Craniomaxillofacial Trauma & Reconstruction

12 pages, 413 KiB

Open AccessArticle

Airway Management in Complex Maxillofacial Trauma: Evaluating the Role of Submental Intubation as a Viable Alternative to Tracheostomy

by Giulio Cirignaco, Gabriele Monarchi, Lisa Catarzi, Mariagrazia Paglianiti, Enrico Betti, Umberto Committeri, Alberto Bianchi, Paolo Balercia and Giuseppe Consorti

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 21; https://doi.org/10.3390/cmtr18010021 - 17 Mar 2025

Viewed by 795

Abstract

Airway management in maxillofacial trauma is a critical and complex challenge, requiring both secure ventilation and optimal surgical access while minimizing risks to vital structures. This study evaluated the efficacy of submental intubation (SMI) as a minimally invasive alternative to tracheostomy in patients [...] Read more.

Airway management in maxillofacial trauma is a critical and complex challenge, requiring both secure ventilation and optimal surgical access while minimizing risks to vital structures. This study evaluated the efficacy of submental intubation (SMI) as a minimally invasive alternative to tracheostomy in patients with complex maxillofacial fractures. A retrospective analysis of 52 patients treated between 2015 and 2023 was conducted by comparing clinical outcomes between those who underwent SMI (n = 26) and those who underwent tracheostomy (n = 26). The duration of hospitalization, infection rates, and perioperative complications were assessed using t-tests, chi-square tests, and multivariate regression. Results indicated that SMI was associated with significantly shorter hospital stays (11.15 ± 3.29 vs. 23.96 ± 6.47 days, p < 0.001) and lower infection rates (3.8% vs. 30.8%, p = 0.028). Additionally, the SMI group demonstrated fewer intraoperative (p = 0.049) and postoperative complications (p = 0.037). Multivariate analysis identified tracheostomy as an independent predictor of prolonged hospitalization and increased complications. These findings support SMI as a safe and effective alternative to tracheostomy for short-term airway management in maxillofacial trauma, providing a shorter recovery period and fewer complications. Therefore, prospective studies with larger cohorts are warranted to confirm these results and establish comprehensive guidelines. Full article

► Show Figures

Figure 1

11 pages, 234 KiB

Open AccessReview

Technique and Muscle Preferences for Dynamic Facial Reanimation in Irreversible Facial Paralysis—A Literature Review

by Hilde Schutte, Robbin Maat, Marvick S. M. Muradin and Antoine J. W. P. Rosenberg

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 20; https://doi.org/10.3390/cmtr18010020 - 5 Mar 2025

Viewed by 1229

Abstract

Study design: literature review. Introduction: Irreversible facial paralysis is a chronic condition characterized by an absence of mimetic muscle tone and function. This disruption of facial expressions not only has functional, but also psychological and social consequences. In facial dynamic reanimation, techniques are [...] Read more.

Study design: literature review. Introduction: Irreversible facial paralysis is a chronic condition characterized by an absence of mimetic muscle tone and function. This disruption of facial expressions not only has functional, but also psychological and social consequences. In facial dynamic reanimation, techniques are proposed partly recovering facial reanimation and function. To date, a vast amount of literature is available on dynamic reanimation techniques. However, no review has yet been published that delineates in detail the musculature and techniques used for dynamic reanimation in irreversible facial paralysis. Objective: the aim of the present paper is to offer a complete overview of possible techniques. Methods: A chapter division is made between the lower, mid-, and upper face. Each chapter is subdivided between local transposition, free muscle flaps, and for the upper face, implantable devices. Results: The literature discussing reanimation of the lower face is limited. In midfacial reanimation, temporalis transposition and gracilis free flap transfer are popular. In upper facial reanimation, no consensus on muscle choice is available, and information is limited too. Suggested techniques include orbicularis oculi transpositioning, temporalis transpositioning, and platysma free muscle transfer. Conclusions: This paper discusses the current techniques for dynamic facial reanimation. Yet, studies comparing different techniques are lacking, setting ground for future research. This paper highlights the importance of a personalized approach in selecting a fitting reconstruction method. Full article

13 pages, 3573 KiB

Open AccessArticle

Need for Redo Surgery of Maxillofacial Fractures

by Hanna Thorén, Sami Suojanen, Anna Liisa Suominen, Tero Puolakkainen, Miika Toivari and Johanna Snäll

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 19; https://doi.org/10.3390/cmtr18010019 - 3 Mar 2025

Viewed by 1566

Abstract

The purpose of the present study was to describe the demographic and clinical features of patients having undergone redo surgery for mandibular and/or midfacial fractures and to identify factors that increase the odds of redo surgery. Included were the files of all patients [...] Read more.

