Craniomaxillofacial Trauma & Reconstruction

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Open AccessEditorial

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Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 267; https://doi.org/10.1177/19433875221128105 - 20 Sep 2022

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Today one can no longer trust what you hear or read. It seems that everyone is out to mislead the other [...] Full article

10 pages, 2483 KiB

Open AccessArticle

A Prospective Study on Autotransplantation of Mandibular Third Molars With Complete Root Formation

by Shishir Dhar, Gaurav Singh, Madan Mishra and Amit Gaur

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 340-349; https://doi.org/10.1177/19433875211055600 - 14 Mar 2022

Cited by 9 | Viewed by 79

Abstract

Study Design: Autotransplantation, if possible, is a viable option for replacing a missing tooth when a donor tooth is available. The most typical tooth transplant is the transfer of a third molar to a first molar site. No immune reaction results from transplants [...] Read more.

Study Design: Autotransplantation, if possible, is a viable option for replacing a missing tooth when a donor tooth is available. The most typical tooth transplant is the transfer of a third molar to a first molar site. No immune reaction results from transplants of this nature. It restores the proprioceptive function and normal periodontal healing; thus, the patient can have a natural chewing feeling and natural biological response. Objective: This study aims to evaluate the prognosis of autotransplanted mandibular third molar and also to evaluate the cost effectiveness of the treatment performed when compared to the other treatment modalities for prosthetic rehabilitation. Methods: A prospective studywas done in theDepartment ofOral & Maxillofacial Surgery, Sardar Patel PostGraduate Institute of Dental &Medical Sciences, Lucknow,UP, India, with over 20 patients to evaluate the prognosis of autotransplanted mandibular third molars with complete root formation after atraumatic extraction of first or second mandibular molar, which were randomly selected irrespective of race, sex, caste, and socio-economic status. Regular clinical and radiographical examinations were performed over a period of 1 year and the patients were assessed for pain, swelling, infection, dry socket, periodontal pocket depth, ankylosis, root resorption, tooth mobility, and level of buccal bone in relation to cementoenamel junction (CEJ). Results: Eighteen out of 20 transplants were successful; only 2 mandibular transplants were extracted because of abnormal horizontal and axial mobility and the reason of failure was attributed to fact that the roots of transplant were short and conical and there was lack of alveolar bone height at the recipient site in one patient, while root resorption was the reason for failure of transplant in the other patient. Conclusions: This study assessed the efficacy of autotransplantation of molars and the viability of the procedure to replace unrestorable molar teeth; it also supports the hypothesis that transplantation of a mandibular third molar for replacement of a lost or seriously damaged molar tooth could be a reasonable alternative. Full article

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6 pages, 1091 KiB

Open AccessArticle

Intraoperative Positioning in Maxillofacial Trauma Patients with Cervical Spine Injury—Is It Safe? Radiological Simulation in a Healthy Volunteer

by Thomas Pepper, Harry Spiers, Alex Weller and Clare Schilling

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 312-317; https://doi.org/10.1177/19433875211053091 - 3 Jan 2022

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Abstract

Study Design: Observational. Objective: To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods: Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations—neutral [...] Read more.

Study Design: Observational. Objective: To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods: Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations—neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. Results: In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4–C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1–2) joints. Conclusions: Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries. Full article

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12 pages, 1065 KiB

Open AccessArticle

The Global Impact of COVID-19 on Craniomaxillofacial Surgeons: A Follow-Up Survey After One Year

by Tevfik Cicek, Justin van der Tas, Thomas Dodson, Daniel Buchbinder, Stefano Fusetti, Michael Grant, Yiu Yan Leung, Erich Roethlisberger, Gregorio Sánchez Aniceto, Alexander Schramm, Edward Bradley Strong, Gerson Mast and Eppo Wolvius

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 350-361; https://doi.org/10.1177/19433875211057877 - 2 Jan 2022

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Abstract

Study Design: Comparative cross-sectional. Objective: To measure the impact that COrona VIrus Disease-19 (COVID-19) has had on craniomaxillofacial (CMF) surgeons after 1 year and compare it with 2020 data by (1) measuring access to adequate personal protective equipment (PPE), (2 [...] Read more.

