Craniomaxillofacial Trauma & Reconstruction

1 pages, 466 KiB

Open AccessEditorial

by Rui Fernandes, Seenu Susarla and Sat Parmar

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 97; https://doi.org/10.1177/19433875221096728 - 12 May 2022

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At the time of writing this editorial, Russia had just invaded Ukraine shattering decades of relative peace in Europe [...] Full article

8 pages, 780 KiB

Open AccessArticle

Incidence, Aetiology, and Associated Fracture Patterns of Infraorbital Nerve Injuries Following Zygomaticomaxillary Complex Fractures: A Retrospective Analysis of 272 Patients

by Kathia Dubron, Maarten Verbist, Eman Shaheen, Titiaan Jacob Dormaar, Reinhilde Jacobs and Constantinus Politis

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 139-146; https://doi.org/10.1177/19433875211022569 - 17 Jun 2021

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Abstract

Study Design: Retrospective study. Objective: Zygomaticomaxillary complex (ZMC) fractures are common facial injuries with heterogeneity regarding aetiologies, fracture types, infraorbital nerve (ION) involvement, and treatment methods. The aim of this study was to identify associations between aetiologies, fracture types, and neurological complications. Additionally, [...] Read more.

Study Design: Retrospective study. Objective: Zygomaticomaxillary complex (ZMC) fractures are common facial injuries with heterogeneity regarding aetiologies, fracture types, infraorbital nerve (ION) involvement, and treatment methods. The aim of this study was to identify associations between aetiologies, fracture types, and neurological complications. Additionally, treatment methods and recovery time were investigated. Methods: Medical files of 272 patients with unilateral and bilateral ZMC fractures were reviewed, whose cases were managed from January 2014 to January 2019 at the Department of Oral and Maxillofacial Surgery, University hospitals Leuven, Belgium. History of ION sensory dysfunction and facial nerve motoric dysfunction were noted during follow-up. Results: ION hypoaesthesia incidence was 37.3%, with the main causes being fall accidents, road traffic accidents, and interpersonal violence. Significant predictors of ION hypoaesthesia were Zingg type B fractures (p = 0.003), fracture line course through the infraorbital canal (p < 0.001), orbital floor fracture (p < 0.001), and ZMC dislocation or mobility (p = 0.001). Conclusion: Of all ZMC fractures, 37.3% exhibited ION hypoaesthesia. Only ZMC Zingg type B fractures (74.0%) were significantly more associated with ION hypoaesthesia. ION hypoesthesia was more likely (OR = 2.707) when the fracture line course ran through the infraorbital canal, and was less dependent on the degree of displacement. Neuropathic pain symptoms developed after ZMC fractures in 2.2% patients, posing a treatment challenge. Neuropathic pain symptoms were slightly more common among women, and were associated only with type B or C fractures. No other parameters were found to predict the outcome of this post-traumatic neuropathic pain condition. Full article

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7 pages, 673 KiB

Open AccessArticle

How Did the COVID-19 Pandemic Affect Trends in Facial Trauma?

by Luke Stanisce, Alec H. Fisher, Bo Young Choi, Andrew Newman, Ju Lin Wang and Yekaterina Koshkareva

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 132-138; https://doi.org/10.1177/19433875211022574 - 10 Jun 2021

Cited by 12 | Viewed by 222

Abstract

Study Design: Retrospective cohort analysis. Objective: To examine the impact the COVID-19 pandemic and its accompanying societal measures had on the incidence, characteristics, and management of maxillofacial traumatic injuries. Methods: This cohort analysis compared facial trauma injuries presenting to the highest-volume Level I [...] Read more.

