Craniomaxillofacial Trauma & Reconstruction

21 pages, 3538 KiB

Open AccessArticle

Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA² (Orbital Assessment Algorithm)

by Nils-Claudius Gellrich, Michael Grant, Damir Matic and Philippe Korn

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 47; https://doi.org/10.1177/19433875241272436 - 24 Oct 2024

Cited by 1 | Viewed by 376

Abstract

Study Design: This study presents a review of the evolutionary development in reconstructive orbital surgery over the past 3 decades. Additionally, it proposes the Orbital Assessment Algorithm (OA²) to enhance decision-making for intraorbital reconstruction of post-traumatic orbital deformities. Objective: The objective [...] Read more.

Study Design: This study presents a review of the evolutionary development in reconstructive orbital surgery over the past 3 decades. Additionally, it proposes the Orbital Assessment Algorithm (OA²) to enhance decision-making for intraorbital reconstruction of post-traumatic orbital deformities. Objective: The objective of this paper is to provide insights into modern post-traumatic orbital reconstruction from a surgeon’s perspective, with a specific focus on adult patients. It aims to highlight the advancements in computer-aided design and manufacturing techniques, particularly in the field of reconstructive orbital surgery, and to introduce the OA² as a tool for improved decision-making in this context. Methods: The study conducts a comprehensive review of the evolution of reconstructive orbital surgery, focusing on the integration of 3D technology into surgical practices. It also outlines the development and rationale behind the proposed OA², emphasizing its potential to enhance the accuracy and efficacy of intraorbital reconstruction procedures for posttraumatic deformities. Results: The review demonstrates the significant progress made in reconstructive orbital surgery, particularly in leveraging 3D technology for virtual modeling, navigation, and the design and manufacturing of patient-specific implants. The introduction of the OA² provides a structured approach to assessing and addressing post-traumatic orbital deformities, offering potential benefits in decision-making and surgical outcomes. Conclusions: In conclusion, this paper underscores the pivotal role of computer-aided design and manufacturing in advancing reconstructive orbital surgery. It highlights the importance of integrating innovative design concepts into implant manufacturing processes and emphasizes the potential of the OA² to guide surgeons in the management of post-traumatic orbital deformities, ultimately contributing to improved patient outcomes. Full article

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1 pages, 466 KiB

Open AccessEditorial

Moving Forward: The Last Subscription Issue and the Dawn of Open Access

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

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 269; https://doi.org/10.1177/19433875241296681 - 23 Oct 2024

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Abstract

As we present this issue of Craniomaxillofacial Trauma and Reconstruction (CMTR), we are filled with a sense of profound gratitude and anticipation [...] Full article

8 pages, 702 KiB

Open AccessArticle

Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma: A Longitudinal Study

by Khalil Issa, Nicholas A. Frisco, Kayla W. Kilpatrick, Maragatha Kuchibhatla, Dane M. Barrett, David B. Powers and Charles R. Woodard

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 40; https://doi.org/10.1177/19433875241292164 - 16 Oct 2024

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Abstract

Study Design: Single-institution retrospective financial analysis. Objective: Trauma care is consistently linked to inadequate reimbursement, posing a significant financial burden for large trauma centers. Data show that declining Medicare reimbursement rates have indirectly led to declining payment for all procedures covered by insurance. [...] Read more.

Study Design: Single-institution retrospective financial analysis. Objective: Trauma care is consistently linked to inadequate reimbursement, posing a significant financial burden for large trauma centers. Data show that declining Medicare reimbursement rates have indirectly led to declining payment for all procedures covered by insurance. The goals of this study are to investigate the opportunity cost associated with contemporary surgical management of CMF trauma at our institution and to evaluate longitudinal financial trends. Methods: Patients with operative facial fractures between 2015 and 2022 at Duke University Medical Center were included and compared to patients undergoing general otolaryngology, plastic surgery and oral surgery operations in the same period. Procedural codes, payor type, charges billed, collections, relative value units (RVUs) and other financial data were obtained and analyzed among the 2 patient populations. Comparative analysis was performed to assess the financial trends in data reported previously from 2007–2015. Results: The collection rate at Duke University Medical Center for operatively managed CMF fractures remains significantly lower than non-CMF counterparts. Interestingly, the collection rate gap between CMF and non-CMF surgeries has narrowed when comparing to the data from 2007–2013. This is largely due to a decrease in collection rates for non-CMF procedures from 29.61% (2007–2013) to 26.57% (2015–2022) [p = 0.0001] and an increase in collection rates for CMF procedures from 17.25% (2007–2013) to 18.05% (2015–2022) [p = 0.0001]. Conclusions: Despite a slight improvement of the gap in reimbursement rates for CMF and non-CMF surgeries over the last several years, trauma care continues to have a negative financial impact on health care institutions. Full article

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10 pages, 606 KiB

Open AccessArticle

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

by Samin Rahbin, Ola Sunnergren, Ellen McBride, Hatef Darabi and Babak Alinasab

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 57; https://doi.org/10.1177/19433875241286544 - 8 Oct 2024

Cited by 1 | Viewed by 96

Abstract

Study Design: Retrospective with follow-up. Objective: To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the [...] Read more.

Study Design: Retrospective with follow-up. Objective: To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods: Patients with unilateral ZMC fractures between 2007–2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018–2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results: The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions: Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery. Full article

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9 pages, 728 KiB

Open AccessArticle

Microvascular Reconstructions in Elderly Patients with Oral Squamous Cell Carcinoma—Too Old for Surgical Treatment?

by Anne Radermacher, Dominik Horn, Michael Fehrenz, Karl Semmelmayer, Oliver Ristow, Michael Engel, Jürgen Hoffmann, Kolja Freier and Julius Moratin

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 48; https://doi.org/10.1177/19433875241272437 - 30 Sep 2024

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Abstract

Study Design: Retrospective cohort study. Objective: A major risk factor for oral squamous cell carcinoma (OSCC) is advanced age. Ablative surgery combined with microvascular reconstruction has become routine for OSCC. Nevertheless, there is an interdisciplinary debate about the appropriateness of surgery combined with [...] Read more.

Study Design: Retrospective cohort study. Objective: A major risk factor for oral squamous cell carcinoma (OSCC) is advanced age. Ablative surgery combined with microvascular reconstruction has become routine for OSCC. Nevertheless, there is an interdisciplinary debate about the appropriateness of surgery combined with prolonged general anesthesia in the elderly. In the present study, the ablative and microvascular strategies in OSCC were evaluated in terms of oncologic safety and surgical morbidity in relation to age. Methods: A total of 345 patients with primary OSCC who underwent ablative tumor surgery and neck dissection according to the German national guideline for OSCC together with microvascular reconstruction from September 2010 to October 2017 were examined. General clinical data was analyzed descriptively with a special focus on perioperative morbidity of an elderly (≥70y) subgroup of 56 patients. Oncological outcome was estimated using Log Rank testing and Kaplan Meier plotting. Results: Estimated 5 year overall survival (OS) and disease-free survival (DFS) was 69.6% (≥70y) vs. 76.7% (<70y) and 62.9% (≥70y) vs. 78.2% (<70y) respectively with no significant difference between the 2 age groups. In multivariate cox regression, only initial stage of disease revealed significant impact on OS. Analysis of perioperative death/complications, flap loss, operation time, dependence on tracheostomy and hospitalization revealed no significant differences between the 2 groups. Conclusions: Tumor surgery including neck dissection in combination with primary microvascular reconstruction is a safe therapy in patients of advanced age. This results in excellent oncological outcome with no significant disadvantages in terms of perioperative morbidity, hospitalization or flap failure. Full article

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8 pages, 1749 KiB

Open AccessArticle

Reconstruction of Maxillary Bone Defects with Cellular Bone Matrix Allografts

by Jeffrey S. Marschall, Stephen S. Davis, Oscar Rysavy and George M. Kushner

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 58; https://doi.org/10.1177/19433875241288138 - 24 Sep 2024

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Abstract

Study Design: Retrospective Cohort Study. Objective: Reconstruction of maxillary bone defects can be completed with vascularized and non-vascularized autografts. Cellular bone matrix allografts (CBMs), which have lineage committed bone cells, has risen as an alternative. The purpose of this study was to describe [...] Read more.