Study Design: Comparative cross-sectional. Objective: To measure the impact that COrona VIrus Disease-19 (COVID-19) has had on craniomaxillofacial (CMF) surgeons after 1 year and compare it with 2020 data by (1) measuring access to adequate personal protective equipment (PPE), (2) performance of elective surgery, and (3) the vaccination status. This should be investigated because most CMF surgeons felt that hospitals did not provide them with adequate PPE. Methods: The investigators surveyed the international AO CMF membership using a 30-item online questionnaire and compared it to a previous study. The primary predictor variable was year of survey administration. Primary outcome variables were availability of adequate personal protective equipment (adequate/inadequate), performance of elective surgery (yes/no), and vaccination status (fully vaccinated/partly vaccinated/not vaccinated). Descriptive and analytic statistics were computed. Binary logistic regression models were created to measure the association between year and PPE availability. Statistical significance level was set at p < 0.05. Results: The sample was composed of 523 surgeons (2% response rate). Most surgeons reported access to adequate PPE (74.6%). The most adequate PPE was offered in Europe (87.8%) with the least offered in Africa (45.5%). Surgeons in 2021 were more likely to report adequate PPE compared to 2020 (OR 3.74, 95% CI [2.59–4.39]). Most of the respondents resumed elective surgery (79.5% vs 13.3% in 2020) and were fully vaccinated (59.1%). Conclusions: Most CMF surgeons now have access to adequate PPE, resumed elective surgery, and are either fully or partly vaccinated. Future studies should investigate the long-term impact of the fast-evolving COVID-19 pandemic on CMF surgeons. Full article

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7 pages, 675 KiB

Open AccessArticle

Quantifying Aerosol Generation in Maxillofacial Trauma Repair Techniques

by Adam McCann, Kyle Singerman, James Coxe, John Singletary, Jun Wang, Ryan Collar and Tsung-yen Hsieh

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 362-368; https://doi.org/10.1177/19433875211059314 - 29 Dec 2021

Cited by 1 | Viewed by 59

Abstract

Study Design: Cadaveric simulation study. Objective: The novel coronavirus (COVID-19), which can be transmitted via aerosolized viral particles, has directed focus on protection of healthcare workers during procedures involving the upper aerodigestive tract, including maxillofacial trauma repair. This study evaluates particle generation at [...] Read more.

Study Design: Cadaveric simulation study. Objective: The novel coronavirus (COVID-19), which can be transmitted via aerosolized viral particles, has directed focus on protection of healthcare workers during procedures involving the upper aerodigestive tract, including maxillofacial trauma repair. This study evaluates particle generation at different distances from open reduction and internal fixation (ORIF) of maxillofacial injuries in the intraoperative setting to reduce the risk of contracting airborne diseases such as COVID-19. Methods: Two cadaveric specimens in a simulated operating room underwent ORIF of midface and mandible fractures via intraoral incisions as well as maxillomandibular fixation (MMF) using hybrid arch bars. ORIF was performed with both selfdrilling screws and with the use of a power drill for creating guide holes. Real-time aerosol concentration was measured throughout each procedure using 3 particle counters placed 0.45, 1.68, and 3.81 m (1.5, 5.5, and 12.5 feet, respectively) from the operative site. Results: There was a significant decrease in particle concentration in all procedures at 1.68 m compared to 0.45 m, but only 2 of the 5 procedures showed further significant decrease in particle concentration when going from 1.68 to 3.81 m from the operative site. There was significantly less particle concentration generated at all distances when using self-drilling techniques compared to power drilling for ORIF. Conclusions: Consideration of using self-drilling screwing techniques as well as maintaining physical distancing protocols may decrease risk of transmission of airborne diseases such as COVID-19 while in the intraoperative setting. Full article

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7 pages, 687 KiB

Open AccessArticle

Facial Trauma During the COVID-19 Pandemic

by Kiranya E. Tipirneni, Amanda Gemmiti, Mark A. Arnold and Amar Suryadevara

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 318-324; https://doi.org/10.1177/19433875211053760 - 27 Dec 2021

Cited by 7 | Viewed by 31

Abstract

Study Design: Retrospective cohort study. Objective: The purpose of this study is to evaluate the impact of the COVID-19 global pandemic on the regional trends in facial trauma at a tertiary care, level 1 trauma center in Central New York. Methods: The study [...] Read more.

