Craniomaxillofacial Trauma & Reconstruction

2 pages, 474 KiB

Open AccessEditorial

Precision and Progress: Key Developments in Craniomaxillofacial Surgery

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

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 179-180; https://doi.org/10.1177/19433875241286628 - 17 Sep 2024

Viewed by 83

Abstract

Dear readers, colleagues, and friends of our journal [...] Full article

10 pages, 1168 KiB

Open AccessReview

Review of the Literature on the Current State of Periosteum-Mediated Craniofacial Bone Regeneration

by Eyituoyo Okoturo

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 253-262; https://doi.org/10.1177/19433875231214068 - 9 Nov 2023

Viewed by 90

Abstract

Study Design: This is an article review on the current state of periosteum-mediated bone regeneration (PMBR). It is a known mandibular reconstruction option in children, and though poorly understood and unpredictable, the concerns of developmental changes to donor and recipient tissues shared by [...] Read more.

Study Design: This is an article review on the current state of periosteum-mediated bone regeneration (PMBR). It is a known mandibular reconstruction option in children, and though poorly understood and unpredictable, the concerns of developmental changes to donor and recipient tissues shared by other treatment options are nonexistent. The definitive role of periosteum during bone regeneration remains largely unknown. Objective: The objective is to review the literature on the clinical and molecular mechanism evidence of this event. Methods: Our search methodology was modeled after the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Search strategies were categorized into search 1 for clinical evidence of mandibular regeneration and search 2 for gene expression review for craniofacial regeneration. The quality assessment of each publication was undertaken, and inclusion criteria comprise mandibular continuity defect for search 1 and use of gene expression assay propriety kit for search 2. Results: 33 studies were selected for search 1 while four studies with non-human subjects were selected for search 2. Monitoring of PMBR onset was advised at 2 weeks post-operative, and the gene expression results showed an upregulation of genes responsible for angiogenesis, cytokine activities, and immune–inflammatory response in week 1 and skeletal development and signaling pathways in week 2. Conclusions: The results suggest that young periosteum has a higher probability of PMBR than adult periosteum, and skeletal morphogenesis regulated by skeletal developmental genes and pathways may characterize the gene expression patterns of PMBR. Full article

► Show Figures

Figure 1

5 pages, 724 KiB

Open AccessArticle

Tomographic Evaluation of Bone Height Between the Mandibular Canal and the Inferior Cortex of the Mandible Related to Bicortical Screws Fixation

by Raissa Dias Fares, João Victor Borges Leal, Manuella Zanela da Silva Areas, Hernando Valentim da Rocha, Sylvio Luiz Costa de Moraes, Nicolas Homsi and Jonathan Ribeiro da Silva

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 181-185; https://doi.org/10.1177/19433875231213892 - 3 Nov 2023

Viewed by 82

Abstract

Study Design: Original Article. Objective: The surgical treatment of mandibular fractures has undergone several changes over the past 100 years, since the use of wires and intermaxillary fixation, until today where most of the fractures are treated with internal fixation using plates and [...] Read more.

Study Design: Original Article. Objective: The surgical treatment of mandibular fractures has undergone several changes over the past 100 years, since the use of wires and intermaxillary fixation, until today where most of the fractures are treated with internal fixation using plates and screws. For the correct use of this hardware, the surgeon must have adequate knowledge of jaw anatomy to prevent complications during the insertion of screws like in fractures of the mandibular body and angle, when the screws of the plate installed in the compression zone can damage the inferior alveolar nerve within the mandibular canal. Methods: To minimize this complication, 66 hemimandibles of adult patients were analyzed in CT scans and manipulated with Dental Slice^® software, (BioParts^®, Brazil) and measured the shortest distance from the inferior cortex of the mandibular canal to the inferior cortex of the mandibular body during the path of the inferior alveolar nerve, since the mandibular foramen until the mental foramen. Results: The result obtained showed a wide variation of the shortest distance measured (3.52 mm–11.5 mm) with an average of 7.99 mm. Conclusion: The conclusion demonstrated a minimum distance of 3.52 mm below the cortical mandibular canal to the lower border of the mandible and should be considered as a safety margin during the application of fixing the material in the region of the mandibular body. Full article

