Craniomaxillofacial Trauma & Reconstruction

2 pages, 662 KiB

Open AccessEditorial

Editorial

by Sat Parmar and Rui Fernandes

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 87-88; https://doi.org/10.1177/19433875231167030 - 8 Apr 2023

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It is with a heavy heart that we write our last Editorial for the CMTR journal and yet it is an honor to dedicate this to our friend, colleague, and my previous boss, Andrew Baker, who tragically passed away in a road traffic [...] Read more.

It is with a heavy heart that we write our last Editorial for the CMTR journal and yet it is an honor to dedicate this to our friend, colleague, and my previous boss, Andrew Baker, who tragically passed away in a road traffic accident in South Africa on 3 February 2023 [...] Full article

9 pages, 1506 KiB

Open AccessArticle

Nine Years of Retrospective Study of Mandibular Fractures in Semi-urban Teaching Hospital, Shimla, Himachal Pradesh, India

by Narotam K. Ghezta, Yogesh Bhardwaj, Rangila Ram, Monika Parmar, Rowena N. Basi and Pooja Thakur

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 138-146; https://doi.org/10.1177/19433875221095984 - 3 May 2022

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Abstract

Study Design: Retrospective study. Objective: To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. Methods: In this retrospective study, records of 910 patients with mandibular fractures were reviewed [...] Read more.

Study Design: Retrospective study. Objective: To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. Methods: In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded. Results: It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21–30 years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%. Conclusions: To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role. Full article

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9 pages, 670 KiB

Open AccessReview

Plastic and Maxillofacial Training for War-Zones—A Systematic Review

by Tiffanie-Marie Borg, Naveen Cavale, Ghassan Abu-Sittah and Ali Ghanem

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 154-162; https://doi.org/10.1177/19433875221083416 - 2 May 2022

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Abstract

Study Design: Injuries sustained in war-zones are variable and constantly developing according to the nature of the ongoing conflict. Soft tissue involvement of the extremities, head and neck often necessitates reconstructive expertise. However, current training to manage injuries in such settings is heterogenous. [...] Read more.

Study Design: Injuries sustained in war-zones are variable and constantly developing according to the nature of the ongoing conflict. Soft tissue involvement of the extremities, head and neck often necessitates reconstructive expertise. However, current training to manage injuries in such settings is heterogenous. This study involves a systematic review. Objective: To evaluate interventions in place to train Plastic and Maxillofacial surgeons for war-zone environments so that limitations to current training can be addressed. Methods: A literature search of Medline and EMBase was performed using terms relevant to Plastic and Maxillofacial surgery training and war-zone environments. Articles that met the inclusion criteria were scored then educational interventions described in included literature were categorised according to their length, delivery style and training environment. Between-group ANOVA was performed to compare training strategies. Results: 2055 citations were identified through this literature search. Thirty-three studies were included in this analysis. The highest scoring interventions were over an extended time-frame with an action-oriented training approach, using simulation or actual patients. Core competencies addressed by these strategies included technical and non-technical skills necessary when working in war-zone type settings. Conclusions: Surgical rotations in trauma centers and areas of civil strife, together with didactic courses are valuable strategies to train surgeons for war-zones. These opportunities must be readily available globally and be targeted to the surgical needs of the local population, anticipating the types of combat injuries that often occur in these environments. Full article

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8 pages, 879 KiB

Open AccessArticle

Extracorporealization of the Mandibular Condyle: Effects on Viability and Function

by Max R. Emmerling, Meghan LaVigne, Gary Warburton, John F. Caccamese and Robert A. Ord

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 130-137; https://doi.org/10.1177/19433875221095989 - 2 May 2022

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Abstract

Study Design: For certain condylar fractures, extracorporealization of the condylar segment may be performed via extraoral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condylesparing resection of osteochondromas of the condyle. Due to controversy regarding [...] Read more.