Study Design: Retrospective cohort study. Objective: The purpose of this study is to evaluate the impact of the COVID-19 global pandemic on the regional trends in facial trauma at a tertiary care, level 1 trauma center in Central New York. Methods: The study sample was derived from the population of patients who presented with facial trauma to the emergency department at the Downtown and/or Community Campuses of SUNY Upstate University Hospital between 1 March 2020, and 15 May 2020, and compared to two historical controls in 2018 and 2019. Descriptive and bivariate statistics were calculated for study variables in each cohort. Poisson regression was used to compare incident rate ratios (IRR) with 95% confidence intervals with significance set at p < 0.05. Results: Sixty five patients presented during the COVID-19 pandemic, while 83 presented in 2019 and 95 in 2018. For the study period, the most common mechanism was assault in 47.7%. IRR was significantly lower than in 2018 (IRR = 1.46, p = 0.018), but not significantly different from 2019 (IRR = 1.28, p = 0.14). During lockdown, IRR was significantly decreased compared to 2019 (IRR = 1.84, p = 0.0029) and 2018 (IRR = 2.16, p < 0.001). Conclusions: The volume of facial trauma seen in Central New York appears undeterred in the absence of “shelter in place” orders. Analysis of pandemic and regional trauma variations can offer valuable insight for improved resource allocation to better prepare for potentially high-risk procedures. Full article

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8 pages, 807 KiB

Open AccessReview

Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review

by Vikas S. Kotha, Brandon J. de Ruiter, M. Grace Knudsen, Marvin Nicoleau and Edward H. Davidson

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 379-386; https://doi.org/10.1177/19433875211059330 - 9 Dec 2021

Cited by 1 | Viewed by 49

Abstract

Study Design: Systematic review. Objective: There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy [...] Read more.

Study Design: Systematic review. Objective: There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation. Methods: PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II). Results: Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04–20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (p = 0.043). Conclusions: For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered. Full article

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8 pages, 888 KiB

Open AccessArticle

Can an App-Based Maxillofacial Trauma Score Predict the Operative Time, ICU Need and Length of Stay?

by Ashutosh Kumar Singh, Safal Dhungel, Zeeshan Ahmad and Simon Holmes

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 332-339; https://doi.org/10.1177/19433875211055598 - 3 Dec 2021

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Abstract

Study Design: Retrospective chart review. Objective: Injury and trauma scores are the mainstay of predicting outcomes of trauma patients. ZS (Zeeshan and Simon) maxillofacial trauma score is based on 4 previous facial trauma scores and is user friendly, app-based visually coded facial trauma [...] Read more.

Study Design: Retrospective chart review. Objective: Injury and trauma scores are the mainstay of predicting outcomes of trauma patients. ZS (Zeeshan and Simon) maxillofacial trauma score is based on 4 previous facial trauma scores and is user friendly, app-based visually coded facial trauma scoring system. Our study was designed to seek the application of an app-based ZS maxillofacial trauma score to predict the operative time, intensive care unit (ICU) need and length of stay. Methods: We performed a retrospective chart review of patients who presented to a university medical college teaching hospital with maxillofacial fractures from October 2018 until October 2019. ZS maxillofacial trauma scoring app was used to calculate the ZS maxillofacial trauma severity score, which was our primary predictor variable. Our primary outcome of interest was operative time. Our secondary outcome of interest was ICU need and length of stay. Correlation analysis, linear regression and logistic regression were performed for statistical analysis. A statistical P-value of 0.05 was considered significant at a 95% confidence interval. Results: There were 95 male and 5 female patients included in the study. The age ranged from 3 to 84 years with a mean of 30.76 (SD = 14.04). A statistically significant correlation between the ZS score and operative time (r = 0.67, P < 0.001) was observed. ZS score predicted operative time (b₁ = 7.67, P < 0.001) in our study sample. Increasing ZS trauma score was also significantly associated with ICU requirement (X²(3) = 13.682, P = 0.003), but the length of stay could not be predicted based on ZS score. Conclusions: ZS maxillofacial trauma score can predict the operative time, and an association was seen with the need for ICU with increasing ZS score, but could not predict the length of stay or the ICU need. It has potential for future integration with electronic health record systems. Full article

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7 pages, 942 KiB

Open AccessArticle

Falls From Height, Facial Injuries and Fatalities: An Institutional Review

by Pasquale G. Mollica, Ellie C. McEwen and Gary R. Hoffman

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 325-331; https://doi.org/10.1177/19433875211055356 - 20 Nov 2021

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Abstract

Study Design: Retrospective cohort review. Objective: To investigate the relationship between falls from height and facial injuries. Methods: This is a retrospective cohort study, conducted over a 7-year period, of the medical records of all patients who presented to hospital for a maxillofacial [...] Read more.