The purpose of the present study was to describe the demographic and clinical features of patients having undergone redo surgery for mandibular and/or midfacial fractures and to identify factors that increase the odds of redo surgery. Included were the files of all patients who had undergone open reduction and fixation of one or more mandibular and/or midfacial fracture or orbital reconstructions at the Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland, between 1 January 2013–31 October 2020. Patients having undergone redo surgery were identified, and descriptive characteristics were calculated. In the data analysis, the association between redo surgery and explanatory variables was analyzed. Altogether, 1176 patients were identified for the analysis. Of these, 25 (2.1%) underwent redo surgery for 28 fracture sites. The most common reasons for redo surgery were inadequate fracture reductions of the zygomatic process or the mandible (19 patients) and inadequate orbital reconstructions (four patients). Compared with surgery of only the mandible, combined surgery of the mandible and midface had almost four times greater odds of redo surgery (95% CI 3.8, 0.8–18.4), but the finding was not statistically significant. Although redo surgery was required fairly infrequently, the findings highlight the relevance of surgical competence to treatment success; suboptimal surgical procedure was the most common reason for redo surgery. The literature supports the use of intraoperative CT scanning as a useful tool in association with the treatment of complex midfacial fractures in general and orbital fractures in particular. The success of orbital reconstruction can be promoted by using patient-specific implants. Full article

► Show Figures

Figure 1

14 pages, 4305 KiB

Open AccessArticle

Virtual Surgical Planning for Management of Acute Maxillofacial Trauma

by Kyle W. Singerman, Megan V. Morisada, J. David Kriet, John P. Flynn and Clinton D. Humphrey

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 18; https://doi.org/10.3390/cmtr18010018 - 21 Feb 2025

Viewed by 1132

Abstract

Study design: A retrospective case series. Objective: The management of acute complex maxillofacial trauma is challenging. The intricate maxillofacial anatomy coupled with the significant functional and aesthetic repercussions of traumatic facial injuries necessitate meticulous preoperative preparation and operative precision to minimize patient morbidity. [...] Read more.

Study design: A retrospective case series. Objective: The management of acute complex maxillofacial trauma is challenging. The intricate maxillofacial anatomy coupled with the significant functional and aesthetic repercussions of traumatic facial injuries necessitate meticulous preoperative preparation and operative precision to minimize patient morbidity. The severe displacement of bone fragments, abnormal occlusion, comminution, and the involvement of multiple skeletal subsites further complicate the restoration of premorbid function and appearance. While previously recognized as a valuable tool for managing oncologic defects, orthognathic surgery, and for the correction of secondary deformities following maxillofacial trauma, virtual surgical planning (VSP) has now emerged as a viable tool for treating select patients following acute complex maxillofacial trauma. Methods: A retrospective chart review of all the complex facial trauma patients treated using VSP services over a 21-month period. Results: Multiple VSP services were used in the primary repair of complex facial trauma, with occlusal splints, pre-contoured plates, and 3D printed models being utilized most frequently. Conclusions: Our experience with VSP for primary maxillofacial trauma repair has helped us to identify specific indications for the use of VSP in this setting. Full article

► Show Figures

Figure 1

9 pages, 200 KiB

Open AccessArticle

Functional and Aesthetic Outcomes of Post-Mohs Nasal Reconstruction

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

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 17; https://doi.org/10.3390/cmtr18010017 - 20 Feb 2025

Viewed by 987

Abstract

Background: Similar to patients undergoing rhinoplasty, patients undergoing post-Mohs micrographic surgery (MMS) nasal reconstruction are concerned with both nasal form and function. Objectives: The objectives were to identify patient, defect, and surgical characteristics associated with post-MMS nasal reconstruction outcomes. Methods & Materials: A [...] Read more.

