Craniomaxillofacial Trauma & Reconstruction

1 pages, 474 KiB

Open AccessEditorial

Resilience at the End of the Year: From Crisis to Innovation and the Future of Craniomaxillofacial Trauma and Reconstruction

by Florian M. Thieringer, Mike Y. Y. Leung and Kathleen Fan

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 257; https://doi.org/10.1177/19433875231217130 (registering DOI) - 16 Nov 2023

Abstract

As the year draws to a close, it is time to reflect on the challenges and successes that have marked our journey in craniomaxillofacial trauma and reconstruction [...] Full article

16 pages, 936 KiB

Open AccessReview

Current Evidence for the Management of Edentulous Atrophic Mandible Fractures: A PRISMA-SWiM Guided Review

by Rathindra N. Bera and Preeti Tiwari

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 317-332; https://doi.org/10.1177/19433875221115585 - 1 Dec 2022

Cited by 2 | Viewed by 111

Abstract

Study Design: PRISMA-SWiM guided systematic review. Objective: 1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic [...] Read more.

Study Design: PRISMA-SWiM guided systematic review. Objective: 1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic mandible; 4. To address the clinical applicability of bone grafts. Methods: A systematic review was conducted using the PRISMA-SWiM protocol. PROSPERO ID: CRD42021235111. Studies with adequate data on outcome, treatment methods were selected. Isolated case reports, case series, and nonhuman studies were excluded. Quality assessment was done using Newcastle -Ottawa scale. The level of evidence was assessed using Oxford Level of Evidence. Results: Mandibular body was the most common type of fracture. Self falls and RTA were the most common etiologies. Condylar fracture was most commonly managed conservatively with ORIF employed in few studies. For the mandible compression and non-compression osteosynthesis were used. Bone grafts were used in cases with segmental defects or cases requiring augmentation. Conclusions: There is lack of proper evidence to definitely conclude any single treatment modality. However, the consensus is towards ORIF. Reconstruction plates are preferred by many authors. However, unilateral fractures may be managed by miniplates. Bilateral fractures require more rigid fixations. Open reduction and internal fixation of condylar fracture is indicated in cases with displacement or low-level fractures Full article

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11 pages, 1096 KiB

Open AccessReview

Comparison of Surgical Decompression and Steroid Therapy for the Management of Traumatic Optic Neuropathy: A Systematic Review and Meta-Analysis

by Sameer Pandey, Gosla S. Reddy, Ashi Chug, Ashutosh Dixit and Balgovind S. Raja

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 306-316; https://doi.org/10.1177/19433875221142682 - 28 Nov 2022

Cited by 1 | Viewed by 77

Abstract

Study Design: A systematic review and meta-analysis. Objective: Treatment of traumatic optic neuropathy (TON) has been a subject of debate for many decades due to the scarcity of evidence-based treatment protocols. This review compares surgical decompression (SD) and steroid therapy (ST) as treatment [...] Read more.

Study Design: A systematic review and meta-analysis. Objective: Treatment of traumatic optic neuropathy (TON) has been a subject of debate for many decades due to the scarcity of evidence-based treatment protocols. This review compares surgical decompression (SD) and steroid therapy (ST) as treatment approaches in TON patients. Methods: A PRISMA-guided systematic review using PubMed, Embase, Ovid and Scopus databases was performed till the last search date of 31 July 2021. The outcome of interest was an improvement in visual acuity. A meta-analysis of the odds ratio was performed using a random-effect model and sub-group analysis based upon criteria for assessment of improvement in visual acuity. Results: Sixteen studies (including 1046 patients) were included in the review. The review could identify 590 patients treated with SD and 456 treated with ST. In addition, there was a second cohort of patients presenting with NLP (no light perception). A meta-analysis with a sub-group analysis revealed that there was statistically no significant difference between the two treatment approaches in terms of improvement in VA. Conclusions: There is no difference in treatment results of SD or ST for TON. Several treatment protocols and different criteria for assessing visual acuity led to difficulty in generating evidence for selecting the correct treatment approach. Full article

5 pages, 750 KiB

Open AccessArticle

Perioperative Management of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis Undergoing LeFort III Osteotomy With Distraction: A Case Series

by Kathryn W. Brown, Shelley R. Edwards and Ian C. Hoppe

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 301-305; https://doi.org/10.1177/19433875221142676 - 28 Nov 2022

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Abstract

Study Design: Retrospective observational study. Objective: The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction [...] Read more.

