’s efficacy in reducing opioid prescriptions following facial fracture repair. Methods: A retrospective chart review of patients who sustained maxillofacial fractures and underwent repair from January 1, 2015 through December 31, 2019 at a level 1 trauma center was performed. The North Carolina Controlled Substance Database was used to quantify perioperative opioid prescriptions in morphine milligram equivalents (MME). Average MME per patient was compared between 2 groups, patients who underwent surgery before the NC STOP Act came into effect and patients who underwent treatment after. This comparison was also performed on case type subgroups including surgically treated fractures of the orbit, mandible, midface, and multiple regions. A student’s t-test was used to compare before and after groups in all analyses. Results: Of the 253 patients who met inclusion criteria, 146 were in the before group, and 107 were in the after group. There was a statistically significant, 30.9% decrease in overall average MME prescribed after the NC STOP Act was enacted. A statistically significant decrease was noted in patients who had facial fractures of multiple regions. Conclusion: Since the implementation of the NC STOP Act in 2018, there have been statistically and clinically significant decreases in the amount of opioids prescribed following surgical management of facial fractures. Full article

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7 pages, 1009 KiB

Open AccessArticle

Biomechanical Analysis of a Custom-Made Mouthguard Reinforced With Different Elastic Modulus Laminates During a Simulated Maxillofacial Trauma

by João Paulo Mendes Tribst, Amanda Maria de Oliveira Dal Piva, Pietro Ausiello, Arianna De Benedictis, Marco Antonio Bottino and Alexandre Luiz Souto Borges

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 254-260; https://doi.org/10.1177/1943387520980237 - 9 Dec 2020

Cited by 14 | Viewed by 35

Abstract

Background/Aims: There is a lack of data regarding the influence of different laminates for mouthguard reinforcement in the mechanical response during an impact in the orofacial region. The aim of this study was to verify the influence of the laminate framework on the [...] Read more.

Background/Aims: There is a lack of data regarding the influence of different laminates for mouthguard reinforcement in the mechanical response during an impact in the orofacial region. The aim of this study was to verify the influence of the laminate framework on the stresses and strains of the anterior teeth and displacement of ethylene-vinyl acetate (EVA) custom-made mouthguards during a simulated impact. The null hypotheses was that the different laminates reinforcement would present the similar effect in maxillary structures, regardless the elastic modulus. Methods: A finite element model of human maxillary central incisors with an antagonist contact was used. A linear quasistatic analysis was used to simulate the force exerted during an impact. A total of 5 different layers were simulated inside the mouthguard at the labial portion according to the Elastic Modulus 1 MPa (Extremely flexible), 9 GPa (Low modulus reinforcement), 18 GPa (Without reinforcement), 50 GPa (Flexible alloy), 100 GPa (Titanium alloy) and 200 GPa (Hard material). The results were evaluated by means of Maximum Principal Stress (in the tooth and bone), Microstrain (periodontal ligament) and Displacement (mouthguard) criteria. Results: The elastic modulus of the material inside the MG influenced the stress distribution on the enamel buccal face. However, it did not affect the bone tissue stress, periodontal ligament strain or root dentin tissue stress. Conclusion: The use of reinforcement inside the custom-made mouthguard can modify the stress generated in the enamel buccal surface without improvement to the root dentin, periodontal ligament or bone tissue. Full article

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7 pages, 1306 KiB

Open AccessArticle

Preparation and In Vitro Analysis of Craniofacial Titanium Implants Surfaces Produced by Additive 3D Printing and Conventional Manufacturing

by Muhanad M. Hatamleh

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 224-230; https://doi.org/10.1177/1943387520970792 - 5 Nov 2020

Cited by 5 | Viewed by 47

Abstract

Study Design: Surface finish of titanium patient-specific craniofacial implants is known to affect their acceptability and durability and relevant literature still inconclusive on the best surface finishing protocol. Objectives: This study investigated surface topography of three-dimensionally (3D) printed and conventionally manufactured craniofacial titanium [...] Read more.