Background: Similar to patients undergoing rhinoplasty, patients undergoing post-Mohs micrographic surgery (MMS) nasal reconstruction are concerned with both nasal form and function. Objectives: The objectives were to identify patient, defect, and surgical characteristics associated with post-MMS nasal reconstruction outcomes. Methods & Materials: A retrospective single-institution cohort study was conducted of post-MMS nasal reconstruction surgeries occurring between 2015 and 2020. Patient, defect, and surgical details were collected along with nasal aesthetic and functional outcomes. Multivariable logistic regressions were used to analyze data. Results: A total of 167 nasal MMS defects among 160 patients met the inclusion criteria. The median age was 66 years, and 70% were female. A poor aesthetic outcome (n = 20, 12.0%) was associated with diabetes (aOR 6.277, 95% CI 2.193–17.965). Post-operative nasal obstruction (n = 17, 10.2%) was associated with obesity (aOR 20.976, 95% CI 2.406–182.845) and major revision surgery (aOR 12.192, 95% CI 2.838–52.382). Conclusion: Post-MMS nasal reconstruction aesthetic and functional outcomes are associated with obesity, diabetes, and revision surgery. Improved standardization of functional and cosmetic outcomes is important to better understand these results in the future. Full article

11 pages, 1273 KiB

Open AccessArticle

General and Treatment-Specific Outcomes with Osseointegrated Implants in Auricular, Nasal, and Orbital Prosthetic Reconstruction

by Morgan M. Sandelski, Deema Martini, Todd M. Kubon, Greg G. Gion and Amy L. Pittman

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 16; https://doi.org/10.3390/cmtr18010016 - 18 Feb 2025

Viewed by 576

Abstract

Background: Osseointegrated implants outside of dental restoration remain an integral area of facial reconstruction in which more outcomes data is needed. We aimed to describe our 13-year experience using osseointegrated implants for orbital, nasal, and auricular reconstruction, looking at general outcomes, including radiated [...] Read more.

Background: Osseointegrated implants outside of dental restoration remain an integral area of facial reconstruction in which more outcomes data is needed. We aimed to describe our 13-year experience using osseointegrated implants for orbital, nasal, and auricular reconstruction, looking at general outcomes, including radiated and surgically manipulated bone. Methods: This retrospective chart review covered demographics and outcomes from January 2008 to August 2021 in patients who underwent an orbital exenteration, partial or total rhinectomy, and partial or total auriculectomy with subsequent osseointegrated implant placement. We hypothesized radiation would increase the failure rate of implants and prostheses. Results: There were 79 implants placed in 27 patients, with over half of the patients requiring implants for reconstruction because of malignancy. The success rate was 86%. Complications were uncommon. Only 2 (7.4%) patients were unable to use their prosthesis. Prior radiation and surgery to the bone were associated with an increased risk of loss of implant (p = 0.008 and p = 0.007, respectively) but not associated with other complications or prosthesis non-viability. Conclusions: Osseointegrated implants are a reliable, permanent option for a realistic prosthesis. Radiation and prior surgery are significantly associated with an increased risk of implant failure but not associated with the inability to use the prosthesis. Regardless of prior treatments, bone-retained implants should be considered in facial reconstruction, especially after failing autologous repair or with concerns for cosmetic outcomes. Full article

► Show Figures

Figure 1

27 pages, 2205 KiB

Open AccessArticle

Patient-Specific Solutions for Cranial, Midface, and Mandible Reconstruction Following Ablative Surgery: Expert Opinion and a Consensus on the Guidelines and Workflow

by Majeed Rana, Daniel Buchbinder, Gregorio Sánchez Aniceto and Gerson Mast

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 15; https://doi.org/10.3390/cmtr18010015 - 13 Feb 2025

Viewed by 1918

Abstract

Reconstruction of cranio-maxillofacial defects following ablative surgeries requires a comprehensive approach that balances functional restoration with aesthetic outcomes. Advances in computer-aided design and manufacturing (CAD/CAM) technology have revolutionized this field, enabling precise preoperative planning, including 3D modeling, segmentation, and virtual resection planning. These [...] Read more.

Reconstruction of cranio-maxillofacial defects following ablative surgeries requires a comprehensive approach that balances functional restoration with aesthetic outcomes. Advances in computer-aided design and manufacturing (CAD/CAM) technology have revolutionized this field, enabling precise preoperative planning, including 3D modeling, segmentation, and virtual resection planning. These methods allow for the production of patient-specific implants and surgical templates while facilitating the evaluation of treatment outcomes. CAD/CAM technology offers numerous benefits, such as enhanced surgical accuracy, improved aesthetic results, reduced operative times, and the possibility of single-stage resection and reconstruction. However, limitations exist, including high costs, the need for specialized expertise, and dependency on accurate imaging data. This paper provides a surgeon-centric evaluation of the advantages and limitations of CAD/CAM in cranio-maxillofacial reconstruction. The discussion encompasses the technological workflow, clinical applications, and recommendations for optimizing outcomes. Future perspectives highlight ongoing developments, such as integrating non-ionizing imaging techniques and expanding the applicability of virtual and augmented reality. By synthesizing technical advancements and clinical expertise, this review aims to establish practical guidelines for implementing CAD/CAM technology in routine surgical practice. Full article

