Craniomaxillofacial Trauma & Reconstruction

1 pages, 50 KiB

Open AccessEditorial

Goal Setting

by Rui Fernandes, Sat Parmar and Srinivas Susarla

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 267; https://doi.org/10.1177/19433875211041008 - 23 Aug 2021

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As we continue to anticipate the return to normalcy post pandemic, we have all had ample time to contemplate our lives and careers.[...] Full article

12 pages, 353 KiB

Open AccessReview

Injuries of the Peripheral Mandibular Nerve, Evaluation of Interventions and Outcomes: A Systematic Review

by Ashleigh Weyh, Resi Pucci, Valentino Valentini, Rui Fernandes and Salam Salman

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 337-348; https://doi.org/10.1177/19433875211002049 - 16 Mar 2021

Cited by 13 | Viewed by 78

Abstract

Trigeminal nerve injuries are common and there is currently no consensus on both timing and type of intervention to achieve the best outcomes. A systematic review was performed to compare the outcomes of the many different types of therapeutic interventions for nerve injury. [...] Read more.

Trigeminal nerve injuries are common and there is currently no consensus on both timing and type of intervention to achieve the best outcomes. A systematic review was performed to compare the outcomes of the many different types of therapeutic interventions for nerve injury. PubMed, EBSCO, and Cochrane Review databases were used to search for studies published from January 1, 2000 to December 31, 2019. Included studies detailed treatment of an injury to peripheral branches of the trigeminal nerve, either known transection or injury causing persistent alteration in sensation. The primary outcome was functional sensory recovery via the Medical Research Council scale. Twenty studies were included, detailing outcomes of 608 subjects undergoing intervention for 622 nerve injuries. Surgical interventions were able to achieve functional sensory recovery in approximately >80% or more of the subjects. There was heterogeneity among how procedures were performed, timing to intervention, and methods of measuring recovery. The data of this study supports the ability of surgical intervention to achieve functional sensory recovery in a significant number of subjects, and found evidence for better outcomes with intervention closer to the time of injury. Full article

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5 pages, 239 KiB

Open AccessArticle

Patterns of Pediatric Facial Fractures

by Kevin Hong, James Jeong, Yehudah N. Susson and Shelly Abramowicz

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 325-329; https://doi.org/10.1177/1943387521991738 - 3 Feb 2021

Cited by 4 | Viewed by 61

Abstract

Objective: The aim of this study was to assess patterns of maxillofacial trauma in the pediatric population in Atlanta. This information is important to help guide management and allocate resources for treatment of maxillofacial injuries at Children’s Healthcare of Atlanta (CHOA). Methods: This [...] Read more.

Objective: The aim of this study was to assess patterns of maxillofacial trauma in the pediatric population in Atlanta. This information is important to help guide management and allocate resources for treatment of maxillofacial injuries at Children’s Healthcare of Atlanta (CHOA). Methods: This study was a retrospective chart review of children who presented from 2006 to 2015. Inclusion criteria were: (1) age 18 years old or younger, (2) presentation to emergency department, (3) diagnosis of maxillofacial fractures, and (4) evaluation by Oral and Maxillofacial Surgery, Otolaryngology, or Plastic Surgery services. Medical records were reviewed to record demographic, mechanism of injury, fracture location, and yearly incidence of injury. Descriptive statistics were computed to summarize findings and overall trends. Results: During the study period, 39,833 patients were identified. Of them, 1995 met the inclusion criteria. The majority were male (n = 1359, 68%) with an average age of 9.4 years old (range of 1 month to 18 years old). Mechanisms of injury were motor vehicle collisions (MVC) (n = 597, 29.9%), fall (n = 565, 28.3%), sports injury (n = 317, 15.9%), pedestrian struck (n = 215, 10.8%), assault/abuse (n = 204, 10.2%), other (n = 81, 4.1%), or gunshot wound (n = 16, 0.8%). Fracture sites were mandible (n = 519, 26%), complex (n = 479, 24%), nasal (n = 419, 21%), dentoalveolar (n = 279, 14%), orbital (n = 259, 13%), and maxilla (n = 40, 2%). Males had a higher incidence of assault than females (n = 185, 91% of assaults). The incidence of maxillofacial trauma increased with age with a peak incidence in 13 to 16-year-olds (n = 566, 28.3%). During the years examined, there was an upward trend in MVCs as the etiology with a peak incidence of facial fractures due to MVCs occurring in 2015. All other mechanisms remained constant during this time period. Conclusions: There was an increase in pediatric facial fractures secondary to motor vehicle collisions from 2007 to 2015 despite improvements in regulations, traffic safety, and technology. Full article