► Show Figures

Figure 1

6 pages, 744 KiB

Open AccessArticle

Facial Lacerations Related to Recreational Activities: A National 10-Year Evaluation From US Emergency Departments

by Sacha C. Hauc, Lioba Huelsboemer, Katelyn Lewis, Helia Hosseini, Mica Williams, Jean Carlo Rivera and Michael Alperovich

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 238-243; https://doi.org/10.1177/19433875231211757 - 2 Nov 2023

Viewed by 106

Abstract

Study Design: This study serves as a nationally representative retrospective cohort of U.S emergency department visits related to facial lacerations caused by recreational activities. Objective: The aim of this work is to offer a representative sample of facial laceration and identify the [...] Read more.

Study Design: This study serves as a nationally representative retrospective cohort of U.S emergency department visits related to facial lacerations caused by recreational activities. Objective: The aim of this work is to offer a representative sample of facial laceration and identify the recreational activities associated with the highest risk of such injuries. Methods: We conducted a retrospective study of patients reported to the National Electronic Injury Surveillance System (NEISS) which collects information on injuries related to consumer products. Patients were included in our dataset from the time period of 2012 to 2021 if they sustained a facial laceration that was caused by a recreational activity. Results: Our findings reveal 2,383,761 facial lacerations between the study period examined. Young male white adults were more likely to sustain a facial laceration related to recreational activities. Injuries related to exercise equipment were also more likely seen in male patients. The most common cause of facial lacerations was associated with bicycles and basketball. Conclusions: This study found that young white adults are notably prone to facial lacerations, with recreational activities such as bicycling and basketball accounting for the majority of cases. Understanding these statistics is pivotal for implementing targeted strategies to prevent these injuries and their associated consequences. Full article

► Show Figures

Figure 1

9 pages, 2485 KiB

Open AccessReview

Narrative Review: Submental Artery Island Pedicled Flap, Indications, Tips, and Pitfalls

by Camilo Mosquera and Carlos Ramirez

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 244-252; https://doi.org/10.1177/19433875231208565 - 13 Oct 2023

Viewed by 528

Abstract

Study Design: Narrative review. Objective: To describe the advantages, challenges, and potential indications of the submental artery island flap as a local pedicled flap for head and neck reconstruction. Methods: We conducted a comprehensive review of the literature to describe the submental artery [...] Read more.

Study Design: Narrative review. Objective: To describe the advantages, challenges, and potential indications of the submental artery island flap as a local pedicled flap for head and neck reconstruction. Methods: We conducted a comprehensive review of the literature to describe the submental artery island flap’s surgical technique, indications, and outcomes. Data sources included peer-reviewed articles, case reports, and clinical studies on using the submental flap in head and neck surgery reconstruction. Results: The submental artery island flap, while offering advantages such as minimal donor site morbidity, and good cosmetic outcomes, presents challenges related to the pedicle dissection and patient selection. This flap is particularly suitable for defects in the oral cavity, oropharynx, parotid bed, and midface or neck skin. Simultaneous neck dissection is feasible but should be approached with caution in patients with a history of prior neck surgery. Conclusions: The submental artery island flap is a valuable option for selected cases. When performed in the right patient with a correct technique, this flap can reconstruct defects in the oral cavity, oropharynx, parotid bed, and skin of the midface or neck with a minimally visible scar of the donor site. Full article

7 pages, 1131 KiB

Open AccessArticle

Comparing Current Practice Habits for Treatment of Subcondylar Fracture Among Craniomaxillofacial Surgeons

by Heather K. Schopper, Brandyn Dunn, Richard Davila, Kevin J. Sykes, John P. Flynn, J. David Kriet and Clinton D. Humphrey

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 225-231; https://doi.org/10.1177/19433875231194242 - 4 Aug 2023

Viewed by 85

Abstract

Study Design: Survey. Objective: Subcondylar fractures stand out as a particular challenge when treating maxillofacial trauma. The fracture site is often difficult to access and adjacent to critical structures like the facial nerve. Current treatment paradigms vary widely and we endeavored to elucidate [...] Read more.

