Craniomaxillofacial Trauma & Reconstruction

1 pages, 458 KiB

Open AccessEditorial

New Beginnings

by Rui Fernandes and Sat Parmar

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 3; https://doi.org/10.1177/19433875231153527 - 16 Jan 2023

Cited by 1 | Viewed by 45

Abstract

The new year brings with it new possibilities [...] Full article

8 pages, 1216 KiB

Open AccessCase Report

Elevated Intracranial Pressure After Primary Surgical Correction of Sagittal Suture Craniosynostosis

by Rami P. Dibbs, Andrew M. Ferry, Lesley Davies, David F. Bauer, Edward P. Buchanan and Han Zhuang Beh

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 70-77; https://doi.org/10.1177/19433875211064680 - 11 Mar 2022

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Abstract

Study Design: A Case Report. Objective: Craniosynostosis is a craniofacial condition defined by premature fusion of at least one cranial suture. Resynostosis or secondary craniosynostosis of a previously patent adjacent suture following primary repair is a relatively common complication. While studies have assessed [...] Read more.

Study Design: A Case Report. Objective: Craniosynostosis is a craniofacial condition defined by premature fusion of at least one cranial suture. Resynostosis or secondary craniosynostosis of a previously patent adjacent suture following primary repair is a relatively common complication. While studies have assessed the rates of secondary craniosynostosis and subsequent reoperation, extremely limited data regarding reoperation techniques is available. Methods: We present a unique case of a pediatric patient with sagittal craniosynostosis who previously underwent a modified pi procedure and later developed resynostosis of the sagittal suture and secondary synostosis of the bicoronal sutures. We subsequently performed total cranial vault reconstruction with virtual surgical planning (VSP). Results: At his 31-month postoperative follow-up, he displayed normal head shape and denied any clinical signs of elevated intracranial pressures with a normal ophthalmological exam. Conclusions: The reoperation was successful with no significant postoperative complications noted. Performing geometric expansion with VSP to manage fusion of a previously open suture following primary treatment of sagittal synostosis should be considered within the armamentarium of operative options. Full article

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8 pages, 776 KiB

Open AccessReview

Systematic Review of Laryngeal Fractures and Trends in Operative Management

by Annie E. Moroco, Vijay A. Patel, Robert A. Saadi, John P. Gniady and Jessyka G. Lighthall

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 62-69; https://doi.org/10.1177/19433875221074847 - 22 Feb 2022

Cited by 3 | Viewed by 59

Abstract

Study Design: Systematic review of the literature. Objective: The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Methods: Independent searches of the PubMed and MEDLINE databases were performed. Articles from the [...] Read more.

Study Design: Systematic review of the literature. Objective: The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Methods: Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 1963 to 2020 were collected. All studies which described laryngeal fractures using the Boolean method and relevant search term combinations, including “Laryngeal”, “Fracture”, “Operative”, and “Management” were collected. Results: A total of 588 relevant unique articles were identified for analysis. Of these, 24 articles were deemed appropriate for inclusion 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: Laryngeal fractures are rare traumatic injuries that require early identification and evaluation with complex management options. This comprehensive review aims to highlight the breadth of the topic with regard to presentation and clinical management. Though there remains no clear best practice for laryngeal fracture management, we review trends in clinical practice throughout the literature. Full article

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16 pages, 3700 KiB

Open AccessArticle

Complicated Facial Lacerations: Challenges in the Repair and Management of Complications by a Facial Trauma Team

by Moumita De, Sushma Sagar, Aniket Dave, Ruchi Pathak Kaul and Maneesh Singhal

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 39-54; https://doi.org/10.1177/19433875211064512 - 1 Feb 2022

Cited by 1 | Viewed by 69

Abstract

Study Design: This is a descriptive study where we present our experience in managing complicated facial wounds over a period of 1 year at a level 1 trauma centre by a dedicated facial trauma team consisting of a plastic surgeon, a trauma surgeon [...] Read more.

Study Design: This is a descriptive study where we present our experience in managing complicated facial wounds over a period of 1 year at a level 1 trauma centre by a dedicated facial trauma team consisting of a plastic surgeon, a trauma surgeon and a Maxillofacial surgeon. Objective: Facial deformities have profound impact on the social and psychological aspect of a person’s life. Hence, management of facial wounds is very crucial. Most of the facial injuries are usually managed by emergency care physician and emergency surgeon. But certain wounds require specialised knowledge and care due to their complicated nature. The objective of this paper is to highlight those special types of wounds and the challenges they pose. It also aims to enumerate the best possible management according to each situation in a protocol-based manner, which will help in decision making by the attending emergency physician/surgeon. Methods: Facial lacerations were designated as “complicated” according to some pre-defined features and pre, intra and post operative data and photographs were collected by interviewing the concerned surgical team. The data were analysed and presented as different clinical scenarios. Results: The cases were broadly grouped under 6 scenarios according to the unique combination of difficulties faced and their specific management. The challenges faced were enumerated and the steps undertaken were also mentioned against them. Lastly, the scenarios were compared with available literature to find out the best possible management in each situation and to present them in a protocol-based manner. Conclusion: Protocol-based management of injuries to the different parts and specialised structures of the face is extremely helpful. Role of a specialised facial trauma team also should be emphasised in complicated facial injuries. Full article