Study Design: Retrospective Cohort Study. Objective: Reconstruction of maxillary bone defects can be completed with vascularized and non-vascularized autografts. Cellular bone matrix allografts (CBMs), which have lineage committed bone cells, has risen as an alternative. The purpose of this study was to describe our experience and to determine the success of CBM based maxillary reconstruction in a variety of clinical scenarios. Methods: A retrospective cohort study was designed and implemented using data from subjects who presented to the University of Louisville and were treated with a CBM for maxillary reconstruction from 2019 to 2023. Subjects were excluded if they were not treated with a CBM, data were not complete, or postoperative follow-up time was less than 3 months. Descriptive statistics were calculated for each variable. To measure the associations between the risk factors and graft success, Fisher’s exact test was implemented. A p-value of <0.05 was considered significant. Results: The sample included 48 subjects. The mean age of all subjects was 43 ± 24 years. Overall, 42 (87.5%) cases were successful. The perioperative antibiotic administered (p = 0.02), etiology (p = 0.021), and the addition of platelet rich fibrin or autograft as an adjunct influenced CBM success (p = 0.039). Conclusions: CBMs are a viable option for reconstruction of maxillary bone defects. CBMs may be an alternative to autografts. Full article

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6 pages, 529 KiB

Open AccessArticle

Premorbid Incidence of Mental Health and Substance Abuse Disorders in Facial Trauma Patients

by Adeeb Derakhshan, Hunter Archibald, Harley S. Dresner, David A. Shaye, Peter A. Hilger, Sofia Lyford Pike and Shekhar K. Gadkaree

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 55; https://doi.org/10.1177/19433875241280780 - 10 Sep 2024

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Abstract

Study Design: A retrospective study. Objective: Facial trauma is a prevalent cause of morbidity and mortality with increasing incidence over recent decades. Few studies have examined the prevalence of mental health and substance abuse disorders at the time of diagnosis. Herein we investigate [...] Read more.

Study Design: A retrospective study. Objective: Facial trauma is a prevalent cause of morbidity and mortality with increasing incidence over recent decades. Few studies have examined the prevalence of mental health and substance abuse disorders at the time of diagnosis. Herein we investigate the psychosocial demographics associated with facial trauma. Methods: The 2016 State Inpatient Database (SID) was used to identify patients with facial trauma from all hospitals in New York, Florida, and Maryland. A non-trauma control group undergoing elective same-day surgeries at ambulatory surgical centers in Florida, Kentucky, Nevada, North Carolina, New York, and Maryland was identified using the State Ambulatory Surgery and Services Database (SASD) from the Healthcare Cost and Utilization Project (HCUP). 777 patients were identified with facial trauma and compared to 500 patients without facial fractures. Results: Patients with facial fractures were statistically significantly more likely to have a substance abuse disorder (OR 34.78, p < 0.001) or mental health disorder (OR 2.75, p < 0.001) compared to controls. Patients with facial fractures were significantly more likely to be black than white (OR 4.80, p < 0.001). Patients with facial fractures were significantly more likely to have Medicaid compared to Medicare (OR 2.12, p = 0.005). Conclusions: Patients with facial fractures are more likely to have premorbid substance abuse and mental health disorders as compared to controls. Full article

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8 pages, 892 KiB

Open AccessArticle

In-Versus Out-Fracture: A Novel Concept in Naso-Orbito-Ethmoid Injury

by Jesse Menville, Luke Soliman, Nidhi Shinde, Carole Spake, Stephanie Francalancia, Josue Marquez-Garcia, Nikhil Sobti, Vinay Rao and Albert S. Woo

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 56; https://doi.org/10.1177/19433875241280781 - 4 Sep 2024

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Abstract

Study Design: A retrospective study. Objective: The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly [...] Read more.

Study Design: A retrospective study. Objective: The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly affect symptomatology and management. We hypothesize that NOE fractures will present differently based upon their severity: Type I injuries are likely to present with medial nasal bone displacement (in-fracture), whereas Type III fractures will be more prone to lateral displacement (out-fracture). Methods: A retrospective review was performed for all patients with NOE fractures who were evaluated by the plastic surgery department at a level 1 trauma center over a 6-year period. Computed tomography data were evaluated to assess for directionality of fracture segment displacement. Frequencies of medial, lateral, and non-displacement across NOE types were compared by Chi-Squared Goodness of Fit and Fisher’s Exact Tests. Results: 111 patients met inclusion criteria. The patient population was 73.9% male and averaged 51.2 years old. When bilateral fractures were counted independently, there were 141 cases in total: 115 Type I, 20 Type II, and 6 Type III. Type I fractures were most commonly in-fractured (48.7%), while Type III injuries were consistently out-fractured (100%) (p < 0.001). Conclusions: While Type II and III NOE fractures have dominated clinical focus, this study highlights the prevalence of impaction within Type I fractures. These findings advocate for a more comprehensive approach to the evaluation of Type I NOE fractures and their potential risks, including traumatic hypotelorism and nasal airway obstruction. Full article

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7 pages, 808 KiB

Open AccessArticle

The Impact of Socioeconomic Status on Pediatric Facial Trauma

by Avery Wright, Madison Hinson, Amelia Davidson, Caitrin Curtis and Christopher Runyan

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 54; https://doi.org/10.1177/19433875241280214 - 3 Sep 2024

Cited by 1 | Viewed by 89

Abstract

Study Design: Retrospective chart review. Objective: Socioeconomic status (SES) greatly impacts one’s health status and the type of trauma that a patient experiences due to increased risk of exposure and varying availability of resources to treat emergent conditions. There is a need for [...] Read more.