Study Design: Retrospective cohort review. Objective: To investigate the relationship between falls from height and facial injuries. Methods: This is a retrospective cohort study, conducted over a 7-year period, of the medical records of all patients who presented to hospital for a maxillofacial injury following a fall from height. Fall heights were classified as low falls (1–3 m), high falls (3–10 m) and very high falls (≥10 m). Results: A total of 111 patients with 218 facial bone fractures were identified (78 men, 33 women and mean age 50.3 years). High falls were the most common (n = 58, 52.3%). Multiple fractures were identified in 51 (46.0%) patients. Orbital and middle third fractures were the most prevalent. Nasal, mandible, bilateral and fractures involving more than one facial third, increased as fall height increased, as did the requirement for operative fixation. The majority of patients had an associated injury (n = 100, 90.1%) and overall mortality was 6.3%. Conclusions: Falls from height are prevalent and there is a trend towards increased severity of facial injury, surgical intervention and associated morbidity as fall height increases. Falls from height are a significant public health concern and an important facet of maxillofacial trauma to recognise, as is the requirement for an interdisciplinary approach as they present to hospital. Full article

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8 pages, 1520 KiB

Open AccessArticle

The Role of Bone Grafts in Preventing Medication-Related Osteonecrosis of the Jaw: Histomorphometric, Immunohistochemical, and Clinical Evaluation in Animal Model

by Jonathan Ribeiro da Silva, Maria Cristina de Moraes Balbas, Caroline Águeda Corrêa, Manuella Zanela, Roberta Okamoto, Rodrigo dos Santos Pereira, Nicolas Homsi and Eduardo Hochuli-Vieira

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 304-311; https://doi.org/10.1177/19433875211048367 - 30 Oct 2021

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Abstract

Objective: To evaluate the effects of inorganic bovine bone graft (Lumina Bone, Criteria, Brazil) and beta-tricalcium phosphate (b-TCP) graft (ChronOS, Synthes, Brazil) in rats with the risk of developing post-extraction medication-related osteonecrosis of the jaw (MRONJ). Methods: Eighteen male Wistar rats weighing 350 [...] Read more.

Objective: To evaluate the effects of inorganic bovine bone graft (Lumina Bone, Criteria, Brazil) and beta-tricalcium phosphate (b-TCP) graft (ChronOS, Synthes, Brazil) in rats with the risk of developing post-extraction medication-related osteonecrosis of the jaw (MRONJ). Methods: Eighteen male Wistar rats weighing 350 to 450 g were induced to develop MRONJ using zoledronic acid for 5 weeks. In the sixth week, the right maxillary first molar was extracted. The animals in Group I (G1) did not receive bone grafts after tooth extraction, while Group II (G2) animals received inorganic bovine bone grafts, and Group III (G3) animals received beta-tricalcium phosphate (b-TCP) grafts. Clinical evaluation and histomorphometric and immunohistochemical analyses were performed. ANOVA and Tukey’s statistical tests were used and a level of significance was considered to be 5%. Results: In the clinical evaluation, animals from G2 and G3 did not present clinical manifestations of osteonecrosis, unlike the control group (G1) animals, which presented necrotic bone tissue exposure in all samples. In the histomorphometric evaluation, animals in G3 showed greater formation of bone tissue (66%) and less formation of bone lacuna (18%) than animals in G1 (58%/32%) and in G2 (59%/27%) (p < 0.05). Moderate (++) immunostaining was observed in G2 and G3 for RANKL, TRAP, and OC, while G1 showed moderate (++) labeling for OC and mild (+) immunostaining for TRAP and RANKL. Conclusions: Greater formation of bone tissue and fewer bone lacunae were found in animals treated with b-TCP. In clinical evaluation, bone graft groups presented with the clinical manifestation of MRONJ and showed higher intensity of immunostaining for TRAP and RANKL. Despite the limitations of experimental animal studies, the results of this work may assist in the development of future clinical research for the prevention of MRONJ. Full article

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9 pages, 658 KiB

Open AccessArticle

Policies and Price Tags: The Public’s Perception of Face Transplantation and Its Funding

by Mya Abousy, Hillary Jenny, Helen Xun, Nima Khavanin, Francis Creighton, Patrick Byrne, Damon Cooney, Richard Redett and Robin Yang

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 295-303; https://doi.org/10.1177/19433875211047025 - 18 Oct 2021

Cited by 1 | Viewed by 49

Abstract

Study Design: Survey study. Objective: Facial vascularized composite allotransplantation (FVCA) can cost over 1 million dollars per procedure and is usually not covered by insurance, yet this financial burden and public opinion surrounding this procedure are not well understood. This study is the [...] Read more.