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5 pages, 539 KiB

Open AccessArticle

Likelihood of Craniofacial Injury and Hospitalization with Alcohol Use While Skateboarding and Scootering

by Thomas J. Sorenson, Matthew D. Rich, Annika Deitermann, Rachael Gotlieb, Nicholas Garcia, Ruth J. Barta and Warren Schubert

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 34-38; https://doi.org/10.1177/19433875211069219 - 21 Jan 2022

Cited by 1 | Viewed by 47

Abstract

Study Design: We designed a cross-sectional epidemiologic study to evaluate the influence of substance use on craniofacial injuries in a population of skateboard and scooter users. Objective: The primary outcome of our study was craniofacial injury. The secondary outcome was hospitalization. Methods: We [...] Read more.

Study Design: We designed a cross-sectional epidemiologic study to evaluate the influence of substance use on craniofacial injuries in a population of skateboard and scooter users. Objective: The primary outcome of our study was craniofacial injury. The secondary outcome was hospitalization. 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 2020, in the United States. Patients were included in our study if they were evaluated in the emergency department (ED) for a skateboard- or scooter-related injury. Results: There were over 5396 total patients who presented to a NEISS-participating ED after skateboard- or scooterrelated trauma during the study period. There were 1136 patients with a craniofacial injury (primary endpoint), and patients under the influence of alcohol or drugs had greater odds of experiencing a craniofacial injury than those not under the influence (odds ratio [OR]: 4.16, 95% confidence interval [CI]: 3.24-5.32, p < 0.0001). Four hundred-thirty patients were hospitalized (secondary endpoint), and patients under the influence had greater odds of being hospitalized than those not under the influence (OR: 2.83, 95% CI: 2.04-3.91, p < 0.0001). Conclusions: Alcohol and drug use while skateboarding or scootering drastically increases the likelihood of craniofacial injury and subsequent hospitalization and should be avoided whenever possible. The importance of wearing a helmet while operating these devices cannot be overstated. Full article

7 pages, 871 KiB

Open AccessArticle

Analysis of Neoclassical Canons in Adult Kenyans of Indian Descent

by Krishan Sarna, Tom Mulama Osundwa, Martin Kamau and Khushboo Jayant Sonigra

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 55-61; https://doi.org/10.1177/19433875221077005 - 19 Jan 2022

Cited by 1 | Viewed by 46

Abstract

Study Design: Descriptive cross-sectional. Objective: To establish anthropometric norms and test the validity of four neoclassical canons among Kenyans of Indian descent. Methods: Using direct anthropometric landmarks, 3 vertical and 4 horizontal measurements were made on the faces of 130 adult Kenyans of [...] Read more.

Study Design: Descriptive cross-sectional. Objective: To establish anthropometric norms and test the validity of four neoclassical canons among Kenyans of Indian descent. Methods: Using direct anthropometric landmarks, 3 vertical and 4 horizontal measurements were made on the faces of 130 adult Kenyans of Indian descent. The mean of each anthropometric measurement was calculated and a student t-test was used to identify significant gender differences. These results were compared to four neoclassical canons and the percentage of each canon and its variants were recorded. A chi-square test was then performed to assess any gender differences between these findings. Results: When comparing sexes, the anthropometric means of males were larger than those of females except for eye fissure length. In addition, only the upper third displayed sexual dimorphism. As for the neoclassical canons, the orbital canon was found to apply to 20.0% of males and 21.6% of females, followed by the naso-oral canon found in 16.4% of males and 17.6% of females, and the orbito-nasal canon present in 14.5% of males and 18.9% of females. The vertical canon was not found to be applicable to any participant. Conclusion: The facial morphometricmeasurements in this population differ from the described neoclassical canons since they do not apply to the majority of these individuals. Therefore surgeons should be guided by the observed populationspecific differences during reconstructive and facial aesthetic surgery. Full article

11 pages, 864 KiB

Open AccessArticle

Comparison of Teriparatide and Combination of Cissus Quadrangularis and Dalbergia Sissoo on Bone Healing Against the Control Group in Maxillofacial Fractures: A Randomized Open-Label Control Trial

by Gigi PG, Ankita Chugh, Kirti Chaudhry, Amanjot Kaur, Pravin Kumar, Shubham Gaur, Shailendra Kumar and Surjit Singh

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 23-33; https://doi.org/10.1177/19433875211067007 - 19 Jan 2022

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Abstract

Study Design: Randomized Control Trial. Objective: A randomized control trial was planned to aim to assess whether subcutaneous Injection of Teriparatide and Tablet Reunion (combination of Cissus Quadrangularis and Dalbergia sissoo) improves maxillofacial fracture healing as compared to the control group. Methods: 24 [...] Read more.