Study Design: Retrospective chart review. Objective: Socioeconomic status (SES) greatly impacts one’s health status and the type of trauma that a patient experiences due to increased risk of exposure and varying availability of resources to treat emergent conditions. There is a need for large-scale databases of pediatric facial trauma to identify discrepancies in occurrence and identify risk factors. Methods: This retrospective examination uses a multi-center database to evaluate pediatric facial trauma patients (n = 644) visiting Atrium Heath Wake Forest Baptist (AHWFB) hospital from 2020 to 2022. Data collected included demographic information, past medical and surgical history, trauma history, interventions, and long-term outcomes such as scarring, deformities, and sensory or motor deficits. The number of incidents for each zip code surrounding AHWFB was compared with SES data including unemployment rate, mean household income, and poverty level. Results: Thirty-five percent of patients sustained a high-energy injury, and 65% sustained a low-energy injury. Within the surrounding counties of AHWFB, there were more incidents of pediatric facial trauma in areas with greater rates of poverty (p = 0.006). Additionally, there were more incidents due to high-energy injuries in areas with lower income (p = 0.044) and more poverty (p = 0.002). Specifically, motor vehicle accidents were more common in areas with lower income (p = 0.017) and more poverty (p = 0.001). Conclusions: These findings in the central Piedmont region of North Carolina are consistent with previous research of SES’s effect on health inequalities and serve as evidence of the need to take steps to prevent pediatric facial trauma in areas of low SES. Full article

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12 pages, 2257 KiB

Open AccessArticle

Unlocking the Potential of Submental Intubation—Redefining Airway Management in Craniomaxillofacial Trauma Patients

by Amit Dharamvir Mahajan, Sharvari Prakash Daithankar, Pratesh Nitin Dholabhai, Aniruddh Pratap Singh, Aditya Rajesh Shah and Nirvani Pinkesh Shah

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 53; https://doi.org/10.1177/19433875241278797 - 27 Aug 2024

Cited by 2 | Viewed by 94

Abstract

Study Design: Submental intubation is and underutilized alternative to traditional techniques of intubation. Complications associated can indeed deter surgeons and anesthesiologist from performing it. Surgeons may opt for submental intubation if they believe that its advantages outweigh the potential risks of the procedure. [...] Read more.

Study Design: Submental intubation is and underutilized alternative to traditional techniques of intubation. Complications associated can indeed deter surgeons and anesthesiologist from performing it. Surgeons may opt for submental intubation if they believe that its advantages outweigh the potential risks of the procedure. Identifying the reasons of complications and implementing of proper strategies to address them can help mitigate risks. Objective: This study aims to compare and analyze the complications experienced during and after submental intubation to comment on its safety, efficacy. Revisiting literature, will help us to comment on diagnosis in trauma and associated perioperative and intraoperative complication with it. It will also help us deduce most preferred way of performing submental intubation and various methods to manage complications. Methods: Submental intubation in patients experiencing craniofacial trauma was reviewed retrospectively for 9 years from January 2015 to August 2023. Common diagnosis sites were analyzed for perioperative and postoperative complications. Results: It was found that there were no much complications faced perioperatively and also notes methods used for management of complications. Most commonly encountered postoperative complication was scar. Literature of past years was reviewed, during process we also came out with novel method for safe extubation for which we have got copyright from Government of India. Conclusions: Submental intubation is a safe and efficient intraoperative airway management technique for patients with craniomaxillofacial injuries when there is concurrent facial trauma. This study findings would underscore the safety and efficacy of SEI, making it a promising unparalleled method of airway management worth considering. Full article

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5 pages, 657 KiB

Open AccessArticle

Management of Le Fort I Fractures

by Jin-yong Cho and Jaeyoung Ryu

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 51; https://doi.org/10.1177/19433875241278796 - 23 Aug 2024

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Abstract

Study Design: A retrospective study. Objective: This retrospective study aims to analyze the results of Le Fort I fracture treatment, with a focus on addressing malocclusion related to the fractures. Methods: The study included 43 patients diagnosed with Le Fort I fractures who [...] Read more.

Study Design: A retrospective study. Objective: This retrospective study aims to analyze the results of Le Fort I fracture treatment, with a focus on addressing malocclusion related to the fractures. Methods: The study included 43 patients diagnosed with Le Fort I fractures who underwent open reduction and internal fixation. Demographic data, causes of trauma, accompanying facial bone fractures, treatment methods, and complications were analyzed. Fisher’s exact test was employed to assess the association between fractures and malocclusion. Results: Postoperative complications included occlusal disorder (6 cases), sensory disturbance (4 cases), and facial deformation (6 cases). Condylar fractures showed a statistically significant association with occlusal disorders (p = 0.044). Surgeon variability did not significantly impact occlusal outcomes (p = 0.25). Conclusions: Proper management of Le Fort I fractures requires a thorough understanding of surgical principles and consideration of concomitant fractures. Achieving anatomical reduction based on occlusion is crucial for successful outcomes, and additional Le Fort I osteotomy may be considered in challenging cases. Full article

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8 pages, 795 KiB

Open AccessArticle

Orbital Trauma Epidemiologic Characteristics by Life Stage

by Aayma Irfan, Nihal Punjabi, Aishwarya Suresh, Ian Waldrop, Jared C. Inman and Nicholas W. Sheets

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 44; https://doi.org/10.1177/19433875241275102 - 17 Aug 2024

Cited by 2 | Viewed by 107

Abstract

Study Design: Retrospective database review. Objective: This study aims to characterize and compare the epidemiological factors of orbital trauma between life stages by utilizing the National Electronic Injury Surveillance System (NEISS), a nationally representative database. Methods: The NEISS was queried for orbital injuries [...] Read more.

Study Design: Retrospective database review. Objective: This study aims to characterize and compare the epidemiological factors of orbital trauma between life stages by utilizing the National Electronic Injury Surveillance System (NEISS), a nationally representative database. Methods: The NEISS was queried for orbital injuries from 2013 to 2022. Demographic data, injury type, injury location, and product related to injury were compared across life stages defined as 0–5 years (young children), 6–17 years (adolescents), 18–64 years (working adults), and >65 years (elderly adults). Results: 7846 orbital injuries were reported in the NEISS from 2013–2022. Incidence increased in all age groups over the study period but was highest in elderly adults. There was a bimodal distribution in the frequency of orbital trauma, with peaks occurring at age<20 and around age 80. Adolescents were most likely to be injured by sports-related products while young children and elderly adults were more likely to be injured by household products. Orbital fractures were the most common type of injury across all age groups (40.6%), with the highest rate observed in working adults. Elderly adults were more likely to be admitted to the hospital compared to working adults (RR 1.62 [1.49–1.77]). Conclusions: The rate of orbital trauma is increasing over time, especially in elderly adults, highlighting the need for increased and improved preventative and education measures. The age-specific epidemiological factors identified in this study may help improve detection and management of injuries and guide public health initiatives. Full article

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13 pages, 1623 KiB

Open AccessArticle

Effectiveness of a Structured Trauma Template in Improving Clinical Examination Accuracy in Maxillofacial Trauma: A Prospective Study

by Akhilesh K. Pandey, Gigi PG, Harshitha Rajanna, Abhishek Anil, Pravin Kumar and Ankita Chugh

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 46; https://doi.org/10.1177/19433875241272435 - 6 Aug 2024

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Abstract

Study Design: Prospective pre-post study. Objective: Maxillofacial trauma presenting to the emergency department (ED) are often accompanied with complex concomitant injuries, thereby making thorough diagnosis and treatment plan quite an exacting task owing to the demanding conditions of the ED. The use of [...] Read more.