Study Design: Survey. Objective: Subcondylar fractures stand out as a particular challenge when treating maxillofacial trauma. The fracture site is often difficult to access and adjacent to critical structures like the facial nerve. Current treatment paradigms vary widely and we endeavored to elucidate these approaches from surgeons across the full breadth of Craniomaxillofacial Surgery. Methods: A survey was designed to gather general background training and experience information, perceived indications for ORIF of subcondylar fractures, options for treating subcondylar fractures, and reasoning for choosing or not choosing a given treatment approach. The survey was sent to members of AO CMF and the American Academy of Facial Plastic Surgery. Responses were collected for 4 weeks. Results: 514 total responses to the survey were obtained (response rate 17%). Of these, 43 (8.4%) identified as Otolaryngology trained, 417 (81.1%) as OMFS trained, and 54 (10.5%) as Plastic Surgery trained. While there was broad agreement in the indications for open repair, surgical approaches differed by specialty background as well as AO faculty member status. Those with less experience were less likely to perform open approaches due to lack of comfort with this skill set. Conclusions: There are some key differences in approaches to treatment of subcondylar fractures based upon specialty background and experience level. This provides an opportunity for further education to ensure optimal treatment for patients. Full article

11 pages, 1077 KiB

Open AccessArticle

Improving Cranial Vault Remodeling for Unilateral Coronal Craniosynostosis—Introducing Automated Surgical Planning

by Emilie Robertson, Pierre Boulanger, Peter Kwan, Gorman Louie and Daniel Aalto

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 203-213; https://doi.org/10.1177/19433875231178912 - 16 Jun 2023

Viewed by 95

Abstract

Study Design: Cranial vault remodeling (CVR) for unicoronal synostosis is challenging due to the asymmetric nature of the deformity. Computer-automated surgical planning has demonstrated success in reducing the subjectivity of decision making in CVR in symmetric subtypes. This proof of concept study presents [...] Read more.

Study Design: Cranial vault remodeling (CVR) for unicoronal synostosis is challenging due to the asymmetric nature of the deformity. Computer-automated surgical planning has demonstrated success in reducing the subjectivity of decision making in CVR in symmetric subtypes. This proof of concept study presents a novel method using Boolean functions and image registration to automatically suggest surgical steps in asymmetric craniosynostosis. Objective: The objective of this study is to introduce automated surgical planning into a CVR virtual workflow for an asymmetric craniosynostosis subtype. Methods: Virtual workflows were developed using Geomagic Freeform Plus software. Hausdorff distances and color maps were used to compare reconstruction models to the preoperative model and a control skull. Reconstruction models were rated as high or low performing based on similarity to the normal skull and the amount of advancement of the frontal bone (FB) and supra-orbital bar (SOB). Fifteen partially and fully automated workflow iterations were carried out. Results: FB and SOB advancement ranged from 3.08 to 10.48 mm, and −1.75 to 7.78 mm, respectively. Regarding distance from a normal skull, models ranged from 0.85 to 5.49 mm at the FB and 5.40 to 10.84 mm at the SOB. An advancement of 8.43 mm at the FB and 7.73 mm at the SOB was achieved in the highest performing model, and it differed to a comparative normal skull by 0.02 mm at the FB and 0.48 mm at the SOB. Conclusions: This is the first known attempt at developing an automated virtual surgical workflow for CVR in asymmetric craniosynostosis. Key regions of interest were outlined using Boolean operations, and surgical steps were suggested using image registration. These techniques improved post-operative skull morphology. Full article