Study Design: For certain condylar fractures, extracorporealization of the condylar segment may be performed via extraoral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condylesparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we conducted a retrospective analysis of surgical outcomes. Objective: For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condylesparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we investigated the viability of this technique through a retrospective analysis of outcomes. Methods: Twenty-six patients were treated using EVRO with extracorporealization of the condyle for both condylar fractures (18 patients) and osteochondroma (8 patients).Of the 18 trauma patients, 4 were excluded due to limited followup. Clinical outcomes were measured, including occlusion, maximum interincisal opening (MIO), facial asymmetry, incidence of infection, and temporomandibular joint (TMJ) pain. Radiographic signs of condylar resorption were investigated, quantified, and categorized using panoramic imaging. Results: Average follow-up was 15.9 months. Average maximum interincisal opening was 36.8 mm. Four patients demonstrated mild resorption and one patient demonstrated moderate resorption. Two cases of malocclusion were attributed to failed repairs of other concurrent facial fractures. Three patients reported TMJ pain. Conclusions: Extracorporealization of the condylar segment with EVRO to facilitate open treatment of condylar fractures is a viable treatment option when more conventional approaches prove unsuccessful. Full article

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9 pages, 959 KiB

Open AccessArticle

Printing in Time for Cranio-Maxillo-Facial Trauma Surgery: Key Parameters to Factor in

by Léonard Bergeron, Michelle Bonapace-Potvin and François Bergeron

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 121-129; https://doi.org/10.1177/19433875221083231 - 20 Apr 2022

Cited by 3 | Viewed by 78

Abstract

Study Design: retrospective cohort study. Objective: 3D printing is used extensively in cranio-maxillo-facial (CMF) surgery, but difficulties remain for surgeons to implement it in an acute trauma setting because critical information is often omitted from reports. Therefore, we developed an in-house printing pipeline [...] Read more.

Study Design: retrospective cohort study. Objective: 3D printing is used extensively in cranio-maxillo-facial (CMF) surgery, but difficulties remain for surgeons to implement it in an acute trauma setting because critical information is often omitted from reports. Therefore, we developed an in-house printing pipeline for a variety of cranio-maxillo-facial fractures and characterized each step required to print a model in time for surgery. Methods: All consecutive patients requiring in-house 3D printed models in a level 1 trauma center for acute trauma surgery between March and November 2019 were identified and analyzed. Results: Sixteen patients requiring the printing of 25 in-house models were identified. Virtual Surgical Planning time ranged from 0 h 08 min to 4 h 41 min (mean = 1 h 46 min). The overall printing phase per model (pre-processing, printing, and postprocessing) ranged from 2 h 54 min to 27 h 24 min (mean = 9 h 19min). The overall success rate of prints was 84%. Filament cost was between $0.20 and $5.00 per model (mean = $1.56). Conclusions: This study demonstrates that in-house 3D printing can be done reliably in a relatively short period of time, therefore allowing 3D printing usage for acute facial fracture treatment. When compared to outsourcing, in-house printing shortens the process by avoiding shipping delays and by having a better control over the printing process. For time-critical prints, other time-consuming steps need to be considered, such as virtual planning, pre-processing of 3D files, postprocessing of prints, and print failure rate. Full article

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10 pages, 1241 KiB

Open AccessArticle

Single Institute Audit of Maxillofacial Trauma Cases Before and During COVID-19 Pandemic

by Mithilesh Kadanthode, Zainab Chaudhary, Pankaj Sharma, Sujata Mohanty and Chayanika Sharma

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 102-111; https://doi.org/10.1177/19433875211064514 - 20 Apr 2022

Cited by 6 | Viewed by 96

Abstract

Study Design: In the year 2020, we saw the emergence of severe acute respiratory syndrome coronavirus 2 causing COVID-19 into a full blown pandemic. This resulted in constraints on healthcare resources, and the attention was shifted to reduce cross contamination and prevent spreader [...] Read more.