Study Design: Prospective pre-post study. Objective: Maxillofacial trauma presenting to the emergency department (ED) are often accompanied with complex concomitant injuries, thereby making thorough diagnosis and treatment plan quite an exacting task owing to the demanding conditions of the ED. The use of a structured maxillofacial trauma template helps in documenting the injuries comprehensively, aids in treatment planning, avoids medical negligence thereby improving the quality of care given to the patient. The study introduced a structured maxillofacial trauma template to improve the quality of the ED documentation. Methods: A total of 220 patients were evaluated for the quality of their ED documentation from September 2023 till February 2024. The group A included 110 patients where complete medical documentation was done routinely on a blank A4 sized paper, group B included 110 patients where the documentation was done using the structured oral and maxillofacial trauma template. The ED notes were thoroughly evaluated by the 2 independent authors for record completeness and documentation rate of history and examination findings. Results: The introduction of trauma template demonstrated a significant improvement of 18.95% in record completeness. Significant improvement was seen in documentation rate among the covariates like place of injury, time of evaluation, primary care given, wound classification, dento-alveolar injury, ophthalmic evaluation, nerve injury evaluation, comorbidities with p = 0.001, and referral with p = 0.03. The ophthalmic evaluation showed significant improvement among covariates (loss of visual acuity, reflexes, diplopia, enophthalmos, subconjunctival haemorrhage, chemosis, periorbital oedema, periorbital ecchymosis, ocular dystopia) with p = 0.001, and extraocular muscle restriction with p = 0.004. Conclusions: The study demonstrated that the use of a structured oral and maxillofacial trauma template can significantly improve the quality of the ED documentation and contributes to better patient care in the ED. Full article

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12 pages, 1201 KiB

Open AccessArticle

Pediatric Facial Fractures: A Multi-Institutional Level 1 Trauma Center Analysis of Incidence, Interventions, and Outcomes

by Madison Hinson, Avery Wright, Amelia Davidson, Samuel Kogan and Christopher Runyan

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 45; https://doi.org/10.1177/19433875241272430 - 5 Aug 2024

Cited by 1 | Viewed by 104

Abstract

Study Design: Retrospective chart review. Objective: The management of pediatric facial fractures presents distinctive considerations compared to adults. This study aims to provide a unique perspective on the correlations between the mechanism of injury, types of facial fractures, and fracture interventions and management [...] Read more.

Study Design: Retrospective chart review. Objective: The management of pediatric facial fractures presents distinctive considerations compared to adults. This study aims to provide a unique perspective on the correlations between the mechanism of injury, types of facial fractures, and fracture interventions and management utilized in 2 North Carolina Level 1 Trauma Centers to determine the optimal management options for this patient population. Methods: An IRB-approved retrospective chart review was performed of pediatric facial trauma patients ages <18 years old between January 2020 and December 2022 at Atrium Health Wake Forest Baptist Medical Center and Atrium Health Charlotte Medical Center. Data on patient demographics, mechanism of injury, facial fractures, interventions, and outcomes were collected. Results: Of 2977 pediatric facial trauma patients, 582 patients sustained at least 1 facial fracture at the time of injury. Adolescents were significantly less likely to be transferred from outside institutions and to be admitted for further care (p = 0.002). Adolescents experienced higher levels of residual symptoms following initial discharge (p = 0.001) and were less likely to have a symptom resolution within 1 year (p < 0.0001). Neonates and infants were significantly more likely to receive conservative interventions and to sustain calvarium and skull base fractures (p < 0.0001). Conclusions: This study identifies differences in pediatric age groups related to transfers, admittance, fracture type, management, and outcomes. Our data suggests adolescent patients may experience a higher incidence of residual symptoms with lower levels of symptom resolution within 1 year. Further investigation into these differences may elicit optimized methods of fracture management in pediatric age groups and allow for effective, individualized care with improved long-term outcomes. Full article

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10 pages, 1317 KiB

Open AccessArticle

Outcome Evaluation of Three-Dimensionally Printed Patient-Specific Surgical Plates for Mandibular Reconstruction

by Wen-Bo Zhang, Chao-Fei Wang, Yao Yu, Shuo Liu, Lei-Hao Hu, Hui Yuh Soh, Jie Zhang and Xin Peng

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 50; https://doi.org/10.1177/19433875241272441 - 3 Aug 2024

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Abstract

Study Design: Prospective and retrospective studies. Objective: The aim of this study was to evaluate the clinical effects and accuracy of three-dimensionally (3D)-printed patient-specific surgical plates used for mandibular defect reconstruction. Methods: This study included patients who underwent mandibular defect [...] Read more.

Study Design: Prospective and retrospective studies. Objective: The aim of this study was to evaluate the clinical effects and accuracy of three-dimensionally (3D)-printed patient-specific surgical plates used for mandibular defect reconstruction. Methods: This study included patients who underwent mandibular defect reconstruction with vascularized autogenous bone grafts between January 2012 and August 2021. They were divided into experimental (fixation with 3D-printed surgical plates) and control (fixation with conventional surgical plates) groups. Flap survival rate, postoperative complications and patient self-evaluated facial appearance were compared. Mandibular reconstruction accuracy evaluation included postoperative position deviation of the whole mandible, transplanted bone graft, lower mandibular border, mandibular condyle, and mandibular angle on the reconstructed side compared to baseline. Results: This study included 20 patients (14 males, six females; age, 39.45 ± 11.69 years), ten each in the experimental and control groups. The mean follow-up was 16 ± 22.05 (range, 6–99) months. All procedures were successful, no plate-related complications (breakage, loosening, or exposure of the surgical plates) were reported, and all patients were satisfied. The groups were statistically similar in th e position deviation of the whole mandible, transplanted bone graft, mandibular condyle, and mandibular angle, but the position and morphology of the lower mandibular border on the reconstructed side in the experimental group were better than those in the control group (p = 0.016). Conclusions: 3D-printed patient-specific surgical plates could be applied in mandibular reconstruction safely and effectively, simplifying the surgical procedure, shortening the preoperative preparation times, achieving satisfactory outcomes, and improving the clinical effects and accuracy of individualized mandibular reconstruction. Full article

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10 pages, 1222 KiB

Open AccessArticle

The Burden of Road Traffic Accidents on Facial Fractures: National Trends, Injury Patterns, and Disparities in 154,185 Patients

by Carol Y. Wang, Daniel Y. Kwon, Olachi Oleru, Nargiz Seyidova, Peter E. Shamamian, Keisha E. Montalmant, Alex Sarosi and Peter J. Taub

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 49; https://doi.org/10.1177/19433875241272440 - 2 Aug 2024

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Abstract

Study Design: National database study. Objective: Road traffic accidents (RTAs) are a common and challenging cause of facial fractures in the United States. The present study sought to utilize the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) to investigate national trends, [...] Read more.

Study Design: National database study. Objective: Road traffic accidents (RTAs) are a common and challenging cause of facial fractures in the United States. The present study sought to utilize the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) to investigate national trends, injury patterns and disparities in facial fractures secondary to RTAs. To date, this is the first study to do so. Methods: A retrospective analysis was conducted of patients with primary facial fractures secondary to RTAs using the 2018–2021 HCUP-NIS. Patients were classified into the RTA and non-RTA group. Demographics, injury patterns, and inpatient outcomes were compared. Results: In total, 154,185 primary facial fractures were identified, of which 17% (n = 26,115) were associated with RTAs. RTAs commonly involved cars (41%), followed by motorcycles (15%), pedestrians (11%), and bicyclists (10%). The RTA group was younger (34% vs 24% < 25 years, p < 0.01) and more frequently Hispanic (18% vs 15%, p < 0.01). The most common fracture types were mandibular (23%), frontal (14%), and orbital fractures (14%). The RTA group was 50% more likely to have multiple facial fractures (OR = 1.5, p < 0.01). The RTA group had a longer length of stay (5.3 vs 4.0 days, p < 0.01), admission charge ($127,932 vs $79,414, p < 0.01), and mortality rate (1.9% vs 1.4%, p < 0.01) than the non-RTA group. Conclusions: The present findings provide valuable insights, informing early involvement of craniofacial surgeons for the assessment of combination facial fractures and tailored treatment approaches for RTA patients. Full article

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9 pages, 791 KiB

Open AccessArticle

Analyzing Epidemiology and Hospital Course Outcomes of LeFort Fractures in the Largest National Pediatric Trauma Database

by Sofia Perez Otero, Michael F. Cassidy, Kerry A. Morrison, Hilliard T. Brydges, John Muller, Roberto L. Flores and Daniel J. Ceradini

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 52; https://doi.org/10.1177/19433875241262616 - 21 Jun 2024

Viewed by 128

Abstract

Study Design: Retrospective observational study. Objective: This study analyzes the epidemiology of pediatric Le Fort fractures and assesses the incidence of concomitant injuries and acute-level hospital course using the largest, national pediatric trauma database to date. Methods: Pediatric midface and Le Fort fractures [...] Read more.