► Show Figures

Figure 1

8 pages, 2155 KiB

Open AccessArticle

Anatomical Landmarks and Branching Patterns of the Greater Auricular Nerve

by Swafiya Busaidy Salim, Thomas Amuti and Fawzia Butt

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 186-193; https://doi.org/10.1177/19433875231183032 - 12 Jun 2023

Viewed by 141

Abstract

Study Design: Descriptive cross-sectional study. Background: The greater auricular nerve (GAN) courses over the sternocleidomastoid muscle (SCM) to supply the area of skin over the parotid gland (PG), the lower auricle and over the mastoid. It is vulnerable to injury during rhytidectomies and [...] Read more.

Study Design: Descriptive cross-sectional study. Background: The greater auricular nerve (GAN) courses over the sternocleidomastoid muscle (SCM) to supply the area of skin over the parotid gland (PG), the lower auricle and over the mastoid. It is vulnerable to injury during rhytidectomies and parotidectomies, resulting in sensory losses and pain. Although previous studies have identified suitable landmarks, injury to the GAN in the Kenyan setting still occurs. This study therefore aimed at identifying specific landmarks for the GAN and describing its branching pattern. Objective: To determine the anatomical landmarks of the GAN and its branching patterns. Methods: Forty six nerves were studied. The skin and fascia of the neck was carefully dissected to reveal the platysma muscle, which was reflected to expose the GAN. The distance of the emergence of the GAN on the posterior border of the sternocleidomastoid muscle as measured from the mastoid process (MP) was measured. Its perpendicular distance from the tragus to the point of branching was also measured. Its distance to the external jugular vein (EJV) was taken using a ruler and a pair of dividers. Finally, the nerve was described according to McKinney’s point. The pattern of branching was described as either type 1 (no branching), type 2 (2 branches) or type 3 (3 branches). The position of branching was classified as either anterior, posterior or middle. Collected data was coded into SPSS software (Version 21.0, Chicago, Illinois), and means ± standard deviation were calculated. Representative photos were taken. Results: The mean distance of the point of emergence of the nerve was 9.13 cm +/− 1.66 cm from the MP, while its distance from the tragus was 6.93 cm +/− 1.55. It was also located at a distance of 1.67 cm from the EJV. It mainly bifurcated into two branches (55.6%) and trifurcated in 4.4% of the cases. It remained undivided in 40% of the cases. In our study, the nerve mainly bifurcates in the anterior third of the SCM (22.2%). Conclusions: The GAN in our population mainly bifurcates, and it is more likely to divide closer to the parotid gland. The data presented in the study may be helpful in avoiding its iatrogenic injury. Full article

► Show Figures

Figure 1

11 pages, 1560 KiB

Open AccessArticle

Revision Surgery with Refixation After Mandibular Fractures

by Claudius Steffen, Margrit Welter, Heilwig Fischer, Maximilian Goedecke, Christian Doll, Steffen Koerdt, Kilian Kreutzer, Max Heiland, Carsten Rendenbach and Jan O. Voss

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 214-224; https://doi.org/10.1177/19433875231179318 - 5 Jun 2023

Cited by 5 | Viewed by 248

Abstract

Study Design: Retrospective, descriptive observational study. Objective: The need for revision surgery after mandibular fractures is an indicator for severe postoperative complications. This study aimed to characterise this patient cohort, describe solutions to deal with complications and evaluate treatment quality as a risk [...] Read more.

