Craniomaxillofacial Trauma & Reconstruction

1 pages, 469 KiB

Open AccessEditorial

Innovations and Insights in Facial Reconstruction: From Gender Affirmation to Trauma Management

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

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 91; https://doi.org/10.1177/19433875241249256 - 23 Apr 2024

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In this issue of the Journal of Craniomaxillofacial Trauma and Reconstruction (CMTR), the articles take us from facial feminization surgery through to facial trauma [...] Full article

9 pages, 749 KiB

Open AccessReview

The Reconstruction of Mandible Defects in War Injuries: Systematic Review and Meta-Analysis

by Umar Rehman, Melissa Shemie, Mohammad Sohaib Sarwar, Oluwasemilore Adebayo and Peter A. Brennan

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 160-168; https://doi.org/10.1177/19433875231198947 - 29 Aug 2023

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Abstract

Study Design: Systematic Review and Meta-Analysis. Objective: There has been an increasing trend in maxillofacial injuries associated with combat trauma. Within the maxillofacial complex, the mandible is the most likely structure to be damaged during combat. The structural deficits as a result can [...] Read more.

Study Design: Systematic Review and Meta-Analysis. Objective: There has been an increasing trend in maxillofacial injuries associated with combat trauma. Within the maxillofacial complex, the mandible is the most likely structure to be damaged during combat. The structural deficits as a result can be reconstructed with many options. These include vascularised bone grafts (VBGs), non-vascularised bone grafts (NVBGs), alloplastic implants, reconstruction bars and distraction osteogenesis. This study aimed to determine the common modality and efficacy of mandibular reconstruction in combat trauma-related defects. Methods: A literature search was conducted on Pubmed, Prospero, Dynamed, DARE, EMBASE, COCHRANE and BMJ databases. Results: A total of six articles met the inclusion criteria identifying 165 patients requiring mandibular reconstruction. Nonvascularised iliac bone graft (n = 137) was the most common method followed by ileac crest bone chips harvest using Dacron urethran osteomesh tray (n = 24) and frontoparietal grafts (n = 4). Meta-analysis of five out of six trials demonstrated an overall success rate of 85% (95% CI 79–90; I² = 59%). A total of 13% (n = 22) of reconstructions failed either completely or partially and 21% (n = 34) of patients suffered postoperative complications. Conclusions: NVBGs are a practical, cost-effective and favourable method of war zone management of mandibular defects with success rates comparable to those reported in the civilian literature. However, general trauma principles take precedence to rule out life-threatening injuries. Due consideration of patient factors, surgical factors, and available resources are required in the first-line management of combat-related mandibular defects. Full article

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2 pages, 478 KiB

Open AccessCorrection

Corrigendum to "The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland"

by Pooja S. Yesantharao, Hillary E. Jenny, Joseph Lopez, Jonlin Chen, Christopher D. Lopez, Oluseyi Aliu, Richard J. Redett, Robin Yang and Jordan P. Steinberg

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 174-175; https://doi.org/10.1177/19433875231189076 - 19 Jul 2023

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Abstract

Our study, “The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland,” published in 2021 (Vol. 14(4), pages 308–316, https://doi.org/10.1177/1943387520983634) in the journal Craniomaxillofacial Trauma & Reconstruction, is an analysis of the HCUP Kid Inpatient Database (KID), a restricted-access, publicly [...] Read more.

Our study, “The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland,” published in 2021 (Vol. 14(4), pages 308–316, https://doi.org/10.1177/1943387520983634) in the journal Craniomaxillofacial Trauma & Reconstruction, is an analysis of the HCUP Kid Inpatient Database (KID), a restricted-access, publicly available dataset that is maintained by the Agency for Healthcare Research and Quality (AHRQ) [...] Full article

14 pages, 2814 KiB

Open AccessArticle

Flattening the Curve and Cutting Corners—Pearls and Pitfalls Facial Gender Affirming Surgery

by Sven Gunther, Jourdan Carboy, Breanna Jedrzejewski and Jens Berli

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 146-159; https://doi.org/10.1177/19433875231178968 - 6 Jun 2023

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Abstract

Study Design: This is an experiential article based on the past 6 years experience of providing facial gender confirmation surgery (fGAS) at an academic medical center. Objective: While trainees are getting increasing exposure to aspects of facial gender affirming surgery (fGAS), the gap [...] Read more.