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8 pages, 630 KiB

Open AccessArticle

COVID-19: The Oral and Maxillofacial Surgery Experience, Oxford, UK

by Toby M. Visholm, Neha Sandhu and Daljit K. Dhariwal

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 317-324; https://doi.org/10.1177/1943387521991267 - 3 Feb 2021

Cited by 7 | Viewed by 57

Abstract

Study Design: In response to the COVID-19 pandemic the Oxford Oral and Maxillofacial Surgery Department, that operates as a Hub and Spoke model underwent several changes to its structure to respond to the change in service. This study is an audit of all [...] Read more.

Study Design: In response to the COVID-19 pandemic the Oxford Oral and Maxillofacial Surgery Department, that operates as a Hub and Spoke model underwent several changes to its structure to respond to the change in service. This study is an audit of all emergency patients seen during a 10-week period and compared these patients to the same time period 1-year previous. Objective: The objective was to observe the change in the service provision during the COVID-19 pandemic. Methods: This study prospectively recorded all the emergency referrals, inpatient admissions and emergency outpatient reviews during a 10-week period, this was compared to data from the same time period in 2019. Results: The unit saw a statistically significant decrease in the number of facial lacerations (p = 0.0007) and fractured mandibles (p = 0.0067) and received a statistically significant increase in patients presenting with dental abscesses (p = 0.0067). Average length of inpatient stay was reduced from 2.4 days to 1.7; of these patients significantly less were reviewed face to face (p = 0.026) in favor of telemedicine options. Conclusions: During this period, the hub and spoke model allowed the service to quickly adapt during the COVID pandemic aiding the dissemination of new guidelines and establishing hub and spoke local consultant led daily emergency and follow up clinics. The Specialist Training Registrars were located in the central hub which allowed the service to have 24-hour resident senior decision makers and enabled the redeployment of junior doctors. The authors believe that the Hub and Spoke model allowed their workforce and resources to best serve their patient population. Full article

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9 pages, 456 KiB

Open AccessArticle

The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland

by Pooja S. Yesantharao, Hillary E. Jenny, Joseph Lopez, Jonlin Chen, Christopher D. Lopez, Oluseyi Aliu, Richard J. Redett, Robin Yang and Jordan P. Steinberg

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 308-316; https://doi.org/10.1177/1943387520983634 - 12 Jan 2021

Cited by 3 | Viewed by 46

Abstract

Study Design: Retrospective, quasi-experimental difference-in-differences investigation. Objective: Pediatric craniofacial fractures are often associated with substantial morbidity and consumption of healthcare resources. Maryland’s All Payer Model (APM) represents a unique case study of the health economics surrounding pediatric craniofacial fractures. The APM implemented global [...] Read more.