► Show Figures

Figure 1

9 pages, 225 KiB

Open AccessArticle

Patient-Reported Donor Site Quality of Life Outcomes Following Fibula Free Flap Reconstruction

by Edgar Ochoa, James Cevallos, Ramon Bustos, Nina Patel, Chase M. Heaton, Rahul Seth, P. Daniel Knott and Andrea M. Park

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 14; https://doi.org/10.3390/cmtr18010014 - 11 Feb 2025

Viewed by 1175

Abstract

Study Design: Retrospective cohort study. Objective: To (1) assess post-operative quality of life (QOL) and functional outcomes of fibula free flap (FFF) donor sites, (2) examine the incidence of post-operative claw toe deformities (CTDs) following FFF harvest, and (3) assess the effect of [...] Read more.

Study Design: Retrospective cohort study. Objective: To (1) assess post-operative quality of life (QOL) and functional outcomes of fibula free flap (FFF) donor sites, (2) examine the incidence of post-operative claw toe deformities (CTDs) following FFF harvest, and (3) assess the effect of flexor hallicus longus (FHL) muscle preservation on the incidence of post-operative CTDs. Methods: Patients aged 18 years or older and at least 6 months from FFF reconstructive surgery completed the Manchester–Oxford Foot Questionnaire (MOXFQ)and the Short-form 36 (SF-36) Questionnaire. The incidence of post-operative CTDs reported by respondents was calculated. We assessed the associations between FHL preservation at time of surgery and QOL and functional outcomes, including the development of post-operative CTDs. Results: Sixty patients completed questionnaires at a mean of 38.3 months from surgery. The cohort consisted of 28 patients in whom the FHL muscle and nerve were preserved and 32 patients in whom they were not. Among respondents, 23.3% (14/60) reported post-operative CTDs. FHL status was not associated with post-operative CTDs or with worse scores in the domains of pain (p = 0.612), walking/standing (p = 0.431), or social functioning (p = 0.400). Overall, majority reported high post-operative QOL. Conclusions: While majority of patients who undergo FFF reconstruction can expect good long-term donor site QOL and functional outcomes, there are risks of functional impairment, including post-operative CTDs. Preservation of FHL muscle did not affect post-operative QOL outcomes or the incidence of CTDs. These data can inform patient QOL expectations following FFF harvest. Full article

10 pages, 420 KiB

Open AccessArticle

Sobering Overview of Traumatic Craniofacial Injuries Involving Drugs and Alcohol: A Comprehensive Analysis of the NEISS Database

by Sam Boroumand, Ismail Ajjawi, Tara Boroumand, Omar Allam, Lioba Huelsboemer, Viola A. Stögner, Martin Kauke-Navarro, Siba Haykal, Michael Alperovich and Bohdan Pomahac

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 13; https://doi.org/10.3390/cmtr18010013 - 7 Feb 2025

Viewed by 1178

Abstract

The purpose of this study is to provide a comprehensive overview of the epidemiology of traumatic craniofacial injuries in the U.S. that occur in the context of drugs and/or alcohol. The National Electronic Injury and Surveillance System (NEISS) database was queried from 2019 [...] Read more.

The purpose of this study is to provide a comprehensive overview of the epidemiology of traumatic craniofacial injuries in the U.S. that occur in the context of drugs and/or alcohol. The National Electronic Injury and Surveillance System (NEISS) database was queried from 2019 to 2022 to identify all emergency department (ED) patients with reported traumatic injuries involving craniofacial anatomy. Clinical and demographic variables were assessed between cases that involved drugs/alcohol and those that did not, utilizing two-proportion z-tests. In total, 441,764 patients with traumatic craniofacial injuries were identified, with 20,285 cases involving drugs and/or alcohol. Cases involving drugs/alcohol had a significantly higher frequency of internal injuries (45.3% vs. 34.9%, p < 0.001), fractures (7.0% vs. 3.4%, p < 0.001), and hematomas (4.6% vs. 2.5%, p < 0.001) than those that did not. Craniofacial injuries involving drugs/alcohol also had a significantly higher frequency of falls to the floor (19.2% vs. 11.8%, p < 0.001) and down stairs/steps (18.3% vs. 6.6%, p < 0.001) and resulted in a significantly greater odds of hospital admission after ED presentation (OR 3.75, 95% CI: 3.63–3.88, p < 0.001). Ultimately, these epidemiological findings can be leveraged to provide clinicians invaluable qualitative context for the most frequent presentations of craniofacial injuries they can anticipate to treat among intoxicated patients. Full article