Study Design: This is an experiential article based on the past 6 years experience of providing facial gender confirmation surgery (fGAS) at an academic medical center. Objective: While trainees are getting increasing exposure to aspects of facial gender affirming surgery (fGAS), the gap between trained providers and patients who can access care is currently still widening. A handful of fellowships across the country have emerged that include fGAS in their curriculum, but it will take another decade before the principles of affirming care and surgeries are systematically taught. Fortunately, the surgical principles and techniques required to perform fGAS are part of the skill set of any specialty surgeon trained in adult craniofacial trauma and esthetic facial surgery/rhinoplasty. It is the aim of this article to provide directly applicable knowledge with the goal to assist surgeons who consider offering fGAS in flattening the learning curve and hopefully contribute to increasing the quality of care provided for the transgender and gender diverse population. We hope to provide the reader with a very tangible article with the aims to (1) provide a simple systematic framework for an affirming consultation and preoperative assessment and (2) provide translatable surgical pearls and pitfalls for forehead feminization and gonial angle resection. The frontal sinus set back and gonial angle resection in our opinion are the most unique aspect to fGAS as rhinoplasty, genioplasty and other associated procedures (e.g., fat grafting) follow well established principles. We hope that the value of this article lies in the translatability of the presented principle to any practice setting without the need for VSP, special surgical instruments or technology beyond basic craniofacial tools. Methods: This is an experiential article based on the senior authors 6 year experience offering fGAS in an academic setting. The article is structured to outline both pearls and pittfalls and is supplemented by photographs and a surgical video. Results: A total of 19 pearls and pitfalls are outlined in the article. Conclusions: Facial gender affirming surgery mostly follows established craniofacial and esthetic surgery principles. Forehead feminization and gonial angle feminization are the 2 components that diverge most from established surgical techniques and this article hopefully provides guidance to shorten the learning curve of surgeons. Full article

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11 pages, 742 KiB

Open AccessArticle

Does Alcohol Use Influence Hospitalization Outcomes in Adults Suffering Craniomaxillofacial Fractures From Street Fighting?

by Dani Stanbouly, Sara J. Stewart, Jack A. Harris and Kevin Arce

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 132-142; https://doi.org/10.1177/19433875231164705 - 2 Jun 2023

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Abstract

Study Design: This retrospective cohort study utilized the National Inpatient Sample (NIS) database for the years 2016–2018. Incidences of street fighting were identified using the corresponding ICD-10 codes. Objective: To determine whether alcohol use (measured by blood alcohol content (BAC)) in patients sustaining [...] Read more.

Study Design: This retrospective cohort study utilized the National Inpatient Sample (NIS) database for the years 2016–2018. Incidences of street fighting were identified using the corresponding ICD-10 codes. Objective: To determine whether alcohol use (measured by blood alcohol content (BAC)) in patients sustaining maxillofacial trauma from hand-to-hand fighting influence hospitalization outcomes. Methods: The primary predictor variable was BAC stratified into six categories of increasing magnitude. The primary outcome variable was mean length of hospital stay (days). The secondary outcome variable was total hospital charges (US dollars). Results: Our final sample consisted of 3038 craniomaxillofacial fractures. Each additional year in age added +$545 in hospital charges (p < 0.01). Non-elective admissions added $14,210 in hospital charges (p < 0.05). Patients admitted in 2018 experienced approximately $7537 more in hospital charges (p < 0.01). Le Fort fractures (+$61,921; p < 0.01), mandible fractures (+$13,227, p < 0.01), and skull base fractures (+$22,170; p < 0.05) were all independently associated with increased hospital charges. Skull base fractures added +7.6 days to the hospital stay (p < 0.01) and each additional year in patient age added +0.1 days to the length of the hospital stay (p < 0.01). Conclusions: BAC levels did not increase length of stay or hospitalization charges. Le Fort fractures, mandible fractures, and skull base fracture each independently increased hospital charges. This reflects the necessary care (i.e., ICU) and treatment (i.e., ORIF) of such fractures.Older adults and elderly patients are associated with increased length of stay and hospital charges—they are likely to struggle in navigating the healthcare system and face socioeconomic barriers to discharge. Full article