Study Design: Retrospective observational study. Objective: This study analyzes the epidemiology of pediatric Le Fort fractures and assesses the incidence of concomitant injuries and acute-level hospital course using the largest, national pediatric trauma database to date. Methods: Pediatric midface and Le Fort fractures from 2016–2019 were identified in the National Trauma Data Bank. Descriptive analyses of Le Fort compared to non-Le Fort midface fractures were performed. Multivariable regression assessed whether Le Fort fractures were risk factors for ICU admission, intracranial injury, cervical spine (C-spine) fracture, tracheostomy, and mortality. Results: A total of 1489 patients with Le Fort fractures were identified. There were 520 Le Fort I, 632 Le Fort II, and 609 Le Fort III fractures. Fracture incidence increased with age. Le Fort fractures showed higher rates of concomitant intracranial injury (p < 0.001), ICU admission (p < 0.001), C-spine fracture (p < 0.001), and tracheostomy (p < 0.001). Incidence of all the above increased with higher-grade Le Fort fractures. Le Fort III fractures had higher rates of mortality than non-Le Fort midface fractures (7.6% vs 3.2%). Multivariable regression showed that all Le Fort patterns were independent risk factors for tracheostomy and ICU admission, but only Le Fort I for C-spine fractures. Conclusions: The incidence of Le Fort fractures appears to increase with age. Higher category Le Fort fractures are associated with greater morbidity. Full article

13 pages, 1868 KiB

Open AccessReview

A Systematic Review of Local Flaps Utilized for External Auditory Canal Defects

by Anna Celeste Gibson, Olivia Speed, Jennings R. Boyette and Robert Saadi

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 59; https://doi.org/10.1177/19433875241262619 - 20 Jun 2024

Viewed by 80

Abstract

Study Design: Systematic review of the literature. Objective: The goal of this study is to review and summarize current literature on local flap reconstruction of external auditory canal (EAC) defects. Methods: PubMed and Ovid databases were queried utilizing search term combinations of “external [...] Read more.

Study Design: Systematic review of the literature. Objective: The goal of this study is to review and summarize current literature on local flap reconstruction of external auditory canal (EAC) defects. Methods: PubMed and Ovid databases were queried utilizing search term combinations of “external auditory canal”, “defects”, “flaps”, “local”, and “reconstruction”. References in included articles were subject for review and inclusion. Articles published between 2013 and 2023 were included in the study. Results: A total of 108 articles were screened after duplicates were excluded. Of the 108 articles, 3 were not written or translated to English, 10 were not accessible for review on either database, and 71 were not applicable to our subject of interest. The remaining 24 articles were included in the systematic review. Due to the primary descriptive nature of the surgical techniques and variability of data collection, a formal meta-analysis was not possible. Conclusions: The EAC defect creates a difficult reconstructive dilemma. The armamentarium for repairing these defects can range from healing by secondary intention to free tissue transfer, however, local flap reconstruction proves to be a reliable and versatile option. This article reviews current local flap techniques for EAC defects and compares their advantages and disadvantages. Further, the authors provide a treatment algorithm and indications for choosing each flap in external auditory canal reconstruction. Full article

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8 pages, 638 KiB

Open AccessArticle

Evaluating Facial Trauma in the Amish: A Study of a Unique Patient Population

by Bao Y. Sciscent, Hanel W. Eberly, Tonya S. King, Richard Bavier and Jessyka G. Lighthall

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 60; https://doi.org/10.1177/19433875241259887 - 14 Jun 2024

Viewed by 85

Abstract

Study Design: Retrospective Chart Review. Objective: The lifestyle of the Amish exposes them to unique mechanisms of injury, making them an important patient population from a facial trauma standpoint. This study analyzes the demographic and clinical risk factors of facial trauma in the [...] Read more.

Study Design: Retrospective Chart Review. Objective: The lifestyle of the Amish exposes them to unique mechanisms of injury, making them an important patient population from a facial trauma standpoint. This study analyzes the demographic and clinical risk factors of facial trauma in the Amish. Methods: This retrospective chart review identified all Amish patients presenting with facial trauma at a single institution between 2013–2023. Results: There were 87 Amish facial trauma patients. The median age was 9 years old, and 67.8% were male. Most injuries occurred on the road (41.4%), farm (28.7%), or at home (25.3%). The most frequent mechanisms were buggies (27.6%), falls (26.4%), and animals (18.4%). Fifty-eight patients sustained facial fractures, with orbital (n = 40), maxillary (n = 25), and nasal (n = 19) fractures being the most prevalent. The most common cause of facial fractures was buggy injuries (n = 17). Facial reconstruction was performed in 54.2% of buggy injuries, 31.3% of animal injuries, and 8.7% of falls. Patients with buggy injuries presented with the lowest Glasgow Coma Scale (GCS) scores (median 13.5) and had the longest inpatient hospital stay (median 3 days). Conclusions: Increased injury prevention efforts, especially towards buggy injuries, are necessary. Full article

8 pages, 1526 KiB

Open AccessArticle

Management of Atrophic Edentulous Mandible Fractures Utilizing Virtual Surgical Planning and Patient-Specific Implants

by Daniel P. Caruso, Vincent M. Aquino and Jeffrey T. Hajibandeh

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 70; https://doi.org/10.1177/19433875241259808 - 6 Jun 2024

Viewed by 117

Abstract

Study Design: This paper presents a case series analysis of 5 patients with Luhr class III mandible fractures treated using virtual surgical planning (VSP) and patient-specific implants (PSI) between October 2020 and February 2023. The study focuses on evaluating the effectiveness of [...] Read more.