Study Design: Surface finish of titanium patient-specific craniofacial implants is known to affect their acceptability and durability and relevant literature still inconclusive on the best surface finishing protocol. Objectives: This study investigated surface topography of three-dimensionally (3D) printed and conventionally manufactured craniofacial titanium implants following non-contact 3D laser profile-meter analysis. Methods: Seven groups of titanium specimens (n = 10) were prepared and their surfaces were treated differently and included sole or combined treatment of mechanical polishing, gritting with 50 micron AL₂O₃, cold acid treatment using nitric acid for 20 hours (70% w/w), etching using acidic solution (69% nitric and 48% hydrofluoric acids) for 10 minutes and then electro-chemically anodized in another acidic solution (85% orthophosphoric and 98%sulphuric acid). Eighth group included specimens that were 3D printed. 3D micro-roughness parameters Sa, Sp, Sv, and Sz were determined (μm) for each specimen. Data was analyzed using one way ANOVA and Dunett T3 post-hoc tests (p < 0.05). Results: There were statistically significant effects of surface finishing protocols (p < 0.05). Sa values were 2.72-13.75 and specimens which were electroplated or mechanically polished and acid treated were the smoothest (p < 0.05). Sp was in the range 9.07-43.56 as sandblasting significantly roughened surfaces (p < 0.05). The same inferior effect was evident for the Sv (p < 0.05). The Sz values were 19.46-107.05 and was the highest for sandblasted surfaces (p < 0.05) and the lowest for surfaces of electro-chemical treatment (p < 0.05). Conclusion: Titanium surfaces are affected by the finishing procedure and electro-chemical treatment or mechanical polishing combined with acid treatment produced clinically-favorable smooth surfaces. Full article

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10 pages, 404 KiB

Open AccessReview

Is the Use of Intermaxillary Fixation Screws an Alternative to Erich Arch Bars for Maxillomandibular Fixation During Management of Maxillofacial Fractures? A Systematic Review and Meta-Analysis

by Anuj Jain and Anshul Rai

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 236-245; https://doi.org/10.1177/1943387520971410 - 2 Nov 2020

Cited by 3 | Viewed by 156

Abstract

Study Design: Systematic review and meta-analysis. Objective: Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws [...] Read more.

Study Design: Systematic review and meta-analysis. Objective: Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws came into existence and are being used routinely. The present study was designed to identify if the intermaxillary fixation screws are really an alternative to Erich arch bars for management of maxillofacial trauma. Methodology: An exhaustive literature search was conducted in May 2020 on various electronic databases and studies comparing Erich arch bars and intermaxillary fixation screws were recruited for the analysis. Random-effects model with Mantel Haenszel statistics was used to analyze oral hygiene and duration of achieving MMF. Results: A total of 96 studies were identified, out of which 8 studies were included in the meta-analysis. There was no statistically significant difference in oral hygiene status of the patients in both the groups. Intermaxillary fixations screws required statistically significantly less time in achieving MMF. Needle stick injury was prominently seen with the use of Erich arch bar whereas other complications like mucosal coverage, root injury, screw loosening and screw fracture makes the use of intermaxillary fixation screws questionable. Conclusion: The present meta-analysis suggests that there is not enough evidence to recommend the use of intermaxillary fixation screws as an alternative to Erich arch bars. Further research with large sample size, high quality evidence and better methodology is recommended in this direction. Full article

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8 pages, 632 KiB

Open AccessCase Report

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

by Salvador Valladares Pérez, Diego Bustamante Correa, Carlos Cortez Fuentes, Felipe Astorga Mori, Gerson Sepúlveda Troncoso and Rodrigo Fariña Sirandoni

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 246-253; https://doi.org/10.1177/1943387520970084 - 29 Oct 2020

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Abstract

Study Design: A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. Objective: [...] Read more.

Study Design: A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. Objective: The purpose of this study was to evaluate a single-institution experience with the transconjunctival approach to the orbit, utilizing a lateral skin extension as unique approach to access to fronto-zygomatic suture, infraorbital rim and/or orbital floor. Method: The authors identified 41 patients with OZMC fractures who underwent to surgical treatment over a 45 months period. Among this group, 21 patients needed fixation with osteosynthesis of the frontozygomatic suture, and 16 of whom were treated with the approach being studied. The authors assessed scleral exposure, eyelid position changes, ectropion, and entropion as outcome measures, and reported satisfactory outcomes at a minimum of 9 months follow-up. Conclusions: This study concludes that in our experience, the transconjunctival approach utilizing a lateral skin extension allows a direct, easy, and quick access to the entire infra orbital rim, orbital floor, fronto-zygomatic suture and lateral wall of the orbit, up to spheno-zygomatic suture, with low associated morbidity and complications. Full article