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1 pages, 466 KiB

Open AccessCorrection

Corrigendum to "A Review of 13470 Head and Neck Injuries From Trampoline Jumping"

by Dani Stanbouly, Rami Stanbouly, Michael Baron, Firat Selvi, Raymond Wong Chung Wen and Sung-Kiang Chuang

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 173; https://doi.org/10.1177/19433875231173469 - 17 May 2023

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Abstract

The authors would like to alert readers to the following updated author list in the above article [...] Full article

5 pages, 619 KiB

Open AccessArticle

Trends in Maxillomandibular Fixation Technique at a Single Academic Institution

by Heather Schopper, Natalie A. Krane, Kevin J. Sykes, Katherine Yu, J. David Kriet and Clinton D. Humphrey

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 119-123; https://doi.org/10.1177/19433875231176339 - 13 May 2023

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Abstract

Study Design: Retrospective chart review. Objective: Restoration of premorbid occlusion is a key goal in the treatment of mandibular fractures. Placement of the patient in maxillomandibular fixation (MMF) is performed during mandibular fracture repair to help establish occlusion. A number of techniques are [...] Read more.

Study Design: Retrospective chart review. Objective: Restoration of premorbid occlusion is a key goal in the treatment of mandibular fractures. Placement of the patient in maxillomandibular fixation (MMF) is performed during mandibular fracture repair to help establish occlusion. A number of techniques are available to achieve MMF. We sought to examine trends in MMF technique at our institution. Methods: A retrospective chart review was conducted to evaluate patients who underwent surgical treatment of mandibular fractures between 1 January 2011 and 31 March 2021. Data including fracture characteristics, mechanism of injury, patient demographics, complication rates, and MMF technique utilized were collected. Results: One hundred sixty-three patients underwent MMF (132 males). The most common etiology of fracture was assault (34%). There was an increasing preference for rapid MMF techniques over time, as opposed to standard Erich arch bars. No significant difference in obtaining adequate fracture reduction as determined by postoperative imaging or complications were noted between those who underwent MMF with newer rapid techniques vs traditional MMF techniques. Conclusions: Our institution has demonstrated changing trends in the technique utilized for establishing occlusion intraoperatively, more recently favoring rapid MMF techniques, with similar rates of complications and ability to adequately reduce fractures. Full article

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4 pages, 515 KiB

Open AccessArticle

Appropriate Use of Preoperative Imaging in Feminization Cranioplasty

by Sabrina Brody-Camp, Jennifer Shehan, Rohith Kariveda and Jeffrey Spiegel

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 115-118; https://doi.org/10.1177/19433875231175703 - 12 May 2023

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Abstract

Study Design: Retrospective chart review. Objective: The objective of this study was to determine if proceeding with feminization frontal cranioplasty without preoperative imaging adversely affected patient outcomes. Methods: This study retrospectively reviewed all patients undergoing frontal cranioplasty for facial feminization at a single [...] Read more.