Study Design: Retrospective cohort analysis. Objective: To examine the impact the COVID-19 pandemic and its accompanying societal measures had on the incidence, characteristics, and management of maxillofacial traumatic injuries. Methods: This cohort analysis compared facial trauma injuries presenting to the highest-volume Level I Trauma Center in New Jersey, USA from 1 January to 31 July in 2020 and 2019. Differences in demographics, mechanisms, and interventions were compared between the pandemic period (16 March–31 July 2020) and the equivalent pre-pandemic date period in 2019 using X2, Fishers Exact, and Mann–Whitney U testing. Results: In total, 616 subjects were included. The daily incidence of facial trauma consults during the 2020 pandemic (1.81 ± 1.1) decreased compared to 2019 (2.15 ± 1.3) (p = 0.042). During the outbreak, there was an increase in the proportion of subjects with positive urine drug screens (21.5% vs. 12.2%; p = 0.011) and injuries related to domestic violence (10.2% vs. 4.5%; p = 0.023). Patients were 30% less likely to be transferred from local hospitals (RR, 0.70 [0.53–0.93]; p = 0.014). Although subjects had a 25% increased risk of presenting with injuries deemed procedural (RR, 1.25 [95% CI, 1.05–1.56]; p = 0.048), a greater proportion were discharged with operative procedures scheduled as outpatients (16.0% vs. 4.9%; p = 0.005). Conclusions: The COVID-19 pandemic has impacted both the epidemiology and management of maxillofacial traumatic injuries, perhaps secondary to modifications in personal and community behaviors or the effects on healthcare systems in our region. Full article

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11 pages, 892 KiB

Open AccessArticle

Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters from a Single Level I Trauma Center

by Ashton Christian, Beatrice J. Sun, Nima Khoshab, Areg Grigorian, Christina Y. Cantwell, Sean A. Melucci, Allison C. Hu, Catherine M. Kuza, Michael E. Lekawa and Jeffry Nahmias

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 111-121; https://doi.org/10.1177/19433875211020615 - 3 Jun 2021

Cited by 3 | Viewed by 65

Abstract

Study Design: Retrospective cohort. Objective: Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing [...] Read more.

Study Design: Retrospective cohort. Objective: Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. Methods: We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Results: Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data (p > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, p = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, p = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, p = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all p > 0.05). Conclusion: Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings. Full article

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4 pages, 562 KiB

Open AccessArticle

The Liability of Performing Orthognathic Surgery

by Steven Halepas, Brendan Bryck, Kevin C. Lee and Alia Koch

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 128-131; https://doi.org/10.1177/19433875211022530 - 2 Jun 2021

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Abstract

Study Design: This is a retrospective case series using the Thomson Reuters Westlaw Edge database, an online subscription- based database of over 40,000 state and federal records. Objective: There is growing academic interest in the medicalmalpractice literature. The primary objective of this study [...] Read more.

Study Design: This is a retrospective case series using the Thomson Reuters Westlaw Edge database, an online subscription- based database of over 40,000 state and federal records. Objective: There is growing academic interest in the medicalmalpractice literature. The primary objective of this study was to examinemedical malpractice in orthognathic procedures in order to characterize factors that determine legal responsibility and help make the craniomaxillofacial (CMF) surgeon more comfortable when treating this patient population. Methods: The database was queried for medical malpractice cases involving orthognathic surgery from 1985–2021. The characteristics of each lawsuit were identified, and descriptive statistics were reported. Results: A total of 42 CMF malpractice cases were available for review, and total of 15 cases were included in the final sample. Verdict decisions and settlements occurred between 1991 and 2012. Of the 15 cases, the highest concentration of cases occurred in California (6) and Pennsylvania (2). 53% of cases were ruled in favor of the defendant, 7% of cases were settled, 27% of cases were ruled in favor of the plaintiff against the surgeon, and 13% were ruled in favor of the plaintiff against the hospital with the surgeon being found not liable. The minimum award of damages was $29,999 and the maximum was $550,000. Conclusion: Litigation experience can be very time consuming and troublesome for medical practitioners. The risk of litigation and complications might be a prohibiting factor as to why CMF surgeons may not be preforming orthognathic surgery. The best defense against a malpractice case is to avoid one altogether. Learning from past mistakes is one way of ensuring that goal. Full article

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6 pages, 554 KiB

Open AccessArticle

Slippery Slopes: Skiing-Related Facial Trauma in Adults

by Alissa C. Galgano, Jason E. Cohn, Jordan J. Licata, Sammy Othman, Fred J. Stucker and Paige Bundrick

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 122-127; https://doi.org/10.1177/19433875211020933 - 1 Jun 2021

Cited by 4 | Viewed by 53

Abstract

Study Design: Retrospective, observational, cross-sectional study. Objective: To determine the incidence of skiing-related facial trauma and to identify their patterns in terms of potential risk factors, mechanism of injury, anatomical location, and degree of severity. Methods: Data was collected using the National Electronic [...] Read more.