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6 pages, 264 KiB

Open AccessArticle

Facial Trauma Patterns Among Young Athletes

by Jason Audlin, Kiranya Tipirneni and Jesse Ryan

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 218-223; https://doi.org/10.1177/1943387520966424 - 14 Oct 2020

Cited by 5 | Viewed by 54

Abstract

Study Design: Retrospective case series review. Objective: Participation in athletics is common in high school and college students and presents an increased risk of injury in this age-group. Previous studies have included National Collegiate Athletic Association athletes but not high school athletes. Here [...] Read more.

Study Design: Retrospective case series review. Objective: Participation in athletics is common in high school and college students and presents an increased risk of injury in this age-group. Previous studies have included National Collegiate Athletic Association athletes but not high school athletes. Here we report the trends of maxillofacial injuries in high school students. Methods: Patients presenting to a level 1 trauma center with maxillofacial injuries were identified by chart query with associated International Classification of Diseases, 10th Revision codes for facial fractures between October 2015 and October 2017. Data collected included age, sport, fracture type, need for surgery, associated concussion, and time to return to play were measured. New York State Public High School Athletic Association regional high school sports participation data from 2016 to 2018 were used to calculate incidence. Results: A total of 33 patients aged 13 to 19 years were identified. Baseball, basketball, and lacrosse were most frequently associated with maxillofacial trauma. Annual incidence rates for mandible fractures in high school athletes were 0.037%, 0.012%, and 0.01% for lacrosse, baseball, and basketball, respectively. Annual fracture incidence rates for midface fractures in high school athletes were 0.17%, 0.018%, and 0.01% for baseball, lacrosse, and basketball, respectively. Conclusion: Maxillofacial fractures are uncommon injuries among athletes but present with serious implications including surgical correction. Baseball was strongly associated with midface fractures despite being considered a noncontact sport. Improved facial protection across all sports will be imperative at reducing the incidences of these injuries. Level of Evidence: Level 4. Full article

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9 pages, 1499 KiB

Open AccessArticle

Computer-Aided Fracture Size Measurement in Orbital Fractures—An Alternative to Manual Evaluation

by Mikko Saloniemi, Valtteri Lehtinen and Johanna Snäll

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 209-217; https://doi.org/10.1177/1943387520962691 - 7 Oct 2020

Cited by 5 | Viewed by 57

Abstract

Objective: We aimed to present a novel semiautomated tool for orbital fracture size measurement and to compare the variability of the proposed method with traditional manual measurements. Methods: Maximal anteroposterior (AP) and mediolateral (ML) dimensions of orbital fractures from computed tomography images were [...] Read more.

Objective: We aimed to present a novel semiautomated tool for orbital fracture size measurement and to compare the variability of the proposed method with traditional manual measurements. Methods: Maximal anteroposterior (AP) and mediolateral (ML) dimensions of orbital fractures from computed tomography images were measured for 15 patients with unilateral orbital fractures by 2 surgeons manually and with a semiautomatic software. Variability was assessed with Bland-Altman limits of agreement plots and intra-class correlation coefficients (ICCs). Results: The intra-observer ICCs in manual and automatic measurements were high, >0.9. The inter-observer ICCs in manual measurements were 0.926 (AP) and 0.631 (ML) and in automatic measurements 0.989 (AP) and 0.989 (ML). The ICCs for manual and semiautomated variability were 0.899 (AP) and 0.669 (ML). The differences were thus particularly pronounced in the ML dimensions. In addition, with the semiautomated technique, a total fracture area could be measured and compared with the total area of the bony orbit and a 3-dimensional reformatted image could be generated. Conclusions: Intra- and inter-observer variability proved to be very low for measuring fracture maximal AP length and ML width, making both the manual and the semiautomatic methods feasible clinically. The semiautomatic fracture size analysis allows better observer-independent repeatability for fracture size measurements and provides the possibility for total fracture area measurements at any orbital bony site, even in challenging nonplanar topography. Full article

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8 pages, 199 KiB

Open AccessArticle

Interfacility Transfers for Isolated Craniomaxillofacial Trauma: Perspectives of the Facial Trauma Surgeon

by Matthew Pontell, Delora Mount, Jordan P. Steinberg, Donald Mackay, Michael Golinko and Brian C. Drolet

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 201-208; https://doi.org/10.1177/1943387520962276 - 1 Oct 2020

Cited by 11 | Viewed by 44

Abstract

Study Design: Secondary overtriage is a burden to the medical system. Unnecessary transfers overload trauma centers, occupy emergency transfer resources, and delay definitive patient care. Craniomaxillofacial (CMF) trauma, especially in isolation, is a frequent culprit. Objective: The aim of this study is to [...] Read more.