► Show Figures

Figure 1

14 pages, 3544 KiB

Open AccessArticle

Patient-Specific Orthognathic Solutions: Expert Opinion on Guidelines and Workflow

by Alf L. Nastri, Isaac Liau, Jaewon Heo and Alexander Schramm

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 12; https://doi.org/10.3390/cmtr18010012 - 6 Feb 2025

Viewed by 2118

Abstract

This document outlines guidelines for the use of three-dimensional virtual surgical planning in orthognathic surgery, with relevance to data acquisition, clinical diagnosis, data workflow sequencing, and operative considerations. A detailed description regarding fundamental principles of orthognathic assessment and planning is beyond the scope [...] Read more.

This document outlines guidelines for the use of three-dimensional virtual surgical planning in orthognathic surgery, with relevance to data acquisition, clinical diagnosis, data workflow sequencing, and operative considerations. A detailed description regarding fundamental principles of orthognathic assessment and planning is beyond the scope of this paper. Full article

► Show Figures

Figure 1

6 pages, 1835 KiB

Open AccessOpinion

Overcoming Barriers: The AO Foundation’s Role in Latin American Scientific Growth

by Rodrigo dos Santos Pereira, Rafael Vago Cypriano, Carlos Gaete Garcia, Juan José Larrañaga and Nicolas Homsi

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 11; https://doi.org/10.3390/cmtr18010011 - 5 Feb 2025

Viewed by 546

Abstract

This manuscript presents an exploratory evaluation of the challenges and opportunities in scientific research among craniomaxillofacial surgeons in Latin America. It focuses on initiatives introduced by the AO Foundation’s Research and Development (R&D) Committee to assess the current state of research involvement among [...] Read more.

This manuscript presents an exploratory evaluation of the challenges and opportunities in scientific research among craniomaxillofacial surgeons in Latin America. It focuses on initiatives introduced by the AO Foundation’s Research and Development (R&D) Committee to assess the current state of research involvement among AO Foundation members in the region and identify barriers to research. A survey conducted in 2023 among Latin American members of the AO Foundation gathered data on their interest in research, obstacles faced, and awareness of available opportunities, such as grants, fellowships, and mentorship programs. The outcomes revealed a strong interest in research, with 96.5% of respondents expressing a desire to engage. However, key barriers included limited time (46.5%), difficulties in project structuring and scientific writing (32.6%), and challenges in publishing (30.2%). Notably, 54.7% of respondents were unaware of the AO PEER program, and 65.6% were unfamiliar with the foundation’s research grant opportunities. The AO Foundation aims to enhance scientific development in Latin America by promoting multicenter research studies, training opportunities, and developing research group leaders. These strategies seek to support and encourage surgeons in advancing their scientific activities. Full article

► Show Figures

Figure 1

12 pages, 1754 KiB

Open AccessArticle

Training of Oral and Maxillofacial Surgery Residents in Virtual Surgical Planning: A Feasibility Study Comparing Open-Source Freeware and Commercially Available Software for Mandibular Reconstruction with Fibula Free Flap

by Bert Rombaut, Matthias Ureel, Benjamin Van der Smissen, Nicolas Dhooghe and Renaat Coopman

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 10; https://doi.org/10.3390/cmtr18010010 - 3 Feb 2025

Viewed by 1809

Abstract

Study Design: This is an experimental feasibility study. Objective: The objective was to analyze the potential of open-source freeware (OSF) to train residents in virtual surgical planning (VSP) and compare this workflow with commercially available software (CAS). Methods: A workflow for mandibular reconstruction [...] Read more.