Study Design: Retrospective chart review. Objective: The objective of this study was to determine if proceeding with feminization frontal cranioplasty without preoperative imaging adversely affected patient outcomes. Methods: This study retrospectively reviewed all patients undergoing frontal cranioplasty for facial feminization at a single tertiary care center between 2013 and 2019. All procedures were performed by a single surgeon (JS), who operated at multiple sites. The site selected is where the majority of these procedures were performed during this time. Type of cranioplasty (I vs III) was recorded. Primary outcomes included postoperative cerebrospinal fluid (CSF) leak, entering the cranium, or dural exposure or injury. Results: 422 subjects underwent cranioplasty for facial feminization between 2013 and 2019. No preoperative imaging was performed. Zero patients had CSF leak. 334 subjects (79%) had type III cranioplasty, while the remaining 88 subjects (21%) had type I cranioplasty. No subjects had documented episodes of dural injury, or postoperative brain or cranial concerns. Conclusions: This study demonstrates that frontal cranioplasty for facial feminization does not require routine preoperative imaging. The authors recommend preoperative imaging for patients with a history of congenital cranial abnormality, prior significant head trauma affecting the frontal bone, and in some cases where the patient has had prior surgery or a history of sinus disease or extensive polyposis. Routine preoperative computed tomography is therefore not indicated for patients undergoing feminizing cranioplasty. Full article

11 pages, 802 KiB

Open AccessArticle

Matrixmidface Preformed Orbital Implants for Three-Dimensional Reconstruction of Orbital Floor and Medial Wall Fractures: A Prospective Clinical Study

by Neha Umakant Chodankar, Vikas Dhupar, Francis Akkara and Vathsalya Vijay

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 104-114; https://doi.org/10.1177/19433875231171749 - 20 Apr 2023

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Abstract

Study Design: Prospective Interventional study. Objective: To evaluate the efficiency of Matrixmidface preformed Orbital plates for three-dimensional reconstruction of orbital floor and medial wall fractures. Methods: This prospective institutional clinical study was conducted on a group of 14 patients who underwent repair of [...] Read more.

Study Design: Prospective Interventional study. Objective: To evaluate the efficiency of Matrixmidface preformed Orbital plates for three-dimensional reconstruction of orbital floor and medial wall fractures. Methods: This prospective institutional clinical study was conducted on a group of 14 patients who underwent repair of orbital floor and medial wall fracture defects using Matrixmidface Preformed Orbital plates and open reduction and internal fixation of associated fractures. The following parameters were studied preoperative and postoperative enophthalmos, hypoglobus, orbital volume; correction of diplopia, intraoperative and postoperative complications. Results: All 14 patients were males aged between 19 and 42 years. The most common mode of injury was found to be road traffic accidents (RTAs) followed by self-fall and trauma at workplace. Orbital fractures were associated with other concomitant maxillofacial fractures in 12 patients (85.7%) while 2 patients (14.3%) had pure blowout fractures. Significant improvement of enophthalmos was noted from preoperative period to 1 week, 6 weeks, and 6 months postoperatively (p value 0.02, 0.01, and 0.01, respectively). Out of 11 patients with preoperative hypoglobus, 5 patients (45.45%) had persistent hypoglobus in the immediate postoperative period which reduced to 4 patients (36.36%) at 6 weeks postoperatively (p value 0.00). The postoperative orbital volume of fractured side ranged from 20.3 cm³ to 26.76 cm³ with a mean of 23.50 cm³ ± 1.74. The mean difference between the volumes of the repaired and uninjured sides was found to be 0.27 cm³ ± 0.39 (p value 0.02) denoting that the reconstruction of the orbit closely approximated that of the uninjured side. Conclusions: The Matrixmidface Preformed Orbital plate provides exceptional reconstruction of the orbital blowout fracture defects and ensures satisfactory results clinically and radiographically. The plate ensures an approximate recreation of topographical anatomy of the orbit and adequately restores the orbital volume. It provides adequate correction of asymmetry, hypoglobus, enophthalmos and attempts to restore eye movements, without causing any significant postoperative complication. Full article

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12 pages, 1220 KiB

Open AccessArticle

Evaluation of Different Patterns of Zygomaticoorbital Complex Fractures

by Andreas Sakkas, Christel Weiß, Sebastian Pietzka, Frank Wilde, Oliver Christian Thiele and Robert Andreas Mischkowski

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 92-103; https://doi.org/10.1177/19433875231161906 - 25 Mar 2023

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Abstract

Study Design: Very few studies exist regarding the fracture pattern variability of the zygomaticoorbital (ZMO) complex. The retrospective evaluation of a large series of surgically treated unilateral ZMO fractures would in certain circumstances help intraoperative predictability and define sensitive indicators for open reduction [...] Read more.