Study Design: Secondary overtriage is a burden to the medical system. Unnecessary transfers overload trauma centers, occupy emergency transfer resources, and delay definitive patient care. Craniomaxillofacial (CMF) trauma, especially in isolation, is a frequent culprit. Objective: The aim of this study is to assess the perspectives of facial trauma surgeons regarding the interfacility transfer of patients with isolated CMF trauma. Methods: A 31-item survey was developed using Likert-type scale and open-ended response systems. Internal consistency testing among facial trauma surgeons yielded a Cronbach’s α calculation of .75. The survey was distributed anonymously to the American Society of Maxillofacial Surgeons, the North American Division of AO Craniomaxillofacial, and the American Academy of Facial Plastic and Reconstructive Surgery. Statistical significance in response plurality was determined by nonoverlapping 99.9% confidence intervals (P < .001). Sum totals were reported as means with standard deviations and z scores with P values of less than .05 considered significant. Results: The survey yielded 196 responses. Seventy-seven percent of respondents did not believe that most isolated CMF transfers required emergency surgery and roughly half (49%) thought that most emergency transfers were unnecessary. Fifty-four percent of respondents agreed that most patients transferred could have been referred for outpatient management and 87% thought that transfer guidelines could help decrease unnecessary transfers. Twenty-seven percent of respondents had no pre-transfer communication with the referring facility. Perspectives on the transfer of specific fracture patterns and their presentations were also collected. Full article

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5 pages, 252 KiB

Open AccessArticle

Clinical Evaluation of Buccal Fat Pad and Nasolabial Flap for Oral Submucous Fibrosis Intraoral Defects

by Venkatesh Anehosur, Pravesh K. Singh, Punit S. Dikhit and Hitesh Vadera

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 196-200; https://doi.org/10.1177/1943387520962264 - 25 Sep 2020

Cited by 9 | Viewed by 49

Abstract

Objective: Surgical defects following fibrotomy in oral submucous fibrosis (OSMF) are difficult to manage due to relapse, and local flaps play a pivotal role in covering the defect. The purpose of this study is to compare the buccal fat pad (BFP) and nasolabial [...] Read more.

Objective: Surgical defects following fibrotomy in oral submucous fibrosis (OSMF) are difficult to manage due to relapse, and local flaps play a pivotal role in covering the defect. The purpose of this study is to compare the buccal fat pad (BFP) and nasolabial flap (NLF) for the reconstruction of intraoral defects after the release of fibrous bands in patients with OSMF. Methods: A prospective study was conducted on patients with OSMF with surgical treatment of fibrotomy excision and reconstruction of the defect with 2 options. Thirty patients with OSMF were divided into 2 groups, group I (BFP) and group II (NLF). Both groups were analyzed for preoperative and postoperative mouth opening and oral commissural width; the extraoral scar was assessed using the Stony Brook Scar Assessment Scale. The data were statistically analyzed using paired and unpaired t test. Results: Thirty patients comprising 27 (90%) male and 3 (10%) female with ages ranging between 19 and 51 years were involved. The mean preoperative and postoperative interincisal mouth opening was 12 mm and 27 mm in group I and 11 mm and 38 mm in group II, respectively, showing a significant increase in group II, and the mean preoperative and postoperative commissural width was 52 mm and 58 mm in group I and 51 mm and 60 mm in group II, respectively. Conclusion: The proposed surgical protocol for the management of OSMF found NLF superior to BFP for the reconstruction of intraoral defects after the release of fibers in patients with OSMF, with a minimal residual scar. Full article

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9 pages, 603 KiB

Open AccessArticle

Validation of Modified Hertel Exophthalmometer

by Rizwana Fathima Jamal, Emmanuel Azariah, Deepak Pandyan and Ravindran Chinnaswami

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 174-182; https://doi.org/10.1177/1943387520954625 - 11 Sep 2020

Cited by 1 | Viewed by 39

Abstract

Study Design: This is a correlation study. Objective: The objective was to obtain normative values from modified Hertel exophthalmometer, to compare difference in values between modified and standard Hertel exophthalmometer and to statistically analyze for correlation. Methods: The study to validate the modification [...] Read more.