Study Design: This paper presents a case series analysis of 5 patients with Luhr class III mandible fractures treated using virtual surgical planning (VSP) and patient-specific implants (PSI) between October 2020 and February 2023. The study focuses on evaluating the effectiveness of VSP and PSI in managing complex mandibular fractures, particularly in edentulous patients. Objective: The primary objective is to assess the outcomes of using VSP and PSI for reconstructive surgery in patients with Luhr class III mandible fractures. The study aims to determine the accuracy of these techniques in fracture reduction and their impact on surgical complications and overall patient outcomes. Methods: The methodology involves a detailed preoperative planning process using VSP to design customized implants tailored to the specific anatomical needs of each patient. The study tracks the surgical procedures, implant placements, and postoperative outcomes, comparing the preoperative plans with the actual surgical results to evaluate accuracy and effectiveness. Results: The results indicate successful fracture reduction in all 5 patients, with a high degree of accuracy in implant placement and alignment compared to the preoperative virtual plans. The study highlights the benefits of VSP and PSI, including precise screw placement and enhanced potential for prosthetic rehabilitation. Despite the higher costs, the outcomes suggest significant advantages in terms of surgical precision and patient recovery. Conclusions: The use of VSP and PSI in the treatment of Luhr class III mandible fractures provides a tailored approach that enhances surgical accuracy and patient outcomes. While acknowledging the increased costs, the findings support the value of these advanced techniques in managing complex edentulous mandible fractures, advocating for their consideration in similar cases to improve surgical results and patient care. The study adds to the growing evidence of the benefits of VSP and PSI in reconstructive maxillofacial surgery. Full article

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7 pages, 546 KiB

Open AccessArticle

Factors Associated with Outcomes of Facial Reconstruction After Mohs Micrographic Surgery

by Jenny Ji, Nora Alexander, Kwasi Enin and Emily Spataro

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 76; https://doi.org/10.1177/19433875241257981 - 31 May 2024

Viewed by 94

Abstract

Study Design: Retrospective cohort study. Objective: To determine patient, defect, and surgical factors associated with facial reconstructive outcomes. Methods: Post-Mohs Micrographic Surgery (MMS) facial reconstructions performed at a single institution between 2015–2020 were reviewed. Patient demographics, comorbidities, defect characteristics, type and timing of [...] Read more.

Study Design: Retrospective cohort study. Objective: To determine patient, defect, and surgical factors associated with facial reconstructive outcomes. Methods: Post-Mohs Micrographic Surgery (MMS) facial reconstructions performed at a single institution between 2015–2020 were reviewed. Patient demographics, comorbidities, defect characteristics, type and timing of reconstruction, and postoperative complications and revisions were collected. Data was analyzed with multivariable logistic regressions. Results: 245 defects in 220 patients (median age 66 years, 143 (65%) female) were included. Most were located on the nose (68%), and median size was 3.0 cm² (IQR 1.32–7.5 cm²). Defect size over 10 cm² (OR 5.176, 95% CI 1.353–19.808) and two-staged melolabial flaps (OR 4.021, 95% CI 1.525–10.603) were associated with complications after univariate analysis. Nasal tip defects (OR 2.324, 95% CI 1.076–5.019) were associated with minor revisions. Major revisions were associated with nasal sidewall (OR 2.873, 95% CI 1.125–7.336) and tip (OR 2.780, 95% CI 1.145–6.749) defects, ear cartilage grafts (OR 3.373, 95% CI 1.382–8.231), two-staged paramedian forehead flaps (OR 19.273, 95% CI 6.864–54.112), and delayed reconstruction over 14 days (OR 5.727, 95% CI 1.298–25.281). On multivariable analysis, defect size over 10 cm² (aOR 4.972, 95% CI 1.286–19.073) and two-staged melolabial flaps (aOR 4.575, 95% CI 1.628–12.857) were independently associated with complications, while two-staged paramedian forehead flaps (aOR 14.421, 95% CI 3.976–52.310) were independently associated with major revisions. Conclusions: More complex reconstructions with larger defects and interpolated flaps were associated with revision surgery and complications of facial reconstruction following MMS. Full article

8 pages, 594 KiB

Open AccessArticle

Incidence and Characterization of Facial Lacerations in Emergency Departments in the United States

by Heather Peluso, Kevin Vega, Sthefano Araya, Lindsay Talemal, Civanni Moss, Jake Siegel and Adam Walchak

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 74; https://doi.org/10.1177/19433875241257572 - 30 May 2024

Viewed by 109

Abstract

Study Design: This is a retrospective study using the Nationwide Emergency Department Sample. Objective: Facial laceration repairs are one of the most common procedures performed in the emergency department (ED). The goal of this study was to describe the patient’s characteristics and healthcare [...] Read more.

Study Design: This is a retrospective study using the Nationwide Emergency Department Sample. Objective: Facial laceration repairs are one of the most common procedures performed in the emergency department (ED). The goal of this study was to describe the patient’s characteristics and healthcare cost associated with ED encounters for facial lacerations using the largest nationally representative database in the United States. Methods: This is a retrospective study using the Nationwide Emergency Department Sample. The data was collected between January and December of 2019. Patients with either a primary or secondary diagnosis of facial laceration were included. The primary outcome was patient characteristics. The secondary outcomes were ED characteristics, number and type of procedures performed and total encounter charges. Diagnoses and procedures were identified using ICD-10 CM codes. Results: There were 2,548,944 ED encounters for facial lacerations in the United States. Of those, laceration was the chief complaint in 75%. 80% of lacerations were unintentional, 8% were due to assaults, and <1% due to suicidal attempts. The most common laceration location was the scalp (21%) followed by the lip (11%) and eyelid (11%). The mean patient age was 38 years. Most patients were adults (69%), male (62%), Caucasian (64%, African American 14%, Hispanic 14%, Other 4%, Asian 2%), from low income levels ($1–$45,999: 29%, $46,000–$58,999: 24%, $59,000–$78,999: 24%, $79,000 or more: 23%), with private insurance (32%, Medicaid 25%, Medicare 24%, self-pay 12%, other 6%). Most encounters were during summer (June, July, August) at large metropolitan areas with at least 1 million residents (52%, small metropolitan: 30%, micropolitan: 10%, other: 7%) at teaching hospitals (65%) located in the southern region of the United States (37%, Midwest: 23%, west: 21%, northeast: 19%). Almost half of the encounters were at non-trauma-designated hospitals (48%, Level 1 trauma center: 21%, Level 2 trauma center: 17%, Level 3 trauma center: 13%). The number of procedures during each encounter was: none: 4%, one: 17%, two: 23%, three: 11%, four: 11%, five or more: 28%. The most frequent laceration repair was a simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes 2.5 cm or less, followed by simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities 2.5 cm or less. Most emergency department visits were billed as a Level 3 encounter, followed by Level 2 then Level 4. CT scan of the head was the most common imaging modality. Of all patients, <1% were admitted to the hospital and 87% were discharged home. The average total emergency department charges were $5733. Conclusions: Facial laceration is a common complaint in the emergency department. It is costly, and disproportionately affects the impoverished. Most lacerations are classified as simple, less than 2.5 cm, involving the scalp, unintentional, with the discharge disposition being home. Thus, exploring pathways to treat facial lacerations outside of the ED can potentially reduce both healthcare cost and ED crowding. Full article

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7 pages, 1172 KiB

Open AccessArticle

Does Platelet-Rich Fibrin Enhance Recovery From Neurosensory Disturbance Following Mandibular Fractures? A Double-Blind, Split-Mouth Randomized Clinical Trial

by Reza Tabrizi, Hamidreza Moslemi, Shervin Shafiei, Ramtin Dastgir and Zachary S. Peacock

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 75; https://doi.org/10.1177/19433875241257737 - 27 May 2024

Viewed by 113

Abstract

Study Design: Randomized Clinical Trial. Objective: Mandibular body fractures may result in inferior alveolar nerve damage. This study examined the effectiveness of platelet-rich fibrin (PRF) application to the inferior alveolar nerve during open reduction and internal fixation (ORIF) of mandibular fractures. Methods: This [...] Read more.

Study Design: Randomized Clinical Trial. Objective: Mandibular body fractures may result in inferior alveolar nerve damage. This study examined the effectiveness of platelet-rich fibrin (PRF) application to the inferior alveolar nerve during open reduction and internal fixation (ORIF) of mandibular fractures. Methods: This was a double-blind, split-mouth randomized clinical trial. Patients with bilateral mandibular body fractures with minimal displacement (<5 mm) who underwent ORIF were assessed for enrollment. PRF was placed within the fracture site before reduction and fixation on the studied side. Fixation was performed on the contralateral side (control side) without PRF. The study and control groups were randomized using QuickCalcs software. Neurosensory disturbance (NSD) was assessed through two-point discrimination (TPD), self-reported NSD (SR-NSD), and brush directional stroke discrimination test (BDSD) at 6 and 12 months postoperatively. Results: Twenty-five subjects were enrolled. BDSB recovery was greater in the study group during all time intervals (p < 0.001). There were no differences between TPD and SR-NSD at the follow-up periods (p > 0.05). Conclusions: The results of this split-mouth randomized clinical trial indicate that PRF may enhance the recovery of a damaged inferior alveolar nerve in mandibular body fractures. Full article

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16 pages, 1534 KiB

Open AccessArticle

Refining Operative Indications for Zygomaticomaxillary Complex Fracture Repair

by Rachna Goli, Vinay Rao, Joseph W. Crozier and Albert S. Woo

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 73; https://doi.org/10.1177/19433875241255223 - 25 May 2024

Viewed by 84

Abstract

Study Design: Case-control. Objective: Although zygomaticomaxillary complex (ZMC) fractures are among the most common facial injuries, the optimal approach to management remains controversial. This study analyzes the relationship between displacement measures derived from pre-operative CT imaging and clinical symptomatology to enhance surgeon understanding [...] Read more.

Study Design: Case-control. Objective: Although zygomaticomaxillary complex (ZMC) fractures are among the most common facial injuries, the optimal approach to management remains controversial. This study analyzes the relationship between displacement measures derived from pre-operative CT imaging and clinical symptomatology to enhance surgeon understanding of the need for operative intervention. Methods: A retrospective analysis was conducted on 95 patients with ZMC fractures seen at a single institution between 2015 and 2020. Patient demographics, CT characteristics, and symptoms prompting surgery were recorded from the medical record. Statistical analysis was conducted to determine relationships between radiographic characteristics, symptomatology, and need for operative intervention. Results: Malar flattening or facial asymmetry was significantly predicted by lateral maxillary wall impaction (OR = 1.36, p < 0.001) and anterior-posterior displacement (OR = 1.18, p = 0.01). Infraorbital rim step-off was significantly associated with lateral maxillary wall impaction (OR = 1.23, p < 0.01). Vertical displacement predicted complaint of malocclusion (OR = 1.47, p = 0.03). Moreover, fractures with posterior displacement greater than 2.5 mm (OR = 14.3, p < 0.001) or lateral maxillary wall impaction greater than 4.5 mm (OR = 12.0, p < 0.001) were significantly more likely to be considered operative. Fractures displaced less than 15 mm total in all directions (OR = 16.0, p < 0.001) were less likely to require surgery. Conclusions: CT characteristics of ZMC fractures reliably predict a patient’s likelihood of developing symptoms, indicating surgical intervention. We hope these findings will aid in surgical decision-making regarding the management of ZMC fractures. Full article

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13 pages, 1537 KiB

Open AccessReview

Two Miniplates Versus Three Dimensional Plate in Management of Mandibular Condylar Fractures: A Systematic Review and Meta-Analysis

by Santhosh Kumar Kuna, Anuj Jain and Vishala Kuna

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 72; https://doi.org/10.1177/19433875241252979 - 8 May 2024

Cited by 4 | Viewed by 118

Abstract

Study Design: Systematic Review and Meta-analysis. Objective: This systematic review and meta-analysis aimed to compare the efficacy of 2 miniplates vs a three-dimensional plate in the management of mandibular condylar fractures. The primary objective was to assess key parameters, including intraoperative time, maximum [...] Read more.

Study Design: Systematic Review and Meta-analysis. Objective: This systematic review and meta-analysis aimed to compare the efficacy of 2 miniplates vs a three-dimensional plate in the management of mandibular condylar fractures. The primary objective was to assess key parameters, including intraoperative time, maximum mouth opening, complications, and functional outcomes, to determine potential differences between the 2 fixation methods. Methods: A comprehensive literature search was conducted to identify relevant studies. Inclusion criteria were applied, and the selected studies underwent systematic review. The key parameters were extracted and subjected to meta-analysis to quantify and compare the outcomes associated with the use of 2 miniplates and three-dimensional plates. The methodologies of the included studies were critically evaluated to address potential biases and confounding factors. Results: The meta-analysis results indicated that there were no statistically significant differences between the 2 fixation methods in terms of intraoperative time, maximum mouth opening, complications, and functional outcomes. However, concerns were raised regarding the high risk of bias, confounding factors, and considerable heterogeneity observed across the reviewed studies. Conclusions: The findings suggest that both 2 miniplates and three-dimensional plates are viable options for the management of mandibular condylar fractures. Despite the lack of statistical significance in the observed differences, the study highlights the need for further prospective research with enhanced methodologies, standardized protocols, larger sample sizes, and reduced bias to refine our understanding and potentially influence clinical management protocols. Full article

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8 pages, 566 KiB

Open AccessArticle

Epidemiology and Characteristics of Women with Facial Fractures Seeking Emergency Care in the United States: A Retrospective Cohort Study

by Heather Peluso, Lindsay Talemal, Civanni Moss, Sthefano Araya, Erica Kozorosky, Sameer A. Patel and Adam Walchak

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 71; https://doi.org/10.1177/19433875241252194 - 7 May 2024

Cited by 1 | Viewed by 84

Abstract

Study Design: Facial bone fractures in women are less common than in men in the United States. However, little is known about the epidemiology of women who sustain facial fractures. Objective: Our aim is to describe the patient population of women seeking emergency [...] Read more.

Study Design: Facial bone fractures in women are less common than in men in the United States. However, little is known about the epidemiology of women who sustain facial fractures. Objective: Our aim is to describe the patient population of women seeking emergency care for facial fractures in the United States and they type and cost of care received in this setting. Methods: This is a retrospective cohort study using the 2019 National Emergency Department Sample. The inclusion criterion was diagnosis of facial fracture. The primary outcome was patient characteristics. The secondary outcomes are emergency department (ED) characteristics, discharge disposition, total visit charges, and most common cause. Diagnoses and procedures were identified using ICD10-CM codes. Outcomes were compared to men. Results: Thirty-seven percent of ED facial fractures were encountered in women. Both women and men were most likely adult, Caucasian, from the lowest median income quartile, sustained nasal bone fractures, and presented to a southern, metropolitan, private nonprofit, non-trauma ED. Conclusions: Women were older, more likely insured by Medicare and less likely by private insurance, discharged home, and had lower ED charges than their male counterparts. However, the financial burden of emergency care for facial fractures among women was $1.6 billion. Full article

9 pages, 624 KiB

Open AccessArticle

Functional and Esthetic Outcomes of Either Surgically or Conservatively Treated Anterior Frontal Sinus Wall Fractures: A Long-Term Follow-Up

by Oscar Solmell, Ola Sunnergren, Abdul Rashid Qureshi and Babak Alinasab

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 69; https://doi.org/10.1177/19433875241250225 - 30 Apr 2024

Cited by 1 | Viewed by 71

Abstract

Study Design: Retrospective cohort study. Objective: Frontal sinus fractures (FSFs) can lead to a range of clinical challenges, including facial deformity, impaired facial sensation, cerebrospinal fluid (CSF) leakage, sinus drainage impairment, chronic sinus pain and mucocele formation. The optimal management approach, whether surgical [...] Read more.