Study Design: Retrospective observational study. Objective: The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement. Methods: After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care. Results: Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation. Conclusions: The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement. Full article

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11 pages, 2359 KiB

Open AccessArticle

Effects of NGF and Photobiomodulation Therapy on Crush Nerve Injury and Fracture Healing: A Stereological and Histopathological Study in an Animal Model

by Esengül Şen, Nilüfer Özkan, Mehmet Emin Önger and Süleyman Kaplan

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 281-291; https://doi.org/10.1177/19433875221138175 - 15 Nov 2022

Cited by 3 | Viewed by 76

Abstract

Study Design: A stereological and histopathological study in an animal model. Objective: This study explores the effects of the nerve growth factor and photobiomodulation therapy on the damaged nerve tissue and fracture healing. Methods: A total of 24 rabbits were divided into 4 [...] Read more.

Study Design: A stereological and histopathological study in an animal model. Objective: This study explores the effects of the nerve growth factor and photobiomodulation therapy on the damaged nerve tissue and fracture healing. Methods: A total of 24 rabbits were divided into 4 groups: control group (n = 5), nerve growth factor (NGF) group (n = 7), photobiomodulation (PBMT) group (n = 6), and nerve growth factor and photobiomodulation therapy (NGF+PBMT) group (n = 6). The vertical fracture was performed between the mental foramen and the first premolar, and the mental nerve was crushed for 30 seconds with a standard serrated clamp with a force of approximately 50 N in all groups. The control group received an isotonic solution (0.02 mL, 0.09% NaCl) to the operation site locally. The NGF group received 1 μg human NGF-β/0.9% 0.2 mL NaCl solution for 7 days locally. The PBMT group received PBMT treatment (GaAlAs laser, 810 nm, 0.3 W, 18 J/cm²) every 48 hours for 14 sessions following the surgery. The NGF+PBMT group received both NGF and PBMT treatment as described above. After 28 days, the bone tissues and mental nerves from all groups were harvested and histologically and stereologically analyzed. Results: According to the stereological results, the volume of the new vessel and the volume of the new bone were significantly higher in the PBMT group than in other groups (p < 0.001). According to the histopathological examinations, higher myelinated axons were observed in experimental groups than in the control group. Conclusions: As a result, PBMT has beneficial effects on bone regeneration. Based on the light microscopic evaluation, more regenerated axon populations were observed in the NGF group than in the PBMT and PBMT + NGF groups in terms of myelinated axon content. Full article

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9 pages, 690 KiB

Open AccessArticle

Retrospective Study of Orbital and Orbitozygomaticomaxillary Complex Fractures Treated at Aalesund Hospital Between 2002 and 2017

by Ingvild Årøen Lein, Tore Bjørnland and Lado Lako Loro

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 292-300; https://doi.org/10.1177/19433875221135932 - 10 Nov 2022

Cited by 2 | Viewed by 48

Abstract

Study Design: Retrospective study. Objective: To evaluate patient demographics, surgical management, and complications of orbital and orbitozygomaticomaxillary complex (OZMC) fractures treated at a district hospital in Norway. Methods: The medical records of patients with orbital fractures treated at Aalesund hospital between January 2002 [...] Read more.

Study Design: Retrospective study. Objective: To evaluate patient demographics, surgical management, and complications of orbital and orbitozygomaticomaxillary complex (OZMC) fractures treated at a district hospital in Norway. Methods: The medical records of patients with orbital fractures treated at Aalesund hospital between January 2002 and July 2017 were reviewed. Data on demographics, signs and symptoms, cause of injury, fracture type, associated fractures, surgical management, and complications were collected. Results: A total of 36 patients were reviewed. Males predominated (1:4.1), and fractures occurred mostly in patients 40–59 years (mean 41.8 years). Interpersonal violence was the leading cause of injury, followed by falls. Alcohol was significantly associated with assault caused fractures (p = 0.001). Orbitozygomaticomaxillary fractures were the most frequent, followed by pure orbital fractures. Clinical findings included periorbital ecchymosis (72%), swelling (56%), sensory nerve dysfunction (53%), diplopia (22%), and restricted eye motility (22%). Commotio cerebri was observed in more than half of our sample and 47% had other facial bone fractures. Referral to tertiary hospitals was done in 19% of the cases. The main treatment done was open reduction and internal fixation (ORIF) (45%). Infection was diagnosed in 17% and managed with antibiotics. Conclusions: The incidence of orbital and OZMC fractures in Moere and Romsdal county in western Norway was low, occurring mainly in males over 40 years. The mechanism of injury was predominantly interpersonal violence and falls. A high proportion of the sample had minor traumatic brain injury (mTBI). Full article

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6 pages, 783 KiB

Open AccessArticle

Simulating A Subcondylar Mandibular Fracture With Intraoral Open Reduction and Internal Fixation: A Novel Education Tool for Residents

by Francisco Rojas, Sebastian Tapia, Andrés Campolo, Alex Vargas, Hernán Ramírez, Benito K. Benitez and Cristian Teuber

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 275-280; https://doi.org/10.1177/19433875221129673 - 21 Sep 2022

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Abstract

Study Design: Face and content validation of a surgical simulation model. Objective: Open reduction and internal fixation in displaced subcondylar mandibular fractures is standard care. This requires an extraoral (e.g.,: retromandibular, transparotideal) or intraoral approach. An intraoral approach requires further training since specialized [...] Read more.