Study Design: This is a correlation study. Objective: The objective was to obtain normative values from modified Hertel exophthalmometer, to compare difference in values between modified and standard Hertel exophthalmometer and to statistically analyze for correlation. Methods: The study to validate the modification done to Hertel exophthalmometer was performed at the Department of Oral and Maxillofacial Surgery at our institute. Informed consent was obtained from patients; measurement in 100 volunteers was made with Hertel and modified Hertel exophthalmometer by a single observer, and the measurements taken by the 2 devices were tabulated along with variables such as age and gender. Data were collected and statistical analysis was performed to compare and correlate the values between standard and modified exophthalmometer. Differences of ocular protrusion values in gender and age were also calculated. Results: There has been no statistically significant difference in the normative data between standard Hertel and modified Hertel exophthalmometer and in relation to age and gender. Conclusions: The modification of the Hertel exophthalmometer is validated and can also be used for relative exophthalmometry to assess the need for treatment and to evaluate the globe position and orbital volume intraoperatively. The proposed modification of the instrument allows it to be used in cases when one of the lateral orbital walls is fractured or displaced due to trauma. Full article

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7 pages, 178 KiB

Open AccessArticle

What Surgeons Want: Access to Online Surgical Education and Peer-to-Peer Counseling—A Qualitative Study

by Astrid D. Häberle, Riya Nath, Shelley N. Facente, Autumn E. Albers and Sabine Girod

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 189-195; https://doi.org/10.1177/1943387520929813 - 17 Aug 2020

Cited by 1 | Viewed by 48

Abstract

Study Design: Mixed methods study including quantitative data analysis and qualitative analysis of semi-structured interviews. Objectives: Utilizing information and communication technology can facilitate professional communication within health care on a global scale. This study aimed to identify the educational and peer-to-peer communication needs [...] Read more.

Study Design: Mixed methods study including quantitative data analysis and qualitative analysis of semi-structured interviews. Objectives: Utilizing information and communication technology can facilitate professional communication within health care on a global scale. This study aimed to identify the educational and peer-to-peer communication needs of craniomaxillofacial (CMF) surgeons across the globe, determine preferred modes of communication, and assess technological and other barriers to online education and peer-to-peer communication. Methods: We performed semi-structured videoconference interviews of 92 CMF surgeons from around the globe, with the largest number in the Asia/Pacific region, the Middle East, and Latin America. We triangulated quantitative summaries with qualitative themes to improve validity and enable a more comprehensive understanding of participant perspectives. Results: The interviews revealed 3 main areas of technology use: new surgical technology, technology that enables information exchange, and communication technology. When asked about technology and communication platforms used in the course of their work, 33 participants (36%) mentioned PubMed or other journal-related sites; 25% recalled using YouTube as a resource; 23% described conducting internet searches using Google or other search engines; 21% used WhatsApp groups; and 11% used closed Facebook groups. Conclusion: CMF surgeons embraced communication technologies that allowed them to quickly obtain knowledge especially on new surgical technology, discuss cases on demand, and maintain strong communication with their global peers. Full article

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6 pages, 240 KiB

Open AccessArticle

Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center

by Jordan Halsey, Marvin Argüello-Angarita, Osward Y. Carrasquillo, Ian C. Hoppe, Edward S. Lee and Mark S. Granick

Craniomaxillofac. Trauma Reconstr. 2021, 14(3), 183-188; https://doi.org/10.1177/1943387520933697 - 18 Jun 2020

Cited by 3 | Viewed by 71

Abstract

Study Design: Retrospective chart review of pediatric and globe injuries associated with orbital fractures. Objective: Our study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients [...] Read more.

Study Design: Retrospective chart review of pediatric and globe injuries associated with orbital fractures. Objective: Our study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods: A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results: One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions: Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 14, Issue 3 (September 2021) – 13 articles

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