Study Design: This is an experimental feasibility study. Objective: The objective was to analyze the potential of open-source freeware (OSF) to train residents in virtual surgical planning (VSP) and compare this workflow with commercially available software (CAS). Methods: A workflow for mandibular reconstruction with a fibular free flap (FFF) was developed in 3D-Slicer^® and Blender^® and compared to our clinical workflow in Materialise Mimics Innovation Suite version 25 (Materialise InPrint^®, ProPlan CMF^® and 3-Matic^®). Five CMF residents, inexperienced in VSP, were trained to use both the OSF and CAS workflows and then performed four planning sessions on OSF and CAS. The duration (minutes) and the amount of mouse clicks (MCs) of every step in the workflow were recorded. Afterwards, the experience with VSP was investigated with the System Usability Scale (SUS) and a self-developed questionnaire. Results: The total VSP time with CAS took 91 ± 15 min and needed 2325 ± 86 MCs compared to 111 ± 26 min and 1876 ± 632 MCs for OSF, respectively. The questionnaire had an 80% response rate. The SUS for CAS was 67.5 compared to 50 for OSF. The participants believe it is extremely valuable to learn VSP during their training and to be able to perform VSP as a surgeon. Conclusion: We believe OSF can be a cost-effective alternative compared to CAS for the training of surgical residents to gain insight in complex surgeries and to better understand CAD limitations and possibilities. Full article

► Show Figures

Figure 1

9 pages, 445 KiB

Open AccessArticle

Comparative Analysis of Open and Closed Nasal Fractures in Trauma Settings: Mechanisms, Intent, Surgical Interventions, and Outcomes

by Ahmad K. Alnemare

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 9; https://doi.org/10.3390/cmtr18010009 - 22 Jan 2025

Viewed by 1115

Abstract

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data [...] Read more.

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data Bank (NTDB) for the years 2013 to 2016. Main outcome measures: Trauma mechanism and mortality rates between closed and open fractures were conducted. Results: This study involved 122,574 closed and 9704 open nasal fractures to elucidate demographic, hospital, and clinical characteristics. Significant risk factors for open nasal fractures included a higher injury severity score, self-inflicted intent, unintentional causes, and firearm mechanism compared to assault injuries. Conclusions: Significant factors associated with open nasal fractures include injury severity, self-inflicted intent, trauma type, and firearm mechanisms, which notably increase the likelihood of open fractures. Findings highlight the need for targeted prevention, efficient resource allocation, and risk screening to enhance the management of complex facial traumas in the national trauma system. Full article

► Show Figures

Figure 1

12 pages, 849 KiB

Open AccessArticle

Oncological Outcomes Following Computer-Aided Reconstructive Jaw Surgery

by John M. Le, John Hofheins, Myra Rana, Jay Ponto, Anthony B. Morlandt and Yedeh P. Ying

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 8; https://doi.org/10.3390/cmtr18010008 - 5 Jan 2025

Viewed by 888

Abstract

The purpose of this study was to analyze computer-aided surgical planning (CAS) and margin status following oncological reconstructive surgery of the jaws. A retrospective study was conducted on patients who underwent microvascular reconstructive surgery from 2014 to 2021. The predictor variable was the [...] Read more.

The purpose of this study was to analyze computer-aided surgical planning (CAS) and margin status following oncological reconstructive surgery of the jaws. A retrospective study was conducted on patients who underwent microvascular reconstructive surgery from 2014 to 2021. The predictor variable was the use of CAS. The primary and secondary outcomes were histopathological bone margin status, local recurrence, and disease-free survival (DFS). Covariates included demographic, operative, pathological, and clinical outcomes. Thirty-five CAS and fifty-two non-CAS subjects were included for analysis. Demographic characteristics such as age, sex, and comorbidities were comparable between the study groups, with all p-values > 0.05. For operative variables, the osteocutaneous radial forearm flap was more commonly used in the non-CAS group (34.6%) compared to the CAS group (2.9%) (p < 0.01). The mean follow-up period was shorter in the CAS group (31.9 months) than in the non-CAS group (42.6 months) (p < 0.01). CAS was not associated with margin status (p = 0.65) or local recurrence (p = 0.08). DFS was comparable between the study groups (p = 0.74). Bone margin involvement was not associated with any covariates. The use of CAS in oncological reconstructive jaw surgery was not associated with increased bone margin involvement. Full article

► Show Figures

Figure 1

11 pages, 5555 KiB

Open AccessArticle

Proportional Condylectomy Using a Titanium 3D-Printed Cutting Guide in Patients with Condylar Hyperplasia

by Wenko Smolka, Carl-Peter Cornelius, Katharina Theresa Obermeier, Sven Otto and Paris Liokatis

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 7; https://doi.org/10.3390/cmtr18010007 - 3 Jan 2025

Viewed by 1650

Abstract

Background: The purpose of the study was to describe proportional condylectomy in patients with condylar hyperplasia using a titanium 3D-printed ultrathin wire mesh cutting guide placed below the planned bone resection. Methods: Eight patients with condylar hyperplasia underwent proportional condylectomy using an ultrathin [...] Read more.