Study Design: In the year 2020, we saw the emergence of severe acute respiratory syndrome coronavirus 2 causing COVID-19 into a full blown pandemic. This resulted in constraints on healthcare resources, and the attention was shifted to reduce cross contamination and prevent spreader events.Maxillofacial trauma carewas also affected similarly, and most of the cases were managed by closed reduction whenever possible. A retrospective study was conducted to document our experience in treating maxillofacial trauma cases before and after nationwide lockdown due to COVID-19 pandemic in India. Objective: The objective of the study was to compare the effect of pandemic in reported pattern ofmandibular trauma and the result of closed reduction procedures in the management of single or multiple fractures in mandible during this time period. Methods: The study was conducted in the Department of Oral and Maxillofacial Surgery, Maulana Azad institute of Dental Sciences, Delhi, for a period of 20 months, that is, 10 months before and after nationwide lock down which was effective from 23 March 2020 due to COVID-19 pandemic. The cases were grouped into Group A (those reporting from 1 June 2019 to 31 March 2020) and Group B (those reporting from 1 April 2020 to 31 January 2021). Primary objectives were assessed and compared according to etiology, gender, location of the mandibular fractures, and treatment provided. Quality of life (QoL) associated with the treatment outcome by closed reduction was assessed after 2 months as a secondary objective using General Oral Health Assessment Index (GOHAI) in Group B. Results: A total of 798 patients sought treatment for mandibular fractures and included 476 patients in Group A and 322 in Group B. The groups showed similar age and male: female ratio. Cases showed a steep fall during first wave of pandemic, and most of the cases occurred as result of RTA followed by fall and assault. The fractures due to fall and assault showed an obvious rise during the lockdown period. There were 718 (89.97%) patients having exclusive mandibular fractures and 80 (10.03%) patients having involvement of both mandible and maxilla. Single fractures of mandible constituted 110 (23.11%) and 58 (18.01%) in Group A and B, respectively. 324 patients (68.07%) and 226 patients (70.19%) had multiple fractures involving mandible in respective groups. Parasymphysis of mandible was most commonly involved (24.31%) followed closely by unilateral condyle (23.48%) then Angle and Ramus of mandible (20.71%) with coronoid being the least fractured. During the initial 6 months after lockdown, all the cases were treated successfully using closed reduction. GOHAI QoL assessment conducted in cases having exclusive mandibular fracture (210 Multiple, 48 Single) showed favorable results with significant (p < 0.05) difference between the single and multiple fractures. Conclusions: After one and half years and recovering fromthe secondwave of pandemic that hit the country, we have come to understand COVID-19 better and embraced better management protocol. The study reveals that IMF remains the gold standard for the management of most of the facial fractures in pandemic situations. Itwas evident fromthe QoL data thatmost of the patients were able to carry out their day-to-day functions adequately. As the country prepares for a third wave of pandemic, management ofmaxillofacial trauma by closed reduction will remain the norm for most unless indicated otherwise. Full article

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9 pages, 796 KiB

Open AccessArticle

Patterns and Trends of Facial Fractures at a Tertiary Care Trauma Center in India—A 13 Years Retrospective Study

by Debraj Shome, Monika Surana, Shiva Ram Male, Vaibhav Kumar, Supriya S. Vyavahare, Arundha Abrol and Rinky Kapoor

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 112-120; https://doi.org/10.1177/19433875221084172 - 19 Apr 2022

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Abstract

Study Design: Retrospective study. Objective: The purpose of this study was to retrospectively analyze the prevalence, pattern, diagnosis, and treatment of the facial fractures falling under ambit of facial plastic surgery in a multi-specialty hospital at India from the year 2006–2019. Methods: This [...] Read more.

Study Design: Retrospective study. Objective: The purpose of this study was to retrospectively analyze the prevalence, pattern, diagnosis, and treatment of the facial fractures falling under ambit of facial plastic surgery in a multi-specialty hospital at India from the year 2006–2019. Methods: This retrospective study analyzed 1508 patients, having orbital fractures (from 2006 to 2019) for demographic data, cause of trauma, type of fracture, and the treatment given. The data were compiled in excel and analyzed by using SPSS version 21.0. Results: Out of these 1508 patient (1127 (74.73%)–males and 381 (25.27%)–females), the etiology of injuries was Road traffic accident (RTA) (49.20%), assault (26.52%), and sports injuries (11.47%). The most common fracture pattern was Isolated Orbit and/or Orbital Floor fracture in 451 patients (32.08%), followed by Mid-facial fractures (21.93%). Also, 105 patients (6.96%) experienced ocular/retinal trauma along with other fractures. Conclusions: Orbit, peri-ocular, and mid-face trauma comprised a large position of this study. It requires a great deal of expertise to treat such complex trauma, which is not covered in one specialty alone. Hence, a holistic approach of craniofacial fracture management, rather than limiting these skills to water-tight craniofacial compartments becomes necessary. The study highlights the critical need of multidisciplinary approach for predictable and successful management of such complex cases. Full article

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8 pages, 1067 KiB

Open AccessArticle

Comparison of Efficacy and Safety of Hybrid Arch Bar with Erich Arch Bar in the Management of Mandibular Fractures: A Randomized Clinical Trial

by Hariram Sankar, Sachin Rai, Satnam S. Jolly and Vidya Rattan

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 94-101; https://doi.org/10.1177/19433875221080019 - 29 Mar 2022

Cited by 4 | Viewed by 107

Abstract

Study Design: A clinical randomized control trial. Objective: To compare the efficacy and safety of Hybrid arch bar (HAB) with Erich arch bar (EAB) in fracture management of the mandible. Methods: In this randomized clinical trial, 44 patients were divided into 2 [...] Read more.