Study Design: Survey study. Objective: Facial vascularized composite allotransplantation (FVCA) can cost over 1 million dollars per procedure and is usually not covered by insurance, yet this financial burden and public opinion surrounding this procedure are not well understood. This study is the first to evaluate the layperson’s opinions on the allocation of financial responsibility for FVCA and its inclusion in organ donation registries. Methods: Eight hundred and fifteen laypersons were surveyed through MTurk to assess their agreement with 11 statements about FVCA perceptions, funding, and inclusion on organ donation registries. Responses were analyzed with the Wilcoxon Signed-Rank test, the Kruskal-Wallis test, and the Dunn’s test. Results: The majority of respondents were supportive of FVCA in 10 out of 11 statements (p < 0.0001). They would be willing to undergo FVCA if they suffered from facial disfigurement; believe FVCA is as important as other organ transplants; believe faces should be included on the organ donation registry; support insurance companies providing coverage for FVCA regardless of trauma etiology; support tax dollars funding the procedure; and believe FVCA improves physical appearance and quality of life. Although respondents generally supported their tax dollars funding the procedure, fewer supported this for self-inflicted trauma (p > 0.01). Conclusions: This study highlights a disconnect between public preference for insurance coverage of FVCA and current lack of coverage in practice. Respondents’ acceptance of including faces in organ donation registries may help alleviate the issue of locating a donor, and increasing financial coverage may broaden this procedure’s accessibility to a wider range of individuals. Full article

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10 pages, 1174 KiB

Open AccessCase Report

Introduction of 3D Printing in a German Municipal Hospital—Practice Guide for CMF Surgery

by H Gleissner, G Castrillon-Oberndorfer and St Gehrlich

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 369-378; https://doi.org/10.1177/19433875211050721 - 30 Sep 2021

Cited by 2 | Viewed by 76

Abstract

Study Design: This study aimed to introduce 3D printing in a municipal hospital to improve the treatment of craniomaxillofacial patients and optimize costs and operating time. Thus we describe the implementation of low-cost in-house 3D printing to facilitate orbital- and mandible reconstruction in [...] Read more.

Study Design: This study aimed to introduce 3D printing in a municipal hospital to improve the treatment of craniomaxillofacial patients and optimize costs and operating time. Thus we describe the implementation of low-cost in-house 3D printing to facilitate orbital- and mandible reconstruction in CMF surgery. Moreover, we address legal requirements, safety at work, fire- and data protection. Finally, we want to share our experiences using 3D printing and point out its advantages in providing better patient care. Methods: We outline the setup of in-house 3D printing and focus on obeying German health care regulations. We based our approach on a fused deposition modeling 3D printer and free software. As proof of concept, we treated 4 cases of severe orbital trauma and 1 case of mandibular reconstruction. We printed a 3D patient-specific model for each case and adapted a titanium mesh implant, respectively, a titanium reconstruction plate before performing the surgery. Results: Our approach reduced costs, duration of anesthesia, operating time, recovery time, and postoperative swelling and increased the revenue. Functional outcome in orbital reconstruction like eye movement and double vision, was improved compared to the conventional technique. No severe complications like loss-of-vision or surgical revision occurred. Likewise, mandibular reconstruction showed no plate loosening or plate fracture. Conclusion: The implementation of cost-efficient 3D printing resulted in successful patient treatment with excellent outcomes. Our practice guide offers a 3D printing workflow and could be adapted to fit the needs of other specialties like neurosurgery, orthopedic surgery as well. Full article

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7 pages, 856 KiB

Open AccessArticle

A Demographic Analysis of Craniomaxillofacial Trauma in the Era of COVID-19

by Robert C. Clark, Bijal Desai and Edward H. Davidson

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 288-294; https://doi.org/10.1177/19433875211047037 - 15 Sep 2021

Cited by 2 | Viewed by 49

Abstract

Study Design: Retrospective cohort study. Objective: The challenges of COVID-19 could magnify socioeconomic vulnerability for craniomaxillofacial (CMF) trauma. This study compares subjects who presented with CMF fractures to a regional healthcare system during the pandemic with those in 2019. We hypothesized societal circumstances [...] Read more.

Study Design: Retrospective cohort study. Objective: The challenges of COVID-19 could magnify socioeconomic vulnerability for craniomaxillofacial (CMF) trauma. This study compares subjects who presented with CMF fractures to a regional healthcare system during the pandemic with those in 2019. We hypothesized societal circumstances of 2020 would correlate with disproportionately more CMF fractures in vulnerable patients compared to pre-pandemic trends. Methods: An IRB approved retrospective study of CMF fracture presentations in 2019 and 2020 was performed. Demographics, injury details, and management details were collected. A residence-based poverty index was calculated for each subject utilizing census data. Pre-pandemic and pandemic cases were compared to identify differences between cohorts. Results: A large decrease in presentations was noted between pre-pandemic and pandemic cohorts. There was significantly greater poverty the pre-pandemic cohort as compared to the pandemic cohort (p = 0.026). Overall, there was a significant correlation between higher poverty and violent MOI (p < 0.001). This association was maintained pre-pandemic, (p = 0.001) but was insignificant in the pandemic cohort (p = 0.108). Difference between cohorts with respect to violent injury was non-significant (p = 0.559) with non-significant difference in demographics including age (p = 0.390), place of injury (p = 0.136), employment status (p = 0.905), insurance status (p = 0.580), marital status (p = 0.711), ethnicity (p = 0.068), and gender (p = 0.656). Management was not significantly different between cohorts including percent hospital admission (p = 0.396), surgical intervention (p = 0.120), and time to operation (p = 0.109). Conclusions: Contrary to our hypothesis, this analysis indicates that the societal changes brought on by the COVID-19 pandemic did not magnify vulnerable populations. Some changes were noted including in volume of presentation, demographic distribution, and injury detail. Full article

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9 pages, 565 KiB

Open AccessReview

Titanium Mesh Exposure After Bone Grafting: Treatment Approaches—A Systematic Review

by Giovanni Cunha, Pedro Henrique de Azambuja Carvalho, Lílian Caldas Quirino, Luiz Henrique Soares Torres, Valfrido Antônio Pereira Filho, Mario Francisco Real Gabrielli and Marisa Aparecida Cabrini Gabrielli

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 397-405; https://doi.org/10.1177/19433875211046114 - 14 Sep 2021

Cited by 9 | Viewed by 273

Abstract

Study Design: A systematic review according to PRISMA statement has been designed to answer the preliminary question: “In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?” and fill the PICO assessment out. Objective: To [...] Read more.

Study Design: A systematic review according to PRISMA statement has been designed to answer the preliminary question: “In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?” and fill the PICO assessment out. Objective: To review studies published in the past 20 years (1999–2019) in which mesh exposure has occurred, detecting the suitable approaches to treat exposure allowing the graft maintenance. Methods: Initial search on PUBMED, SCOPUS, and COCHRANE databases resulted in 777 articles, and hand-searching identified 6 articles. After removing duplicates and unrelated articles, eligibility criteria were applied, and 31 studies were selected (randomized clinical trials, retrospective/prospective clinical trials, and case series). Results: A total of 677 surgical sites and 225 cases of mesh exposure were identified. Eleven treatments have been identified. Chlorhexidine was the primary approach in 46% of cases, followed by oral hygiene instructions and follow-up with 22.5% of occurrences. In 21% of clinical situations, titanium mesh removal was the treatment of choice, associated with other measures (i.e., antibiotic prescription). There seems to be a consensus in cases of infection. When this complication was associated with tissue dehiscence, the primary treatment was mesh removal. The same does not occur when the site needs to be cleaned for long-term periods. Conclusion: In 2 decades of use of titanium meshes, the available treatments do not seem to have evolved, and there is not enough data to establish a guideline. Full article

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6 pages, 484 KiB

Open AccessArticle

Recreational Motorized Vehicle Use Under the Influence of Alcohol or Drugs Significantly Increases Odds of Craniofacial Injury

by Thomas J. Sorenson, Matthew D. Rich, Abhinav Lamba, Annika Deitermann, Ruth J. Barta and Warren Schubert

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 282-287; https://doi.org/10.1177/19433875211046721 - 14 Sep 2021

Cited by 2 | Viewed by 24

Abstract

Study Design: Cross-sectional study. Objective: Concurrent substance-use, including alcohol and drugs, increases the risks of many recreational activities. Our purpose was to determine the relationship between substance use and craniofacial injuries in a large population of patients experiencing trauma due to recreational motorized [...] Read more.

Study Design: Cross-sectional study. Objective: Concurrent substance-use, including alcohol and drugs, increases the risks of many recreational activities. Our purpose was to determine the relationship between substance use and craniofacial injuries in a large population of patients experiencing trauma due to recreational motorized vehicle use. Methods: We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from 1 January 2019 to 31 December 2019, in the United States. Patients were included in our study if they were evaluated in the emergency department (ED) for a recreational motorized vehicle-related injury. Primary outcome was craniofacial injury. Results: There were a total of 6485 adult patients who experience an injury after recreational motorized vehicle trauma reported by NEISS-participating EDs during the study period. Of this, 1416 (21.8%) patients had a craniofacial injury, and 201 patients with craniofacial injuries were under the influence of alcohol/drugs (201/1416; 14.2%). Injured patients under the influence of alcohol/drugs experienced greater odds of sustaining a general craniofacial injury (OR 2.50, 95% CI: 2.07–3.01, p < 0.0001), including craniofacial fracture (OR: 2.98, 95% CI: 2.01–4.40, p < 0.0001), laceration (OR: 2.19, 95% CI: 1.51–3.16, p < 0.00001) and internal injury (OR: 2.33, 95%CI: 1.84–2.95, p < 0.00001) than injured patients not under the influence. Conclusions: Using recreational motorized vehicles under the influence of alcohol or drugs is not safe and increases the likelihood of craniofacial injuries, including fractures, lacerations, and internal injuries. As operating these recreational motorized vehicles under the influence is illegal, the law should be strictly enforced to prevent the occurrence of these injuries. Additional undertakings to increase helmet usage would be valuable. Full article

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10 pages, 769 KiB

Open AccessReview

Recent Advances in Nasoalveolar Molding Therapy Using 3D Technology

by Sofia Ahsanuddin, Mairaj Ahmed, Leslie Slowikowski and Jenna Heitzler

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 387-396; https://doi.org/10.1177/19433875211044622 - 3 Sep 2021

Cited by 7 | Viewed by 91

Abstract

Presurgical Nasoalveolar Molding (NAM) is an adjunctive treatment modality designed to reorient misaligned tissue structures and nasal cartilage in cleft lip and/or palate (CL/P) patients. Recent advances in NAM therapy focus on modifications to the intraoral molding plate or nasal stent intended to [...] Read more.

Presurgical Nasoalveolar Molding (NAM) is an adjunctive treatment modality designed to reorient misaligned tissue structures and nasal cartilage in cleft lip and/or palate (CL/P) patients. Recent advances in NAM therapy focus on modifications to the intraoral molding plate or nasal stent intended to improve treatment outcomes, ease of use, compliance, and cost-effectiveness. Notably, 3D technological advancements have been employed to design NAM devices more efficiently and create objective, standardized means of measuring progressive morphological changes during therapy. These advances are designed to incorporate 3D technology in the treatment of cleft lip and/or palate to render it more precise, accurate, and time-efficient. Full article

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7 pages, 475 KiB

Open AccessArticle

Are Facial Gunshot Wounds More Fatal When They Are Self-Inflicted or Other-Inflicted?

by Kevin C. Lee, Brendan W. Wu and Sung-Kiang Chuang

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 275-281; https://doi.org/10.1177/19433875211039919 - 17 Aug 2021

Cited by 2 | Viewed by 70

Abstract

Study Design: This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample (NEDS). Objective: Intraoral and submental projectile entry points may be less fatal than other facial entry points due to the indirect access to the intracranial structures and the [...] Read more.

Study Design: This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample (NEDS). Objective: Intraoral and submental projectile entry points may be less fatal than other facial entry points due to the indirect access to the intracranial structures and the protection offered by the intervening maxillofacial complex. Because intraoral and submental trajectories are almost always present in the setting of attempted suicide, this study sought to determine if intent (self-harm versus other-harm) influenced mortality in facial gunshot wound (GSW) patients. Methods: All patients with a diagnosis of a facial fracture secondary to firearm injury were included in the study sample. The primary predictor was self-harm. Secondary predictors were derived from patient, injury, and hospitalization characteristics. The study outcome was death. Univariate time to event analyses were conducted for all study predictors. A multivariate regression model for mortality was created using all relevant predictors. Results: The final sample included 668 facial GSW injuries, of which 19.3% were attributed to self-harm. Self-inflicted GSWs were more likely to involve the mandible (58.9 vs 46.0%, p < 0.01), ZMC/maxilla (47.3 vs 32.5%, p < 0.01), and intracranial cavity (48.1 vs 22.6%, p < 0.01). The overall mortality rate was 7.3%, and the mean time to death was 2.2 days. After controlling for pertinent covariates, the risk of mortality was independently decreased with mandibular injury (HR = 0.36, p = 0.03). However, mortality was increased by self-harm intent (HR = 3.94, p < 0.01) and intracranial involvement (HR = 11.24, p < 0.01). Conclusions: Consistent with a pattern of intraoral and submental entry points, self-inflicted facial GSWs demonstrated higher rates of mandibular injury. Despite this finding, self-harm injuries still carried a higher incidence of intracranial injury and a greater independent risk of mortality. Our results refute any notion that the mechanism and trajectory of self-inflicted GSWs is less fatal. Full article

7 pages, 748 KiB

Open AccessArticle

Odontogenic Keratocyst: A Clinical Entity With Favorable Response to Active Decompression and Distraction Sugosteogenesis

by Juan-Pablo Porte, Lidia M. Guerrero, Bonifacio Rivera, Andres Wiscovitch and Jaime Castro-Núñez

Craniomaxillofac. Trauma Reconstr. 2022, 15(4), 268-274; https://doi.org/10.1177/19433875211035237 - 5 Aug 2021

Cited by 2 | Viewed by 58

Abstract

Objective: The purpose of this study was to determine the usefulness of active decompression and distraction sugosteogenesis (ADDS) for the management of non-syndromic odontogenic keratocysts (OKC). Materials and Methods: A retrospective case series study was designed and implemented. The study observed the Declaration [...] Read more.

Objective: The purpose of this study was to determine the usefulness of active decompression and distraction sugosteogenesis (ADDS) for the management of non-syndromic odontogenic keratocysts (OKC). Materials and Methods: A retrospective case series study was designed and implemented. The study observed the Declaration of Helsinki on medical protocol and ethics and it was approved by the university’s Institutional Review Board (IRB). The medical files of all patients who underwent ADDS for OKCs of the jaws at the Department of Oral and Maxillofacial Surgery of a tertiary university-affiliated medical center were reviewed. Data were collected on patient’s age, gender, presenting signs and symptoms, lesion location, locularity, pre-ADDS, size of the lesion, post-ADDS, pain, days with bloody discharge and/or proteinaceous fluid inside the system’s external unit, days to achieve hermetic seal, size of the lesion 2 weeks after ADDS, percentage of reduction, patient’s complaints/complications, and follow-up period. Preand post-ADDS panoramic radiographs were reviewed for reduction parameters. Results: Six patients, 5 males and 1 female, with an average age of 45.16 years (range 16–74 years) were studied. ADDS was performed during 4 weeks in all patients. During the therapy, the extraoral unit collected blood during 2.83 days in average. In average, after the third day, the cystic cavity started to drain a proteinaceous fluid for about 9.33 days (range 6–15 days). The average pre-ADDS Standard Lesional Area Index (SLAI) was 18.17 cm² (range 4.40 cm²–34.58 m²) and, after 2 weeks of ADDS, the average SLAI was 5.47 cm² (range 0.49 cm²–15.39 cm²). The average percentage of reduction, after 2 weeks, was 73.93% (range 55.49%–97.51%), which yielded an overall good reaction of OKCs to ADDS. No significant reduction of the lesions was observed from week 2 to week 4, when ADDS ceased. All lesions were enucleated after 3 months. After an average of 14 months of follow-up (12 to 17 months), no signs of recurrence have been observed. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 15, Issue 4 (December 2022) – 18 articles

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