Study Design: Randomized Control Trial. Objective: A randomized control trial was planned to aim to assess whether subcutaneous Injection of Teriparatide and Tablet Reunion (combination of Cissus Quadrangularis and Dalbergia sissoo) improves maxillofacial fracture healing as compared to the control group. Methods: 24 patients of mandibular fracture with or without concomitant maxillofacial fractures were randomly divided into 3 equal groups (Group 1—Control, Group 2—Tablet Reunion, and Group 3—Injection Teriparatide) and the treatment duration was 4 weeks. Pain, fracture site mobility, bite force, serum markers, and radiographic healing were assessed preoperatively and postoperatively at regular intervals till 12 weeks. Results: Group 2 showed early pain relief, although it was insignificant. Group 3 showed the highest anterior bite force at all the time points. Change in mean posterior bite force (PBF) showed a statistically significant increase at 8th week and 12th week in intergroup comparison; however, at 12thweek, Group 3was significantly better than Group 1 and reported the highest posterior bite force compared to other groups. Serum calcium and PTH level showed no significant difference, whereas SerumALP showed a statistically significant increase in Group 3. The radiographic assessment showed no significant difference among the 3 groups. Conclusions: Both the intervention group drugs showed a promising effect on accelerating the fracture healing and improving bite force restoration with the osteoanabolic action; however, early radiographic healing and increased serum osteogenic markers in Group 3 indicate its possible optimistic role in maxillofacial fracture healing. Full article

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8 pages, 740 KiB

Open AccessArticle

The Most Dangerous Game: A Review of Head and Neck Injuries in American Football and Rugby

by Jordan Richardson, Dani Stanbouly, Harrison Moynihan, Renée M. Reynolds, Matthew J. Recker and Michael R. Markiewicz

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 15-22; https://doi.org/10.1177/19433875211073437 - 13 Jan 2022

Cited by 2 | Viewed by 334

Abstract

Study Design: The investigators designed and implemented a 20-year cross-sectional study using the National Electronic Injury Surveillance System database. Objective: The purpose of this study is to estimate and compare hospital admission (danger) rates between rugby and football of those who presented to [...] Read more.

Study Design: The investigators designed and implemented a 20-year cross-sectional study using the National Electronic Injury Surveillance System database. Objective: The purpose of this study is to estimate and compare hospital admission (danger) rates between rugby and football of those who presented to the emergency department with head and neck injuries after playing these sports. Methods: The primary predictor variable was sport played. The primary outcome variable was danger, measured by hospital admission rates. Results: Over the past 20 years, there has been a trend of decreasing incidence of injuries presenting to the emergency department in both sports. There was no difference in the rate of hospital admission when comparing football and rugby (OR, 1.2; p = 0.1). Male gender was associated with an increased risk of admission. Other variables associated with hospital admission included white racial group, injury taking place in the fall, being either young (15–24 years old) or senior (65 years of age and over), and being injured at school or at a sport/recreational facility. Conclusions: There is no difference in danger as measured by admission rates between American football and rugby. There exists, however, several variables that are associated with admission when sustaining injury to the head and neck, when playing these two sports. Full article

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5 pages, 807 KiB

Open AccessArticle

Associated Injuries Related to Patients with Facial Fractures

by Rajarshi Ghosh and Kulandaswamy Gopalkrishnan

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 10-14; https://doi.org/10.1177/19433875211069024 - 3 Jan 2022

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Abstract

Study Design: Retrospective Study. Objective: To find out the incidence, type, and severity of injuries in other parts of the body in patients diagnosed with facial fractures. The study also analyzed any correlation between these injuries and facial fractures. Methods: A retrospective study [...] Read more.