Study Design: Retrospective, observational, cross-sectional study. Objective: To determine the incidence of skiing-related facial trauma and to identify their patterns in terms of potential risk factors, mechanism of injury, anatomical location, and degree of severity. Methods: Data was collected using the National Electronic Injury Surveillance System and included snow skiing-related incidents during the years 2009 to 2018. Specifically, injuries limited to the facial region including the head, face, eye(s), mouth, neck or ear(s) were reported. Patients with fractures were further classified by the study variables. Descriptive statistics were used to classify continuous variables while chi-square analysis was used to compare categorical variables. Results: A total of 514 (n = 514) patients met the inclusion criteria within the study period. The majority of injuries were due to concussions (59%), followed by lacerations (18%), fractures (11%), contusions (11%) and dental injuries (1%). Of the fractures seen, the majority were nasal (30%) and cervical spine (30%), followed by midface (27%), mandible (9%) and skull (4%). In our population, head injuries were more common in females (80%) than in males (60%), whereas, mouth injuries were more common in males (8%) than females (1%) [χ²= 30.2, p < 0.001]. Conclusions: Skiing-related craniofacial trauma remains a significant mechanism of injury. Our data illustrates a need to correlate these injuries to the use of personal protective equipment. Furthermore, this data calls for the strict implementation of such equipment and the development of safety protocols to further prevent deleterious injury. Full article

7 pages, 591 KiB

Open AccessArticle

Children in Boxing and Martial Arts Should Be Better Guarded from Facial Injuries

by Rachael J. Gotlieb, Thomas J. Sorenson, Vedant Borad and Warren Schubert

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 104-110; https://doi.org/10.1177/19433875211016666 - 9 May 2021

Cited by 4 | Viewed by 44

Abstract

Study Design: Cross-sectional study. Objective: Childhood participation in boxing and martial arts has increased over the past decade, and these activities are well-known causes of traumatic injury. We hypothesized that the face is frequently injured in the setting of pediatric boxing and martial [...] Read more.

Study Design: Cross-sectional study. Objective: Childhood participation in boxing and martial arts has increased over the past decade, and these activities are well-known causes of traumatic injury. We hypothesized that the face is frequently injured in the setting of pediatric boxing and martial arts trauma in the United States and that there are identifiable injury patterns. Methods: We performed a cross-sectional study of consecutive pediatric patients in the National Electronic Injury Surveillance System (NEISS) from 1 January 2010 to 31 December 2019. Patients were included in our study if they were younger than 18 years of age and evaluated in the emergency department (ED) after boxing or martial arts trauma. Primary outcome was facial injury. Other variables of interest include age, sex, ED disposition, type and location of injury. Descriptive and univariate statistics of the primary outcome were computed with these variables. Results: There were 4978 total pediatric patients injured due to boxing and martial arts trauma reported by NEISS-participating EDs during the study period, and 264 patients experienced injury to the face (264/4978; 5.3%). Over 20% (n = 60) of reported facial injuries were fractures; the most fractured structure was the nose (42/60; 70), orbit (11/60; 18.3%), and mandible (6/60; 10%). Almost 20% (11/60%) of pediatric facial fractures due to boxing and martial arts trauma involved fighting a family member or friend, and a punch was the most common mode of fracture (42/58; 72.4%). Conclusions: Facial injuries comprise about 5% of injuries after boxing and martial arts trauma and 22% of these facial injuries are fractures. If children choose to participate, parents, coaches, trainers, officials, and community leaders should make the greatest effort possible to minimize risk, including the mandatory use of head and face protective gear and elimination of training fighting, or “sparring.” Full article

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5 pages, 514 KiB

Open AccessReview

Platelet-Rich Fibrin in Third Molar Surgery: Systematic Review and Meta-Analysis Protocol

by Gaston A. Salas, Shuheng A. Lai, Francisca Verdugo-Paiva and Roberto A. Requena

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 164-168; https://doi.org/10.1177/19433875211016203 - 6 May 2021

Cited by 3 | Viewed by 99

Abstract

Objective: The objective of this systematic review is to assess the effectiveness and safety of platelet-rich fibrin (PRF) in third molar surgery. Data Sources: A comprehensive search strategy is meant to be used in an attempt to identify all relevant randomized controlled trials [...] Read more.

Objective: The objective of this systematic review is to assess the effectiveness and safety of platelet-rich fibrin (PRF) in third molar surgery. Data Sources: A comprehensive search strategy is meant to be used in an attempt to identify all relevant randomized controlled trials (RCTs), ongoing investigation reported in specialty congresses and trials regardless of language or publication status (published, unpublished, in press and in progress). Searches will be conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, Embase, Lilacs, the International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, US National Institutes of Health (NIH), grey literature and in specialized congresses and conferences. Eligibility Criteria: We will include randomized trials evaluating the effect of PRF on wound healing after third molar surgery. Two reviewers will independently screen each study for eligibility, data extraction and risk of bias assessment using Cochrane “risk of bias” tool. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome. Ethics and Dissemination: As researchers will not access information that could lead to the identification of an individual participant, obtaining ethical approval was waived. Full article

6 pages, 556 KiB

Open AccessArticle

The Effect of COVID on Nasal Fracture Management in ENT Emergency Clinics

by Keshav Kumar Gupta, Vinay Kumar Gupta, Ranjodh Singh Sanghera, Karan Jolly and Lisha McClleland

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 98-103; https://doi.org/10.1177/19433875211015036 - 5 May 2021

Cited by 2 | Viewed by 38

Abstract

Study design: Retrospective cohort study. Objective: Management of nasal fractures is usually in ENT emergency clinics, with our center aiming to assess patients within 10-days. During 2020, there have been numerous lockdowns and social distancing measures implemented in the UK as a result [...] Read more.

Study design: Retrospective cohort study. Objective: Management of nasal fractures is usually in ENT emergency clinics, with our center aiming to assess patients within 10-days. During 2020, there have been numerous lockdowns and social distancing measures implemented in the UK as a result of the coronavirus pandemic (COVID). This study aimed to assess the effect of COVID on nasal fracture management in ENT emergency clinics in terms of number of patients seen, time to follow up and their management strategies. Methods: All patients with suspected or confirmed nasal bone fractures presenting to the emergency department (ED) between 1 January 2019 and 31 December 2020 at our major trauma center were analyzed in 2 groups depending on the year they were seen (2019 vs. 2020). Results: There was a total of 104 patients analyzed, with 51.4% decrease in the number of patients seen in 2020 versus 2019. The mean days to follow up in 2019 was 8.09 days and 7.65 days in 2020 (p = 0.37). There was no statistically significant difference in the number of patients seen within the 10-day target between years (2019 = 65.7% vs. 2020 = 76.5%, p = 0.35). The majority of patients were managed with manipulation under anesthesia (MUA) in 2019 (n = 32, 45.7%) vs. discharge from clinic in 2020 (n = 21, 61.8%). Conclusions: Our study shows a drastic reduction in the number of patients seen in ENT emergency clinic from 2019 to 2020. This is in-keeping with other studies that have shown a reduction in ED attendances, trauma admissions and admissions across other specialties all around the world. Full article

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9 pages, 1454 KiB

Open AccessArticle

Endoscopically Assisted Marginal Mandibulectomy Using an Intraoral Approach Alone for Squamous Cell Carcinoma of the Posterior Mandibular Gingiva: A Technical Note

by Atsushi Shudo

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 175-183; https://doi.org/10.1177/19433875211015045 - 2 May 2021

Cited by 1 | Viewed by 50

Abstract

Study Design: Technical note. Objective: Marginal mandibulectomy is a surgical procedure for treatment of mandibular gingival tumors. The intraoral approach to the posterior region of the mandible for marginal mandibulectomy is difficult due to limited access and operating field visibility; the conventional surgical [...] Read more.

Study Design: Technical note. Objective: Marginal mandibulectomy is a surgical procedure for treatment of mandibular gingival tumors. The intraoral approach to the posterior region of the mandible for marginal mandibulectomy is difficult due to limited access and operating field visibility; the conventional surgical procedure may require some skin incisions. This report discusses the effectiveness of endoscopic assistance in marginal mandibulectomy. Methods: This article describes endoscopically assisted marginal mandibulectomy using an intraoral approach alone for squamous cell carcinoma of the posterior mandibular gingiva. Results: The advantages of this surgical method are twofold: (1) superior visibility to the lower edge of the mandible without any skin incision; and (2) safe surgical confirmation of important anatomy on the buccolingual side (e.g., mental foramen, lingual nerve, mandibular foramen, and neurovascular bundle). This minimally invasive approach without any skin incision, as well as the superior visibility of the operating field, are important advantages of endoscopically assisted marginal mandibulectomy that cannot be obtained by other surgical methods. Conclusions: Endoscopically assisted marginal mandibulectomy using an intraoral approach alone may be useful because it avoids damage to facial skin and improves safety by employing an enlarged bright field. Full article

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17 pages, 1419 KiB

Open AccessReview

Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies

by Alisa Girard, Christopher D. Lopez, Jonlin Chen, David Perrault, Nikhil Desai, Karl C. Bruckman, Scott P. Bartlett and Robin Yang

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 147-163; https://doi.org/10.1177/19433875211008086 - 8 Apr 2021

Cited by 4 | Viewed by 71

Abstract

Study Design: This is a literature review with 3 case studies. Objective: Intraoperative and postoperative bleeding are the most common complications of orthognathic surgery and have the potential to become life-threatening. The rarity of severe postoperative epistaxis has resulted in limited characterization of [...] Read more.

Study Design: This is a literature review with 3 case studies. Objective: Intraoperative and postoperative bleeding are the most common complications of orthognathic surgery and have the potential to become life-threatening. The rarity of severe postoperative epistaxis has resulted in limited characterization of these cases in the literature. The purpose of this study is to (1) differentiate various presentations of epistaxis following orthognathic surgery in the literature, (2) identify management approaches, and (3) to synthesize a treatment algorithm to guide future management of postoperative epistaxis. Methods: A literature search of PubMed was conducted and 28 cases from 17 studies were assessed. Results: Bleeding within the first week may indicate isolated epistaxis, often resolved with local tamponade. Half of cases were attributed to pseudoaneurysm rupture (n = 14), with epistaxis onset ranging from postoperative day 6 to week 9. Angiography was used in most cases (n = 17), often as the primary imaging modality (n = 11). Nasal endoscopy is a less invasive and effective alternative to angiography with embolization. Proximal vessel ligation was used in 3 cases but is not preferred because collaterals may reconstitute flow through the defect and cause rebleeding. Repeat maxillary down-fracture with surgical exploration was described in 4 cases. Conclusions: As outlined in our management algorithm, nasal packing and tamponade should be followed by either local electrocautery or vascular imaging. Angiography with embolization is the preferred approach to diagnosis and management, whereas surgical intervention is reserved for cases of embolization failure or unavailability. Full article

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6 pages, 1068 KiB

Open AccessCase Report

An Alternative Approach Using Circummandibular Wiring for Treatment of Dentoalveolar Fractures in Children: A Case Report

by José Henrique Santana Quinto, Andressa Bolognesi Bachesk, Lucas Costa Nogueira and Liogi Iwaki Filho

Craniomaxillofac. Trauma Reconstr. 2022, 15(2), 169-174; https://doi.org/10.1177/1943387521990283 - 1 Mar 2021

Cited by 2 | Viewed by 50

Abstract

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage [...] Read more.

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 15, Issue 2 (June 2022) – 12 articles

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