Study Design: A clinical randomized control trial. Objective: To compare the efficacy and safety of Hybrid arch bar (HAB) with Erich arch bar (EAB) in fracture management of the mandible. Methods: In this randomized clinical trial, 44 patients were divided into 2 groups:- Group 1, N = 23 (EAB group) and Group 2, N = 21 (HAB group). The primary outcome was time taken for the application of arch bar, while the inner and outer glove puncture, operator prick, oral hygiene, arch bar stability, complications of HAB, and cost comparison were secondary outcomes. Results: The time taken for the application of arch bar in group 2 was significantly shorter than group 1 (55.66 ± 17.869 min vs. 82.04 ± 12.197 min) and the frequency of outer glove puncture was also significantly lesser for group 2 (0 punctures vs 9 punctures). Better oral hygiene was found in group 2. EAB was cost-effective than HAB (Rs 700 ± 239.79 vs. Rs 1742.50 ± 257.14). The stability of the arch bar was comparable in both groups. Group 2 had associated complications of root injury in 2 out of 252 screws placed and the screw head got covered by soft tissue in 137 out of 252 screws placed. Conclusions: Thus, HAB was better than EAB with a shorter time of application, less risk of prick injury, and improved oral hygiene. Clinical trial registry name- clinical trials registry- India, URL-http://ctri.nic.in, registration number- CTRI/2020/06/025966. Full article

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5 pages, 570 KiB

Open AccessArticle

Treatment of Persistent Post-Traumatic Diplopia—An Algorithmic Approach to Patient Stratification and Operative Management

by Sashank K. Reddy, Salih Colakoglu, Joshua S. Yoon, Myan Bhoopalam, Shannath L. Merbs, Paul N. Manson and Michael P. Grant

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 89-93; https://doi.org/10.1177/19433875221083084 - 26 Mar 2022

Cited by 1 | Viewed by 68

Abstract

Study Design: Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma. Objective: Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present [...] Read more.

Study Design: Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma. Objective: Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes. Methods: A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005–2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified. Results: Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair. Conclusions: Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery. Full article

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7 pages, 966 KiB

Open AccessReview

Systematic Mapping Review of Orthognathic Surgery (Protocol)

by Josefina Bendersky, Macarena Uribe, Maximiliano Bravo, Juan Pablo Vargas, Julio Villanueva, Gerard Urrutia and Xavier Bonfill

Craniomaxillofac. Trauma Reconstr. 2023, 16(2), 147-153; https://doi.org/10.1177/19433875221078385 - 18 Mar 2022

Cited by 1 | Viewed by 153

Abstract

Study Design: This document details the planning phase of a systematic mapping review. Objective: The objective of this mapping review is to identify, describe, and organize evidence currently available from systematic reviews and primary studies regarding different co-interventions and surgical modalities used in [...] Read more.

Study Design: This document details the planning phase of a systematic mapping review. Objective: The objective of this mapping review is to identify, describe, and organize evidence currently available from systematic reviews and primary studies regarding different co-interventions and surgical modalities used in orthognathic surgery (OS) and their outcomes. Methods: Systematic reviews (SRs), randomized controlled trials (RCTs), and observational studies that evaluate perioperative OS co-interventions and surgical modalities will be identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature will also be screened. Results: Expected results include identification of all PICO questions available in the evidence regarding OS and generation of evidence bubble maps, involving a matrix of all identified co-interventions, surgical modalities, and outcomes presented in the studies. This will achieve identification of research gaps and prioritization of new research questions. Conclusions: The significance of this review will result in a systematic identification and characterization of the available evidence, leading to a reduction in research waste and a guidance of future efforts in developing studies for unsolved questions. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 16, Issue 2 (June 2023) – 10 articles

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