Study Design: Retrospective cohort study. Objective: Frontal sinus fractures (FSFs) can lead to a range of clinical challenges, including facial deformity, impaired facial sensation, cerebrospinal fluid (CSF) leakage, sinus drainage impairment, chronic sinus pain and mucocele formation. The optimal management approach, whether surgical or conservative, remains a topic of ongoing discussion. The aim of this study was to evaluate and compare the functional and esthetic outcomes of patients with surgically and conservatively treated FSFs. Methods: In this retrospective study, patients treated for FSFs at the Karolinska university hospital 2004 to 2020 were identified in hospital records and invited to participate in a long-term follow-up. Sequelae and satisfaction with the esthetic result were assessed trough questionnaires and physical examinations. Results: A total of 93 patients were included in the study, with 49 presenting isolated anterior wall fractures and 44 presenting combined anterior and posterior wall fractures. Surgical intervention was performed in 45 cases, while 48 were managed conservatively. Among patients with moderate anterior wall fractures (4–6 mm dislocation), 80% of surgically treated patients compared to 100% of conservatively treated patients expressed satisfactionwith their cosmetic outcomes at follow-up (p = 0.03). In conservatively treated patients with a forehead impression, the anterior wall fracture dislocation ranged from 5.3 to 6.0 mm (p < 0.0001). Approximately 50% of surgically treated patients vs 15% of conservatively treated patients developed impaired forehead sensation at follow-up (p = 0.03). Thirty-six percent of surgically treated patients reported dissatisfaction with surgery-related scarring, particularly those who underwent surgery via laceration or bicoronal incision. Conclusions: This study suggests that anterior FSFs with a dislocation of 5 mm or less can be effectively managed conservatively with high patient satisfaction, low risk of long-term forehead sensation impairment and without potential development of forehead impression. Bicoronal incision or incision via a laceration may be associated with esthetic dissatisfaction and late sequelae such as alopecia. Full article

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5 pages, 1013 KiB

Open AccessArticle

Endoscopic Dacryocystorhinostomy Following Nasolacrimal Drainage System Trauma and Medial Orbital Wall Reconstruction

by Laura Drayer Turner, Pav A. Gounder, Randolph Dobson and Saul N. Rajak

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 62; https://doi.org/10.1177/19433875241250221 - 24 Apr 2024

Viewed by 89

Abstract

Study Design: Case series. Objective: To describe the assessment and surgical approach to dacryocystorhinostomy (DCR) for patients with nasolacrimal duct obstruction (NLDO) in the presence of orbital wall hardware. Methods: The pre-operative assessment, management and outcomes of two patients with secondary acquired NLDO [...] Read more.

Study Design: Case series. Objective: To describe the assessment and surgical approach to dacryocystorhinostomy (DCR) for patients with nasolacrimal duct obstruction (NLDO) in the presence of orbital wall hardware. Methods: The pre-operative assessment, management and outcomes of two patients with secondary acquired NLDO following medial orbital wall fracture repair treated by nasal endoscopic DCR. Results: Anatomical and functional success was achieved in both cases at 6 weeks post operatively without disruption of the orbital plate. There was persistent success at 1 and 3 years’ post-operatively. Conclusions: Endoscopic DCR is a good option for the treatment of NLDO in patients with previous medial orbital wall fracture repair where the location of the plate may complicate the external approach. Full article

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9 pages, 1549 KiB

Open AccessArticle

Isolated Orbital Fracture—Treatment and Outcomes in a Single Tertiary Care Centre

by Mirko K. K. Maunula, Karin Blomgren, Saku T. Sinkkonen, Kristofer Nyman and Laura K. Tapiovaara

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 68; https://doi.org/10.1177/19433875241247370 - 19 Apr 2024

Viewed by 91

Abstract

Study Design: Retrospective, questionnaire survey. Objective: The literature lacks a consensus on treatment of isolated orbital fracture. Our aim was to explore treatment schemes and outcomes of patients with isolated orbital fracture treated at a single tertiary care centre. Methods: We performed a [...] Read more.

Study Design: Retrospective, questionnaire survey. Objective: The literature lacks a consensus on treatment of isolated orbital fracture. Our aim was to explore treatment schemes and outcomes of patients with isolated orbital fracture treated at a single tertiary care centre. Methods: We performed a retrospective chart review and a cross-sectional questionnaire survey. We reviewed the medical records of all patients diagnosed with isolated orbital fracture at an outpatient referral clinic in an urban university hospital between 2010 and 2016. We included only patients with isolated inferior, medial, or inferomedial orbital fracture in the study cohort. Wesent a questionnaire to these patients to assess the prevalence and severity of long-term symptoms. Results: We included 246 patients in the study cohort, of which 96 (39%) were treated surgically and 150 (61%) nonsurgically. Median time from injury to surgery was 11 days (range = 0–44, IQR = 8.15), and to sending the questionnaire 44 months (range = 16–93). The questionnaire was completed by 89 patients (36%), of whom 51 (57%) reported at least one mild long-term symptom, 24 (27%) at least one moderate long-term symptom, and 17 (19%) at least one severe longterm symptom. Conclusions: Patients with isolated orbital fracture treated at our unit reported severe long-term symptoms more frequently than would have been expected based on earlier research. Patients at our unit were treated surgically more often than in other similar units, which suggests that surgical treatment may be chosen over non-surgical treatment unnecessarily often at our unit. Full article

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8 pages, 862 KiB

Open AccessArticle

Orbital Floor Fractures: Treatment and Diagnostics—A Survey Among Swiss, German and Austrian Maxillofacial Units

by Thomas Burger, Kathleen Fan, Johannes Brokmeier, Florian M. Thieringer and Britt-Isabelle Berg

Craniomaxillofac. Trauma Reconstr. 2024, 17(4), 67; https://doi.org/10.1177/19433875241245498 - 18 Apr 2024

Viewed by 107

Abstract

Study Design: N/A. Objective: This study investigated the different ways of orbital floor reconstruction with special focus on reconstruction materials, imaging modalities (intra-/ post-operative), 3D printing and navigation. Methods: The heads of all governmental-run or associated cranio-maxillofacial surgery units in Switzerland, Austria and [...] Read more.

Study Design: N/A. Objective: This study investigated the different ways of orbital floor reconstruction with special focus on reconstruction materials, imaging modalities (intra-/ post-operative), 3D printing and navigation. Methods: The heads of all governmental-run or associated cranio-maxillofacial surgery units in Switzerland, Austria and Germany were asked in person or received an email link for an online survey with 12 questions. Results: The return rate was 57%. The most often selected number of reconstructions was between 10 and 50 per year. Resorbable polydioxanone (PDS) foils (41%) and titanium mesh (18 %) were most often used to reconstruct the orbital floor. 31% use 3D Navigation intraoperative. Post-operative imaging was most often performed with CBCT (34.5%) in patients without complications, whereas CT scans were most often performed (63.3%) in patients with persisting complications. In total, 27% stated that they never use preformed orbital plates, and the remaining units use them more or less regularly. 48% have access to a 3D printer and 75% of the respondents use patient specific implants. Conclusions: The majority of the participating units prefer to use resorbablematerial for the reconstruction of the orbital floor defects. 3D printing facilities are not available in the majority of units, but it can be expected that the number of units with 3D printing facilities will rise in the near future. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 17, Issue 4 (December 2024) – 48 articles

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