Study Design: Retrospective, quasi-experimental difference-in-differences investigation. Objective: Pediatric craniofacial fractures are often associated with substantial morbidity and consumption of healthcare resources. Maryland’s All Payer Model (APM) represents a unique case study of the health economics surrounding pediatric craniofacial fractures. The APM implemented global hospital budgets to disincentivize low-value care and encourage preventive, community-based efforts. The objective of this study was to investigate how this reform has impacted pediatric craniofacial fracture care in Maryland. Methods: Children (≤18 years) receiving inpatient craniofacial fracture-related care in Maryland between January, 2009 through December, 2016 were investigated. New Jersey was used for comparison. Data were abstracted from the Kid’s Inpatient Database (Healthcare Cost and Utilization Project). Results: Between 2009–2016, 3,655 pediatric patients received inpatient care for craniofacial fractures in Maryland and New Jersey. Prior to APM implementation, around 20% of Maryland patients received care outside of urban teaching hospitals. After APM implementation, less than 6% of patients received care outside of urban teaching hospitals (p = 0.003). Implementation of the APM in Maryland also resulted in fewer pediatric craniofacial fracture admissions than New Jersey, though this only reached borderline significance (adjusted difference-in-differences estimate: −1.1 fewer admissions, 95% confidence interval: −2.1 to 0.0, p = 0.05). Inpatient costs for pediatric craniofacial care and mean did not change post-APM. Conclusions: Maryland’s APM consolidated pediatric craniofacial fracture inpatient care at urban, teaching hospitals. Inpatient costs and lengths of stay did not change after policy implementation, but overall admission rates decreased. Such considerations are important when considering national expansion of global hospital budgeting. Full article

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9 pages, 351 KiB

Open AccessArticle

A Systematic Review of Surgical Techniques for Management of Severe Rhinophyma

by Sarah Benyo, Robert A. Saadi, Scott Walen and Jessyka G. Lighthall

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 299-307; https://doi.org/10.1177/1943387520983117 - 6 Jan 2021

Cited by 4 | Viewed by 56

Abstract

Study Design: Systematic review of the literature. Objective: The goal of this study is to review the current literature on severe rhinophyma requiring operative management for significant cosmetic deformity or nasal obstruction. We aim to provide a treatment algorithm for the various surgical [...] Read more.

Study Design: Systematic review of the literature. Objective: The goal of this study is to review the current literature on severe rhinophyma requiring operative management for significant cosmetic deformity or nasal obstruction. We aim to provide a treatment algorithm for the various surgical techniques employed in the treatment of severe rhinophyma. Methods: Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 2010 to 2020 were collected. All studies which described surgical treatment of severe rhinophyma using the Boolean method and relevant search term combinations, including “rhinophyma,” “severe,” “operative” and “surgery” were collected. Results: A total of 111 relevant unique articles met criteria for eligibility analysis. Of these, 85 articles were deemed inappropriate for the literature review due to exclusion criteria. The remaining 26 articles were included in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions: Severe rhinophyma may present a reconstructive challenge to reestablish normal contour and patent nasal airway. Significant deformity necessitates surgical correction. The present article reviews the current literature and provides a summary and stepwise explanation of established surgical techniques for addressing the cosmetic and functional deficits these patients encounter. Full article

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10 pages, 239 KiB

Open AccessArticle

Resuming Dental and Craniomaxillofacial Surgical Missions During the COVID-19 Pandemic: Guidelines and Recommendations

by Victoria A. Mañón, Ashley Tran, Ziad C. Sifri and Shahid R. Aziz

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 289-298; https://doi.org/10.1177/1943387520983125 - 4 Jan 2021

Cited by 3 | Viewed by 38

Abstract

Study Design: Descriptive review article. Objective: The purpose of this article is to provide guidelines and recommendations for how to safely resume dental and craniomaxillofacial STSMs. The following considerations will be discussed: the need for extensive collaboration between organizations and local leadership, the [...] Read more.

Study Design: Descriptive review article. Objective: The purpose of this article is to provide guidelines and recommendations for how to safely resume dental and craniomaxillofacial STSMs. The following considerations will be discussed: the need for extensive collaboration between organizations and local leadership, the importance of COVID-19 testing, use and management of personal protective equipment, team selection and training, social distancing protocols, and criteria for patient and case selection. Methods: A literature review was completed, identifying resources and current data regarding the safe resumption clinical activities during the COVID-19 pandemic. Results: At this time, there are no protocols developed regarding the safe resumption of STSMs. Primary resources, including the CDC, WHO, and FDA should be closely monitored so that developed protocols from these recommendations reflect the latest information. Conclusion: This paper outlines general considerations and recommendations for dentists, oral health specialists, and craniomaxillofacial surgeons seeking to safely resume STSMs. These recommendations are designed to minimize the risk of exposure to COVID-19 by reinforcing social distancing protocols, reviewing criteria for patient and case selections, encouraging collaboration between organizations and local leadership, and team training. These guidelines should be tailored to fit the needs of each individual mission while keeping the safety as the main objective. Full article

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5 pages, 214 KiB

Open AccessArticle

Is There a Safe Zone for Lateral Border Fixation of Mandibular Angle Fractures?

by Steven G. Press, Andrew J. Miller and Michelle Campbell Luschen

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 284-288; https://doi.org/10.1177/1943387520983118 - 24 Dec 2020

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Abstract

Study Design: Cross-sectional study design. Objective: There are multiple accepted treatment options for internal fixation of mandibular angle fractures. The purpose of this study was to determine if there is a safe zone for lateral border fixation of mandibular angle fractures. Methods: One [...] Read more.

Study Design: Cross-sectional study design. Objective: There are multiple accepted treatment options for internal fixation of mandibular angle fractures. The purpose of this study was to determine if there is a safe zone for lateral border fixation of mandibular angle fractures. Methods: One hundred coronal images of facial computed tomography (CT) scans were reviewed on patients between the ages of 18 to 48. Measurements were taken in the area of the second and third molar region related to the inferior border to the superior extent of the inferior alveolar canal and apex of the second molar root, along with buccal cortical measurements to the inferior alveolar canal and apical third of the second molar root. Results: The average measurement of the inferior border in the second molar area to the inferior alveolar canal and apex of the root was 1.12 cm (0.70-1.77) and 1.39 cm (0.91-2.30), respectively. The average measurement of the inferior border of the thirdmolar to the inferior alveolar canal was 1.26 cm (0.78-1.83). The averagemeasurement of the buccal cortex of the second molar to the inferior alveolar canal and apical one-third of the root was 0.64 cm (0.34-1.25) and 0.59 cm (0.33-0.98), respectively. The average measurement of the thirdmolar buccal cortex to the inferior alveolar canal was 0.45 cm (0.18-0.98). Conclusion: In the area of the second molar region, there is no ubiquitous safe zone for screw placement, cortical bone thickness is more critical than vertical placement of the fixation plate and screws. In the third molar region, cortical bone thickness and vertical orientation may provide a safe zone for screw placement. Full article

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7 pages, 368 KiB

Open AccessArticle

Epidemiology of Maxillo-Facial Trauma During COVID-19 Lockdown: Reports From the Hub Trauma Center in Milan

by Gabriele Canzi, Elena De Ponti, Federica Corradi, Roberto Bini, Giorgio Novelli, Alberto Bozzetti and Davide Sozzi

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 277-283; https://doi.org/10.1177/1943387520983119 - 23 Dec 2020

Cited by 17 | Viewed by 86

Abstract

Study Design: Retrospective study. Objective: Following SARS-CoV-2 pandemic break-out a lockdown period for the population and a reorganization of the Health System were needed. Hub-function Centers for time-dependent diseases were identified and Niguarda Hospital (Milan) was selected as main Regional Trauma Center. [...] Read more.

Study Design: Retrospective study. Objective: Following SARS-CoV-2 pandemic break-out a lockdown period for the population and a reorganization of the Health System were needed. Hub-function Centers for time-dependent diseases were identified and Niguarda Hospital (Milan) was selected as main Regional Trauma Center. The purpose of our study is to report the experience of Niguarda Maxillofacial Trauma Team during this period, pointing out epidemiological changes in the presentation of trauma in comparison to the previous 3 years. Methods: Two hundred and sixteen patients were admitted to the Emergency Department from 8th March 2020 to 8th May 2020. One hundred and eighty-one had a diagnosis of Major Trauma and 36 had also facial fractures; 35 patients had isolated facial fractures. Data were compared to the activity during the same period in 2017-2019 and statistical analysis was carried out concerning demographic and clinical characteristics, trauma dynamics and positivity to COVID-19. Results: Cumulative curves of patients admitted because of Major Trauma describe a superimposable linear trend in years 2017-2019, while 2020 shows an increase from April 16th. Average age and number of more severe patients were higher than previous years. Epidemiological changes concerned road accidents, accidents involving pedestrians and cyclists, interpersonal violence, suicide attempts and domestic accidents. The incidence of facial fractures was confirmed through years and, according to its measured severity, 75% of patients required management. COVID-19 positivity without systemic symptoms didn’t influence the type of treatment. Conclusion: The COVID-19 lockdown offers a unique opportunity to study the reversal epidemiological effects on trauma. Full article

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9 pages, 4810 KiB

Open AccessArticle

Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps

by Jorge Ernesto Cantini Ardila, Carlos Eduardo Torres Fuentes, Giovanni Montealegre Gomez, Susana Correa, Erika Paola Gutierrez, Maria Paula Castiblanco and Francisco Sebastián Carvajal Flechas

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 268-276; https://doi.org/10.1177/1943387520980246 - 22 Dec 2020

Cited by 1 | Viewed by 66

Abstract

Study Design: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a [...] Read more.

Study Design: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. Objective: To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. Methods: This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. Results: There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. Conclusion: Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique. Full article

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7 pages, 310 KiB

Open AccessReview

Pseudoaneurysm of the Internal Carotid Artery After Craniofacial Traumatism: Series of Cases and Integrative Literature Review

by Priscilla Sarmento Pinto, Ruan de Sousa Viana, Rosa Rayanne Lins de Souza, João Luiz Gomes Carneiro Monteiro and Suzana Célia de Aguiar Soares Carneiro

Craniomaxillofac. Trauma Reconstr. 2021, 14(4), 330-336; https://doi.org/10.1177/1943387520980946 - 14 Dec 2020

Cited by 2 | Viewed by 46

Abstract

The present study aims to develop an integrative review about pseudoaneurysms after traumatic facial trauma, through the analysis of its etiology, type of fracture, signs and symptoms, time elapsed between the trauma and the exposure of signs and symptoms, and treatment performed in [...] Read more.

The present study aims to develop an integrative review about pseudoaneurysms after traumatic facial trauma, through the analysis of its etiology, type of fracture, signs and symptoms, time elapsed between the trauma and the exposure of signs and symptoms, and treatment performed in these cases. Furthermore into the report, there are 3 clinical cases that occurred in the Buccomaxillofacial Surgery and Traumatology service of Hospital da Restauração Recife/PE. The study was carried out in 2 phases, first, a digital research about post-traumatic craniofacial pseudoaneurysm was performed in the following databases “MEDLINE/PubMed,” “Scielo” and “Scopus,” in September 2019, with 5 articles being included. In the second, 3 cases of patients with high-impact facial trauma who developed pseudoaneurysm of the internal carotid artery were reported. The average age of the patients was 35.6 years, all patients were male (100%), the majority (60%) being victims of an automobile accident, 3 patients (60%) suffered craniofacial trauma and 2 (40%) had trauma only to the face, most of them had symptoms later on due to the trauma, in 80% of cases the therapy instituted was embolization. Cases of high-impact craniofacial traumas, which present epistaxis and/or ophthalmological alterations correlated to fractures, should be carefully evaluated, determining a better prognosis for the patient. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 14, Issue 4 (December 2021) – 11 articles

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