Study Design: Retrospective, descriptive observational study. Objective: The need for revision surgery after mandibular fractures is an indicator for severe postoperative complications. This study aimed to characterise this patient cohort, describe solutions to deal with complications and evaluate treatment quality as a risk variable for complications. Methods: Patients with revision surgery with refixation after open reduction and internal fixation (ORIF) of a mandible fracture were included. Patient- and therapy-specific information were assessed together with postoperative complications. The quality of fixation was evaluated individually by 6 specialists. Interobserver agreement was analysed using Fleiss’ kappa. Results: Out of 630 patients, inclusion criteria were met by 17 patients (14 male, 3 female) with an average age of 43.3 (±15.5) years. Complications at the mandible body/angle/symphysis led to refixation in all cases. Main indications for refixation were osteomyelitis (52.9%) or pseudarthrosis (41.2%). Risk factors were drug-related immune suppression, local infection or substance abuse (nicotine, alcohol or drugs). Six patients did not present any of these predictors. Of these, treatment of 4 patients was rated as not in accordance to the AO principles. The interrater reliability of treatment quality assessments was 0.239. Conclusions: Patients with risk factors need to be carefully observed perioperatively after ORIF of mandibular fractures and treatments need to be adapted to these patients. Discrepancies of treatments to common guidelines may also be an independent predictor for treatment failure in patients without risk factors. Current treatment guidelines should be reevaluated concerning additional treatment strategies for patients with specific risk factors. Full article

► Show Figures

Figure 1

6 pages, 527 KiB

Open AccessArticle

A Single Center Experience: A Retrospective Study Over 10-Years Period on Mandible Fractures

by Gabriele Monarchi, Riccardo Girotto, Mariagrazia Paglianiti and Paolo Balercia

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 232-237; https://doi.org/10.1177/19433875231176338 - 18 May 2023

Cited by 1 | Viewed by 101

Abstract

Study Design: The purpose of this study was to do a retrospective analysis about patients with mandibular fracture who were treated at the department of Maxillofacial Surgery, Regional University Hospital of Ancona, Italy, between 2011 and 2021. Objective: In this study we evaluated [...] Read more.

Study Design: The purpose of this study was to do a retrospective analysis about patients with mandibular fracture who were treated at the department of Maxillofacial Surgery, Regional University Hospital of Ancona, Italy, between 2011 and 2021. Objective: In this study we evaluated clinical and epidemiological findings of mandible fractures focusing on the association between surgical timing, type of surgical approach and mid- and long-term outcomes. Methods: Patients were evaluated based on various parameters including age, sex, etiology, symptoms, comorbidity, clinical findings, mandible fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described, we recorded 1023 mandibular fractures. 93% of patients underwent surgery under general anesthesia, almost exclusively patients undergoing an open approach to internal fixation. Results: Of the patients, 684 were male (66.86%) and 339 were female (33.13%). The average age of the patients was 42, 38 years (range, 7–94 years). The leading cause of these fractures was traffic accidents (27.3%) and mandibular parasymphysis fractures were the most frequent (34.1%). The most common clinical signs and symptoms were malocclusion, difficulty in chewing, limitation of the buccal opening, hypoesthesia extending through the territory of the inferior alveolar nerve, difficulty in protrusion movements and mandibular lateralization. Conclusions: The continuous research in epidemiology, etiology, materials, and techniques will further refine the treatments of mandible fractures, which are nowadays more and more customized according to the type of trauma. Full article

9 pages, 1036 KiB

Open AccessArticle

Patterns of Midface and Mandible Fractures in a Government Hospital

by Daniel Delgado-Piedra, Guillermina Castillo Ham, Mario A. Téliz, Fabiola Salgado-Chavarría and Paola García-Vázquez

Craniomaxillofac. Trauma Reconstr. 2024, 17(3), 194-202; https://doi.org/10.1177/19433875231151317 - 19 Jan 2023

Viewed by 76

Abstract

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: [...] Read more.

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (p = 0.06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (p = 0.019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (p = 0.028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence. Full article

► Show Figures

Figure 1

Journal Menu

Journal Browser

Craniomaxillofac. Trauma Reconstr., Volume 17, Issue 3 (September 2024) – 11 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI