Craniomaxillofacial Trauma & Reconstruction

2 pages, 474 KiB

Open AccessObituary

Iain Hamilton McVicar (12/08/1958–11/06/2022)

by Sat Parmar and Rui Fernandes

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 187-188; https://doi.org/10.1177/19433875221110417 - 30 Jun 2022

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It is with great sadness that I write this in memory of Iain. Iain sadly passed away on Saturday 11 June 2022, in Nottingham, surrounded by his close family [...] Full article

11 pages, 2033 KiB

Open AccessCase Report

Staged Head and Neck Reconstruction: Heresy or a Reasoned Approach in a Select Group of Patients?

by Mark L. Urken, Quinn O’Malley, Mykayla Sandler, Monica H. Xing, Edward Ansari, Neil Mundi, Daniel Buchbinder, Eran Alon and Devin Okay

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 253-263; https://doi.org/10.1177/19433875211031361 - 8 Jul 2021

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Abstract

Study Design: case series. Objective: The restoration of defects in a single procedure with microvascular free flap reconstruction has become a mainstay of head and neck surgery. Yet in patients with complex defects and pre-existing comorbid medical conditions, a staged-reconstructive approach can enhance [...] Read more.

Study Design: case series. Objective: The restoration of defects in a single procedure with microvascular free flap reconstruction has become a mainstay of head and neck surgery. Yet in patients with complex defects and pre-existing comorbid medical conditions, a staged-reconstructive approach can enhance the safety of the procedure and improve the patient’s outcome. Methods: We present 3 representative case examples of a larger series of patients who underwent reconstruction of major defects and discuss the usefulness of a staged-reconstructive approach in the management of complex patients. Results: All 3 patients, with an existing composite defect in the setting of prior radiation therapy, underwent successful staged-reconstructive surgery using a variety of free tissue and regional flap transfers. Conclusions: A staged approach facilitates the reconstruction of complex composite defects, increases vessel availability, and mitigates the risk of flap failure. Although this approach commits the patient to multiple procedures and a more prolonged plan of care, it is preferable to 1 operation in specific complex situations with adverse, high-risk clinical features. Full article

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8 pages, 839 KiB

Open AccessArticle

Intraoperative Use of Ultrasonography in the Reduction of Zygomatico-Maxillary Complex Fractures

by Jagdish Eswari, C. Ravindran and C. Deepak

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 229-236; https://doi.org/10.1177/19433875211029145 - 7 Jul 2021

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Abstract

Study Design: A single blind randomized controlled study. Objective: The aim of this study is to evaluate the use of ultrasonography intraoperatively to assess the reduction of unilateral zygomatic complex fractures with a control group using the conventional blind digit palpation. Methods: The [...] Read more.

Study Design: A single blind randomized controlled study. Objective: The aim of this study is to evaluate the use of ultrasonography intraoperatively to assess the reduction of unilateral zygomatic complex fractures with a control group using the conventional blind digit palpation. Methods: The study comprised of a sample size of 24 patients with 21 male and 3 female patients. Patients of all age groups diagnosed with unilateral displaced zygomatic complex fracture with or without mandible fracture were included in the study. The subjects were randomized into study and control groups based on a standard protocol with a total of 24 patients. Imaging was in the form of a preoperative and postoperative 3D computed tomography scan with reconstruction of the maxilla and mandible to interpret the diagnosis for all subjects. The inter-fracture distance of the fractured infraorbital rim were measured in 3 dimensions (antero-posterior, medio-lateral and supero-inferior) and compared pre and postoperatively. Preoperative, intraoperative and postoperative ultrasonographic examination was performed and recorded on all patients at the frontozygomatic region, infraorbital rim and zygomatic buttress to assess the proximity of the fractured margins pre reduction, post reduction and post fixation of the fracture segments. Result: Statistical analytic results were significant in all 3 dimensions when measured postoperatively using computed tomography. Conclusion: Ultrasonography is an effective screening and intraoperative tool in the armamentarium of oral and maxillofacial surgery to assess zygomatic complex fractures, avoiding incisions in aesthetic areas of the maxillofacial region. Full article

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9 pages, 271 KiB

Open AccessReview

Controversies and Contemporary Management of Orbital Floor Fractures

by Shivam Patel, Tom Shokri, Kasra Ziai and Jessyka G. Lighthall

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 237-245; https://doi.org/10.1177/19433875211026430 - 24 Jun 2021

Cited by 19 | Viewed by 498

Abstract

Substantial controversy exists regarding the timing of intervention and management of patients with orbital floor fractures. Recent advances in computer-aided technology, including the use of 3-dimensional printing, intraoperative navigational imaging, and the use of novel implants, have allowed for improvement in prospective management [...] Read more.

Substantial controversy exists regarding the timing of intervention and management of patients with orbital floor fractures. Recent advances in computer-aided technology, including the use of 3-dimensional printing, intraoperative navigational imaging, and the use of novel implants, have allowed for improvement in prospective management modalities. As such, this article aims to review the indications and timing of repair, surgical approaches, materials used for repair, and contemporary adjuncts to repair. Indications for orbital floor fracture repair remain controversial as many of these fractures heal without intervention or adverse sequelae. Intraoperative navigation and imaging, as well as endoscopic guidance, can improve visualization of defects mitigating implant positioning errors, thereby reducing the need for secondary corrective procedures. Patient-specific implants may be constructed to fit the individual patient’s anatomy using the preoperative CT dataset and mirroring the contralateral unaffected side and have been shown to improve pre-operative efficiency and minimize postoperative complications. With increased data, we can hope to form evidence-based indications for using particular biomaterials and the criteria for orbital defect characteristics, which may be best addressed by a specific surgical approach. Full article

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10 pages, 754 KiB

Open AccessArticle

Current Practice for Transverse Mandibular and Maxillary Discrepancies in the Netherlands: A Web-Based Survey Among Orthodontists and Oral and Maxillofacial Surgeons

by Atilla Gül, Stephen T. H. Tjoa, Jan P. de Gijt, Justin T. van der Tas, Hadi Sutedja, Eppo B. Wolvius, Karel G. H. van der Wal and Maarten J. Koudstaal

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 219-228; https://doi.org/10.1177/19433875211027694 - 24 Jun 2021

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Abstract

The main objective of this study was to provide an overview of the current practice for transverse mandibular and maxillary discrepancies in the Netherlands using a web-based survey. Orthodontists (ORTHO) and Oral and Maxillofacial Surgeons (OMFS) in the Netherlands were invited to the [...] Read more.

The main objective of this study was to provide an overview of the current practice for transverse mandibular and maxillary discrepancies in the Netherlands using a web-based survey. Orthodontists (ORTHO) and Oral and Maxillofacial Surgeons (OMFS) in the Netherlands were invited to the web-based survey via their professional association. Three cases were presented which could be treated non-surgically and surgically. Participants were asked what treatment they preferred: no treatment, orthodontic treatment with optional extractions or surgically assisted orthodontic treatment. The web-based survey ended with questions on various technical aspects and any experienced complication. Invitation was sent to all 303 members of professional association for ORTHO and to all 379 members of professional association for OMFS. Overall response number was 276 (response rate of 40.5%), including 127 incomplete responses. Generally, ORTHO prefer orthodontic treatment with optional extractions and OMFS lean towards surgically assisted orthodontic treatment. Mandibular Midline Distraction appears to be less preferred, possibly due to lack of clinical experience or knowledge by both professions despite being proven clinical stable surgical technique with stable long-term outcomes. There seems to be consensus on technical aspects by both professions, however, there are various thoughts on duration of consolidation period. Complications are mostly minor and manageable. Full article

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7 pages, 509 KiB

Open AccessReview

Long-Term Complications of Isolated and Combined Condylar Fractures: A Retrospective Study

by Margaux Nys, Tim Van Cleemput, Jakob Titiaan Dormaar and Constantinus Politis

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 246-252; https://doi.org/10.1177/19433875211026759 - 23 Jun 2021

Cited by 7 | Viewed by 76

Abstract

Study Design: Fractures of the mandibular condyle are a common injury in maxillofacial trauma. Both conservative treatment (i.e., analgesic therapy and soft diet) and intermaxillary fixation (IMF) or open reduction internal fixation (ORIF) have satisfactory and functional outcomes, though severe late-onset complications have [...] Read more.

Study Design: Fractures of the mandibular condyle are a common injury in maxillofacial trauma. Both conservative treatment (i.e., analgesic therapy and soft diet) and intermaxillary fixation (IMF) or open reduction internal fixation (ORIF) have satisfactory and functional outcomes, though severe late-onset complications have been reported. Objective: We compared the long-term complications of patients with condylar fractures treated conservatively, with IMF, or with combined ORIF and IMF. Methods: We retrospectively analyzed all patients diagnosed with unilateral or bilateral condylar fracture, isolated or combined with a fracture of the mandibular body, admitted to the Department of Maxillofacial Surgery at UZ Leuven between January 2013 and January 2020. We collected data on age, gender, side of condylar fracture, presence of associated fracture of the mandibular body, referrals, initial treatment, long-term complications and secondary treatment. Long-term complications were defined as sequelae still present 6 weeks after initial treatment. Results: Among 192 patients, 68.8% had unilateral and 31.2% bilateral condylar fractures; an associated fracture of the mandibular body was seen in 45.8%, 31% received conservative treatment, 51% IMF only, and 18% combined ORIF and IMF. Forty-eight percent of all patients suffered from 1 or more long-term complications, most frequently malocclusion (24%), reduced mouth opening (15.1%), nerve disturbances (13.5%), pain (8.9%), and facial asymmetry (2.6%). Surgery as a secondary treatment was necessary in 25% of all cases. Conclusions: The presence of bilateral condylar fractures or associated fracture of the mandibular body is a risk factor for developing long-term complications. Most patients with long-term complications were initially treated with combined ORIF and IMF, but long-term complications after initial conservative or IMF treatment were treated with secondary surgery. Full article

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13 pages, 1478 KiB

Open AccessArticle

Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review

by Sean A. Knudson, Kristopher M. Day, Patrick Kelley, Pablo Padilla, Ian X. Collier, Steven Henry, Raymond Harshbarger and Patrick Combs

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 206-218; https://doi.org/10.1177/19433875211026432 - 21 Jun 2021

Cited by 3 | Viewed by 46

Abstract

Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: [...] Read more.

Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction. Full article

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5 pages, 69 KiB

Open AccessArticle

Maxillofacial Horse Trauma: A 10-Year Retrospective Study at a UK Major Trauma Center

by Rajeevan Sritharan, Christopher David Blore and Daya Singh Gahir

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 201-205; https://doi.org/10.1177/19433875211025910 - 21 Jun 2021

Cited by 1

Abstract

Introduction/Objecive: There are very few studies that have investigated equestrian-related maxillofacial injuries. A retrospective review was performed to investigate maxillofacial horse trauma at a Level 1 Trauma Centre at the Royal Stoke Hospital over the last 10 years between 2010 and 2020. Study [...] Read more.

Introduction/Objecive: There are very few studies that have investigated equestrian-related maxillofacial injuries. A retrospective review was performed to investigate maxillofacial horse trauma at a Level 1 Trauma Centre at the Royal Stoke Hospital over the last 10 years between 2010 and 2020. Study Design/Methods: Search of the hospital’s major trauma database as well as ED records showed 51 patients who sustained maxillofacial injuries related to horses. Statistical analysis was performed using Chi Squared tests. Results: 41 patients were female and the remaining 10 were male. 43% of patients were female and aged 30 and under. Kicks from horses accounted for 64.4% of equine-related maxillofacial injuries. A total of 90 injuries were recorded. Hard tissue injuries which include all fractures accounted for 66.3% of injuries sustained. 70.5% patients sustained isolated maxillofacial trauma. There was an association between patients sustaining non-isolated maxillofacial trauma and hard tissue maxillofacial injuries (p = 0.04). 65.6% of injuries were managed operatively. Patients aged 30 and under were more likely to be managed operatively (p = 0.03). Conclusion: Equestrian related maxillofacial trauma represents a proportion of trauma workload. The safety aspect of horse riding should be considered and education in safe riding and the use of appropriate safety equipment is vital. Full article

12 pages, 670 KiB

Open AccessArticle

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

by Matthew E. Pontell, Eva B. Niklinska, Stephane A. Braun, Nolan Jaeger, Kevin J. Kelly and Michael S. Golinko

Craniomaxillofac. Trauma Reconstr. 2022, 15(3), 189-200; https://doi.org/10.1177/19433875211022573 - 21 Jun 2021

Cited by 17 | Viewed by 329

Abstract

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This [...] Read more.

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990–2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; p = 0.07), and titanium hardware was more frequently removed on an elective basis (p < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (p = 0.01); whereas angle fractures were more often treated with titanium hardware (p < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 15, Issue 3 (September 2022) – 9 articles

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