Background: The purpose of the study was to describe proportional condylectomy in patients with condylar hyperplasia using a titanium 3D-printed ultrathin wire mesh cutting guide placed below the planned bone resection. Methods: Eight patients with condylar hyperplasia underwent proportional condylectomy using an ultrathin titanium 3D-printed cutting guide placed below the planned bone resection. The placement of the guide was facilitated by the incorporation of anatomical landmarks. The accuracy of bone resections guided by such devices was evaluated on postoperative radiographs. The mean postoperative follow-up was 30 months. Results: Surgery could be performed in all patients in the same manner as virtually planned. The fitting accuracy of the cutting guides was judged as good. Postoperative radiographs revealed that the virtually planned shape of the newly formed condylar head after condylectomy could be achieved. Conclusions: In conclusion, the use of virtual computer-assisted planning and CAD/CAM-based cutting guides for proportional condylectomy in unilateral condylar hyperplasia of the mandible offers high accuracy and guarantees very predictable results. Full article

► Show Figures

Figure 1

15 pages, 1664 KiB

Open AccessSystematic Review

Obstructive Sleep Apnea Following Secondary Velopharyngeal Insufficiency in Children with Non-Syndromic Cleft Palate: A Systematic Review

by Milton Chin, Mona Haj, Sarah L. Versnel, Henriette H. W. de Gier and Eppo B. Wolvius

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 6; https://doi.org/10.3390/cmtr18010006 - 3 Jan 2025

Viewed by 1596

Abstract

Study design: Systematic review. Objective: Obstructive sleep apnea (OSA) is a possible complication following secondary velopharyngeal insufficiency surgery in patients with repaired cleft palate. Various surgical techniques are used to treat secondary velopharyngeal insufficiency after cleft palate repair, but the optimal procedure remains [...] Read more.

Study design: Systematic review. Objective: Obstructive sleep apnea (OSA) is a possible complication following secondary velopharyngeal insufficiency surgery in patients with repaired cleft palate. Various surgical techniques are used to treat secondary velopharyngeal insufficiency after cleft palate repair, but the optimal procedure remains debatable. This review provides an overview of the incidence of airway obstructive outcomes related to different surgical modalities. Methods: A systematic search was performed on the 1st of February following the PRISMA guidelines and registered on PROSPERO (CRD42022299715). The following databases were reviewed: Medline, EMBASE, Web of Science, Google Scholar, and the Cochrane Library databases. Studies that included data on the occurrence of OSA following velopharyngeal surgery in children with a repaired non-syndromic cleft palate were included. Non-English articles and studies that included syndromic cleft palate patients were excluded. Results: Twenty-eight articles met the inclusion criteria. The surgical procedures are classified into three groups: pharyngeal flap procedure (PF), sphincter pharyngoplasty (SP), and palatal muscle repositioning (PMR). Incidence of post-operative OSA and symptoms of OSA were lowest after PMR compared to SP and PF (3%; 34%; 29%, respectively). Pharyngeal flap procedures resulted in the best speech outcomes. Conclusions: PMR results in fewer postoperative complications in terms of OSA and achieves a satisfactory reduction in hypernasal speech. PF procedure carries a higher risk of developing OSA postoperatively but seems to be superior in the reduction in hypernasality. Full article

► Show Figures

Figure 1

17 pages, 2919 KiB

Open AccessSystematic Review

Evaluating Genioplasty Procedures: A Systematic Review and Roadmap for Future Investigations

by Sebastiaan W. R. Dalmeijer, Tom C. T. van Riet, Jean-Pierre T. F. Ho and Eddy (A. G.) Becking

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 5; https://doi.org/10.3390/cmtr18010005 - 3 Jan 2025

Viewed by 1643

Abstract

Study design: Systematic review. Objective: This systematic review examines the existing literature concerning the objective and subjective evaluations of osseous genioplasty outcomes. Methods: A comprehensive search was conducted in databases including PubMed, Embase, and Web of Science, yielding 2563 references, which were screened [...] Read more.