Study Design: Retrospective Study. Objective: To find out the incidence, type, and severity of injuries in other parts of the body in patients diagnosed with facial fractures. The study also analyzed any correlation between these injuries and facial fractures. Methods: A retrospective study of 991 patients with facial fractures during the period of 2006–2016. Results: 111 patients reported associated injuries (11.1%). The most common type of injury was limb injury (33.33%), followed by head injury (22.5%), clavicle fracture (14.7%), rib fracture (10.9%), cervical spine injury (5.4%), and other injuries constituted (13.2%). Multiple associated injuries were observed in 14% of patients. Conclusion: The findings show that facial fracture management is a multidisciplinary approach. Prompt diagnosis and proper management are important to reduce the mortality rate and improve the prognosis of the patient. Full article

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6 pages, 795 KiB

Open AccessArticle

The ‘Maxillary Pull-Through’ Technique: A Minimally Invasive Endoscopic-Assisted Approach to Nasal Septum Neoformations with Maxillary Bone Infiltration

by Paolo Priore, Filippo Giovannetti, Andrea Battisti, Danilo Di Giorgio, Marco Della Monaca, Ingrid Raponi, Andrea Cassoni and Valentino Valentini

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 78-83; https://doi.org/10.1177/19433875211067010 - 29 Dec 2021

Cited by 4 | Viewed by 60

Abstract

Study Design: Description and validation of a surgical technique. Objective: En-bloc maxillectomy with removal of the nasal septum is a rare procedure; preservation of the nasal bones and integrity of the alveolar ridge is even rarer. These procedures traditionally required a combined transfacial-transoral [...] Read more.

Study Design: Description and validation of a surgical technique. Objective: En-bloc maxillectomy with removal of the nasal septum is a rare procedure; preservation of the nasal bones and integrity of the alveolar ridge is even rarer. These procedures traditionally required a combined transfacial-transoral approach based on lateral rhinotomy. We describe a combined endoscopic transnasal-transoral approach for treatment of nasal septal malignancies that involve the hard palate. Methods: Excision of malignant tumours arising from the nasal septum was achieved in 4 patients using a transnasaltransoral endoscopic approach. Using 4-mm optics angled at 0° and 30°, the septum was freed from the ethmoid and removed en-bloc with the hard palate, by pulling the septum down through the hard palate. Results: Of the 4 patients, 2 underwent complete removal of septal chondrosarcomas, one removal of a sinonasal undifferentiated carcinoma and one removal of a mucoepidermoid carcinoma. In two cases, the palatal mucosa was spared and repositioned to restore separation between the nose and oral cavity. The remaining two cases underwent complete resection of the hard palate; one palate was reconstructed using a pedicled temporalis muscle flap and the other by employing an obturator. No infection was encountered. Partial ethmoidectomy was performed in all four cases. The mean hospital stay was 5 days. All patients are free of disease after a mean follow-up of 4 years (range: 2–7 years). Conclusions: Our new approach allows for minimally invasive resection of nasal septal malignancies that extend to the palate. Our maxillary pull-through technique is a valuable new surgical procedure for malignant pathologies of the nasal septum; the only drawback is that endoscopic surgery has a steep learning curve. Full article

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6 pages, 619 KiB

Open AccessArticle

Epidemiology of Blindness from Facial Trauma: A Multi-Centre Nigerian Study

by Bamidele A. Famurewa, Fadekemi Olufunmilayo Oginni, Bolajoko A. Adewara, Benjamin Fomete, Chukwudi Aniagor, Bayo Aluko-Olokun, Regina E. Morgan and McKing I. Amedari

Craniomaxillofac. Trauma Reconstr. 2023, 16(1), 4-9; https://doi.org/10.1177/19433875211060931 - 9 Dec 2021

Cited by 3 | Viewed by 95

Abstract

Study Design: This is a multi-centre retrospective study. Objective: To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians. Methods: A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by [...] Read more.

Study Design: This is a multi-centre retrospective study. Objective: To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians. Methods: A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by maxillofacial surgeons and ophthalmologists in 4 Nigerian public tertiary hospitals between January 2010 and December 2019 was undertaken. Data was analysed by IBM SPSS Statistics (version 21.0 for windows, IBM© Inc, Chicago, IL, USA). Results: Of 2070 patients who presented with major facial injuries during the study period, 61 eyes of 56 (2.7%) patients were blind. Blindness was bilateral and unilateral in 5 (8.9%) and 51 (92.1%) patients, respectively. The mean age (SD) at presentation was 36.2 (16.6) years, and 47 (83.9%) of these patients were males. Road traffic accident (n = 27; 48%) was the commonest mechanism of facial trauma, the cheek (n = 18; 40.9%) was the commonest site of associated soft tissue injury and zygomatic complex fracture (n = 19; 24.1%) was the commonest related fracture. Globe rupture (n = 34; 55.7%) was the leading cause of blindness. Enucleation (n = 7; 13.2%) and evisceration (n = 22; 41.5%) were performed on 29 eyes of which 12 (41.4%) patients had ocular prosthesis post-operatively. Conclusions: Blindness was recorded in 2.7% of Nigerians with facial trauma. The commonest mechanism of trauma and cause of blindness in at least one eye were road traffic accident and globe rupture, respectively. Eye removal surgery was necessary in about half of the blind eyes. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 16, Issue 1 (March 2023) – 11 articles

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