Study Design: Face and content validation of a surgical simulation model. Objective: Open reduction and internal fixation in displaced subcondylar mandibular fractures is standard care. This requires an extraoral (e.g.,: retromandibular, transparotideal) or intraoral approach. An intraoral approach requires further training since specialized instrumentation such as the 90° screwdriver system and endoscopes might be needed. Currently, no simulation models are available for training residents in intraoral reduction and fixation of subcondylar mandibular fractures. Therefore, we present a validated simulation model for intraoral treatment of subcondylar mandibular fractures. Methods: Based on a computer tomography data set, we designed and printed a 3D model of a mandible with a unilateral subcondylar fracture. To simulate intraoral work depth, it was positioned inside a dental phantom. We tested the model by a group of experts (n = 8), simulating intraoral reduction and fixation of a unilateral subcondylar fracture, using a 90° screwdriver system, a 1.0 subcondylar plate (lambda), and 5–6 mm screws. We assessed Face and Content validity by survey. Results: We provided an open-source printable fracture model. Printing costs were approximately US $10. Experts “Agreed” the model resembling the real scenario and its use for training intraoral reduction and fixation of subcondylar mandibular fractures. Conclusions: We developed a low cost, reproducible, open-source simulator for subcondylar mandibular fractures. Face and Content validity was achieved through evaluation by a group of experts. Full article

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7 pages, 960 KiB

Open AccessArticle

Post-Operative Scar Comparison With Supraorbital Eyebrow and Upper Blepharoplasty Approach in the Management of Zygomaticomaxillary Complex Fractures

by Hamza H. Mirza, Faheem Ahmed, Murtaza Rahber and Zahoor A. Rana

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 268-274; https://doi.org/10.1177/19433875221124406 (registering DOI) - 30 Aug 2022

Abstract

Study Design: A prospective randomized comparative study was conducted to evaluate the postsurgical scar with Supraorbital Eyebrow (SE) Approach and Upper Blepharoplasty (UB) Approach used for open reduction and internal fixation (ORIF) of zygomaticomaxillary complex (ZMC) fractures. Objective: To evaluate and compare the [...] Read more.

Study Design: A prospective randomized comparative study was conducted to evaluate the postsurgical scar with Supraorbital Eyebrow (SE) Approach and Upper Blepharoplasty (UB) Approach used for open reduction and internal fixation (ORIF) of zygomaticomaxillary complex (ZMC) fractures. Objective: To evaluate and compare the post-operative scar using Vancouver Scar Scale (VSS) following ORIF of ZMC fractures with SE and UB approaches. Methods: In this study, 88 patients with ZMC fractures requiring ORIF and meeting the inclusion criteria were recruited between 2019 and 2020. Patients were randomly divided into SE and UB group, 44 patients in each. Clinical and radiological assessment was done preoperatively and post-operative scar evaluation was carried out at different intervals over a period of 6 months using VSS. A blinded observer rated the scar. Results: The results showed that after 6 months of surgery, all the 44 (100%) patients in UB group had a mild scar (VSS score 1–5), while in the SE group 34 (77.3%) patients had a mild scar (VSS score 1–5) and 10 (22.7%) had a moderate scar (VSS score 6–10). The difference between the 2 groups was statistically significant (p-value = 0.001). Conclusions: The UB approach has been established to be superior to SE approach in terms of post-operative scar as the results were statistically significant. This study can be used to advocate more frequent use of UB approach as compared to the previously popular SE approach for the management of ZMC fractures. Full article

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10 pages, 547 KiB

Open AccessArticle

Motorcycle Accidents are the Strongest Risk Factor for Panfacial Fractures Among Pediatric Patients

by Dani Stanbouly, Dylan Koh, Jordan Halsey, Firat Selvi, Fereshteh Goudarzi, Kevin Arce and Sung-Kiang Chuang

Craniomaxillofac. Trauma Reconstr. 2023, 16(4), 258-267; https://doi.org/10.1177/19433875221116961 - 3 Aug 2022

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Abstract

Study Design: A retrospective cohort study was conducted using the Kids’ Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective: The purpose this study was to determine the [...] Read more.

Study Design: A retrospective cohort study was conducted using the Kids’ Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective: The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population. Methods: The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures. Results: Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (p < 0.01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (p < 0.01) to result in panfacial fractures while car accidents were over two times more likely (p < 0.01) to result in panfacial fractures. Falls were less likely (OR, 0.39; p < 0.01) to result in panfacial fractures. Conclusions: Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 16, Issue 4 (December 2023) – 9 articles

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