Study Design: Very few studies exist regarding the fracture pattern variability of the zygomaticoorbital (ZMO) complex. The retrospective evaluation of a large series of surgically treated unilateral ZMO fractures would in certain circumstances help intraoperative predictability and define sensitive indicators for open reduction and internal fixation. Objective: The aim of this study was to investigate the different fracture patterns after ZMO complex injury regarding the 5 anatomic sutures of the zygoma as well as the concomitance of the paranasal buttress and maxillary sinus wall fracture. Methods: The medical records of all patients with unilateral ZMO fractures who underwent surgical intervention in a single trauma center department between April 2015 and June 2020 were retrospectively reviewed. Demographic and anamnesis data, radiologic findings, and surgical reports were evaluated. According to the preoperative radiologic evaluation, ZMO fractures were classified as unisutural, bisutural, trisutural, tetrasutural, and complete based on the number of zygomatic sutures. The prevalence of various fracture patterns was analyzed. The impact of patient’s age and trauma etiology on the fracture pattern was evaluated using descriptive statistical analysis. Results: The study included 492 patients with unilateral ZMO fractures, with a mean age of 49.93 years (SD = 20.66) and a male:female ratio of 2.23:1. The most affected age group was 19–44 years (41.67%) and tripping falls were the most common etiology (27.24%). Trisutural (57.32%) and unisutural fractures (23.17%) were the most common, followed by tetrasutural (8.94%), bisutural (8.54%), and complete fractures (2.03%). A trisutural fracture involving the zygomaticomaxillary suture, the infraorbital rim, and the zygomaticosphenoidal suture was the most common fracture pattern (52.03%). Most fractures were observed in the zygomaticosphenoidal suture (86.99%), followed by the infraorbital rim (74.59%) and the zygomaticomaxillary suture (68.29%). Fractures of the maxillary sinus wall and the paranasal buttress co-existed in 9.55% and 31.30% of all cases, respectively. No correlation was detected between age and fracture pattern (p = 0.4111). Tripping falls and bicycle accidents significantly influenced the fracture pattern (p < 0.0001). Conclusions: According to the results, knowledge of the fracture pattern variability of the ZMO complex could in certain circumstances designate CT or CBCT as mandatory before operating on ZMO fractures. Consequently, unnecessary incisions could be avoided. The high concomitance of paranasal buttress fracture also suggests its intraoperative surgical exploration. Further studies should correlate the clinical findings with indication for surgery and postoperative outcome for the different fracture patterns described. Full article

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4 pages, 872 KiB

Open AccessArticle

Measuring Orbital Volume Using Open Source Software and Its Application in Orbitozygomatic Fractures

by Taradevi P. V. Narayan and Vikas Dhupar

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 169-172; https://doi.org/10.1177/19433875231163982 - 16 Mar 2023

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Abstract

Study Design: Technical note. Objective: Changes in orbital volume can lead to esthetic and functional complications of the orbit. In this article, the procedure to calculate the orbital volume using the open source software Aliza 3D DICOM is described. Methods: This article describes [...] Read more.

Study Design: Technical note. Objective: Changes in orbital volume can lead to esthetic and functional complications of the orbit. In this article, the procedure to calculate the orbital volume using the open source software Aliza 3D DICOM is described. Methods: This article describes the steps to use this novel software. To validate the software, the normal orbital volume was calculated bilaterally on CT scans with normal orbital anatomy. The volumes of unilateral orbitozygomatic fracture cases were compared. Results: This open source software has easy access. The normal orbital volume calculated using this software was 24.4 cc ± 0.72. In the unilateral orbitozygomatic fracture cases, an increased orbital volume was calculated. Conclusions: This easy access, inexpensive, and convenient computer aided software can be used to calculate orbital volume facilitating treatment plan for correction of the orbit volume. Full article