Study design: Systematic review. Objective: This systematic review examines the existing literature concerning the objective and subjective evaluations of osseous genioplasty outcomes. Methods: A comprehensive search was conducted in databases including PubMed, Embase, and Web of Science, yielding 2563 references, which were screened by two independent reviewers. We included 105 articles originating from 25 different countries. Data were systematically extracted, categorized, and documented. Results: Genioplasty was performed in 5218 patients, either independently (3560 cases) or in combination with other orthognathic procedures (1696 cases), with a predominant focus on female patients (64%). Objective evaluation primarily focused on surgical accuracy, relapse, and neurosensory disturbance, while subjective assessments were largely related to aesthetics and patient satisfaction. Despite significant advancements in three-dimensional surgical planning and assessment, the review highlights a lack of standardized methods for evaluating isolated genioplasty outcomes. Conclusions: The findings emphasize the need for improved and validated instruments that specifically assess the functional and aesthetic results of genioplastic surgery. Future research should prioritize patient-centered prospective studies and the development of assessment tools to ensure more comprehensive and reliable outcome evaluations. Full article

► Show Figures

Figure 1

15 pages, 731 KiB

Open AccessArticle

Social Media Depiction of Cleft Lip and Cleft Palate: Instagram Versus YouTube Shorts Analysis: Instagram Post Versus Instagram Reel Analysis

by Joshua Lewis, Manav Patel, Nangah Tabukumm and Wei-Chen Lee

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 4; https://doi.org/10.3390/cmtr18010004 - 3 Jan 2025

Cited by 2 | Viewed by 1266

Abstract

Study Design: Qualitative analysis study. Introduction: Social media has been pivotal in the dissemination of medical knowledge to the public. The aim was to identify the demographics of individuals posting about cleft lip and palate on YouTube Shorts and Instagram, to characterize the [...] Read more.

Study Design: Qualitative analysis study. Introduction: Social media has been pivotal in the dissemination of medical knowledge to the public. The aim was to identify the demographics of individuals posting about cleft lip and palate on YouTube Shorts and Instagram, to characterize the content of these posts, and to highlight factors that could aid surgeons in better educating patients with cleft lip and palate. Methods: Instagram posts and YouTube Shorts with “#cleftlip”, “#cleftawareness”, “#cleftpalate”, “#cleftplipandpalate”, and “#cleftproud” were searched on 8 June 2024. Postings were subclassified and analyzed for content, including topics of posts, authors, media type, tone of the post, and year of post. Results: A total of 3321 posts were analyzed, with 2698 coming from Instagram and 623 from YouTube Shorts. The majority of content creators were patients and their family members (n = 2054, 61.8%), cleft lip and palate foundations (n = 384, 11.6%), and companies (n = 381, 11.5%). Only 167 posts were authored by physicians (5.1%). Among the educational and informational posts, patients and family members accounted for the majority of the posts (409 posts, 57.7%). Physicians contributed to a small fraction of the educational content (37 posts, 5.2%). Conclusions: Physician participation in the cleft lip and palate social media realm on Instagram and YouTube Shorts was found to be limited. Moreover, there was a scarcity of educational content on both platforms, indicating a significant opportunity for physicians to engage more actively in cleft lip and palate social media discussions. Full article

► Show Figures

Figure 1

9 pages, 3699 KiB

Open AccessArticle

A Shift in Conceptual Thinking of Panfacial Fracture Sequencing: The Major Fragment Theory

by Patrick Wong, Antonio Atte, David Powers and Paul Tiwana

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 3; https://doi.org/10.3390/cmtr18010003 - 3 Jan 2025

Viewed by 2637

Abstract

Study Design: A literature review of relevant publications regarding panfacial fracture sequencing. Objective: To review the current landscape of sequencing of panfacial trauma and propose the utilization of the Major Fragment Theory when conventional sequencing techniques are inadequate. Methods: We conducted a review [...] Read more.

Study Design: A literature review of relevant publications regarding panfacial fracture sequencing. Objective: To review the current landscape of sequencing of panfacial trauma and propose the utilization of the Major Fragment Theory when conventional sequencing techniques are inadequate. Methods: We conducted a review of existing literature on panfacial fracture management, focusing on sequencing techniques. Additionally, we analyzed unique fracture patterns to identify instances where conventional sequencing may be insufficient. Results: Existing literature emphasizes directional-based sequencing techniques for panfacial fracture reduction. However, unique fracture patterns often necessitate deviation from these sequences. The Major Fragment Theory suggests prioritizing the reduction of larger fragments over conventional sequencing, particularly when dealing with complex fractures. Conclusions: While directional-based sequencing techniques provide a valuable framework for panfacial fracture management and almost any approach can be utilized successfully, the Major Fragment Theory offers a complementary approach for cases where conventional sequencing falls short. Incorporating this theory into practice may enhance outcomes in the treatment of panfacial fractures. Full article

► Show Figures