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3 pages, 635 KiB

Open AccessArticle

Objective Photoanalysis of Feminizing Frontal Cranioplasty Outcomes

by Abel P. David, Adrian E. House, Sonia Targ, W. Taylor DeBusk, Andrea Park, P. Daniel Knott and Rahul Seth

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 143-145; https://doi.org/10.1177/19433875221143609 - 11 Feb 2023

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Abstract

Study Design: Retrospective analysis at a tertiary care center. Objective: This study describes a method of analyzing postoperative results using lateral view clinical photographs to create normalized projection ratios of the glabella and radix. Methods: We reviewed preoperative and postoperative photographs of 15 [...] Read more.

Study Design: Retrospective analysis at a tertiary care center. Objective: This study describes a method of analyzing postoperative results using lateral view clinical photographs to create normalized projection ratios of the glabella and radix. Methods: We reviewed preoperative and postoperative photographs of 15 patients. All photographs were in the lateral view Frankfort horizontal plane. We calculated the distances between the (a) tragus and cornea, (b) cornea and radix, (c) cornea and glabella, and the (θ) nasofrontal angle. Results: Fifteen sets of patient photographs were analyzed and found that there was a favorable 14% reduction at the radix and an even greater reduction (78.9%) at the glabella. The nasofrontal angle was improved to a more feminine range from 131.84° preoperatively to 145.86° postoperatively. Conclusions: Normalized projection ratios of the glabella and radix, along with the nasofrontal angle, can be used to objectively measure outcomes of frontal feminizing cranioplasty. Full article

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1 pages, 473 KiB

Open AccessCorrection

Erratum to "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. 2024, 17(2), 176; https://doi.org/10.1177/19433875221150350 - 2 Jan 2023

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Abstract

In the above-referenced article, the abstract has been corrected after the publication of the article [...] Full article

8 pages, 665 KiB

Open AccessArticle

A Review of 13,470 Head and Neck Injuries from Trampoline Jumping

by Dani Stanbouly, Rami Stanbouly, Michael Baron, Firat Selvi, Raymond Wong Chung Wen and Sung-Kiang Chuang

Craniomaxillofac. Trauma Reconstr. 2024, 17(2), 124-131; https://doi.org/10.1177/19433875221125644 - 15 Sep 2022

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Abstract

Study Design: The authors designed a 20-year cross-sectional study using the National Electronic Injury Surveillance System (NEISS) database. Objective: The purpose of the study is to determine the risk factors for hospital admission among individuals who suffer head and neck injuries secondary to [...] Read more.

Study Design: The authors designed a 20-year cross-sectional study using the National Electronic Injury Surveillance System (NEISS) database. Objective: The purpose of the study is to determine the risk factors for hospital admission among individuals who suffer head and neck injuries secondary to trampoline use. Methods: The primary predictor variables were a set of heterogenous variables that were categorized into the forementioned study variable groups (patient characteristics and injury characteristics). The primary outcome variable was hospital admission. Multivariate logistic regression was used to determine independent risk factors for hospital admission. Results: The final sample consisted of 13,474 reports of trampoline injuries to the head and neck. Relative to females, males (OR 1.66, p < 0.05) were at an increased risk for hospital admissions. Fractures (OR 35.23, p < 0.05) increased the risk for hospital admissions relative to dental injuries. Concerning anatomical region of injury, neck injuries (OR 30.53, p < 0.05) were at an increased risk for hospital admissions. Conclusions: Injuries to the neck from trampoline jumping significantly increased the risk for admission. The severity of neck injuries from trampoline jumping is well established in the literature. Additionally, male sex and fractures were each risk factors for hospital admission. Given the rising prevalence of trampoline-related head and neck injuries over the past 2 decades, it is crucial for individuals to take the necessary precautions when jumping on a trampoline. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 17, Issue 2 (June 2024) – 14 articles

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