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Craniomaxillofac. Trauma Reconstr., Volume 18, Issue 2 (June 2025) – 7 articles

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10 pages, 3366 KiB  
Case Report
A 3D Printed Hydroxyapatite Implant for Temporal Hollowing Reconstruction: A Patient-Specific Approach
by Lukas B. Seifert, Alexander Aigner, Sead Abazi, Michel Beyer, Jokin Zubizarreta-Oteiza, Neha Sharma and Florian M. Thieringer
Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 28; https://doi.org/10.3390/cmtr18020028 - 12 May 2025
Viewed by 211
Abstract
Temporal hollowing, which is a depression in the temple region, often results from trauma, surgical interventions, or neurological conditions. This condition is frequently observed after the resection of encephaloceles, where it can cause esthetic and functional challenges due to temporalis muscle atrophy and [...] Read more.
Temporal hollowing, which is a depression in the temple region, often results from trauma, surgical interventions, or neurological conditions. This condition is frequently observed after the resection of encephaloceles, where it can cause esthetic and functional challenges due to temporalis muscle atrophy and nerve palsy. We present a case of a 21-year-old female patient who developed temporal hollowing and complete atrophy of the right temporalis muscle following an encephalocele resection in childhood. The patient also suffered from right-sided frontal nerve branch palsy. To address this complex deformity, a patient-specific implant (PSI) made of hydroxyapatite (HA) was digitally designed and produced using 3D printing technology. The postoperative course was uneventful, with the implant securely positioned and the esthetic result highly satisfactory. This case highlights the potential of 3D printed PSIs in craniofacial reconstruction, offering an optimal solution for both functional restoration and esthetic enhancement. HA further ensures the long-term stability and integration of the implant, providing a promising approach for addressing complex craniofacial defects. Full article
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15 pages, 3423 KiB  
Article
The Accuracy of an Optical White Light Desktop 3D Scanner and Cone Beam CT Scanner Compared to a Multi-Slice CT Scanner to Digitize Anatomical 3D Models: A Pilot Study
by Mauranne Lievens, Lisa De Kock, Matthias Ureel, Geert Villeirs, Wim Van Paepegem and Renaat Coopman
Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 27; https://doi.org/10.3390/cmtr18020027 - 25 Apr 2025
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Abstract
Additive manufacturing, in combination with virtual surgery planning, leads to the predictability of complex surgical cases. To guarantee patient safety, three-dimensional (3D) print quality must be ensured and verified. The aim of this study is to compare the accuracy of an optical white-light [...] Read more.
Additive manufacturing, in combination with virtual surgery planning, leads to the predictability of complex surgical cases. To guarantee patient safety, three-dimensional (3D) print quality must be ensured and verified. The aim of this study is to compare the accuracy of an optical white-light desktop scanner (OWLDS) and a cone beam CT (CBCT) scanner to that of a multi-slice CT scanner (MSCT) for scanning and digitizing 3D anatomical models. Twenty-two removable parts of a CE-certified anatomical skull, used as a patient-specific surrogate in a clinical workflow, were each scanned by MSCT, CBCT, and OWLDS scanners. The accuracy of the scanning modalities was investigated through a part comparison analysis of the stereolithography (STL) files derived from the different scanning modalities. The high-resolution OWLDS STL files show the smallest overall surface match deviation, at 0.04 mm, compared to the MSCT STL files. The CBCT STL files show an overall deviation of 0.07 mm compared to the MSCT STL files. This difference between the scan modalities increases as the volume of anatomical models decreases. The OWLDS is a safe, cost-effective, user-friendly, and highly accurate scanning modality suitable for accuracy evaluation during the manufacturing process of in-house 3D models. For smaller models, high-resolution optical scans are recommended. Full article
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13 pages, 7695 KiB  
Article
Hybrid Technique in Temporomandibular Joint Ankylosis Arthroplasty Using Surgical Cement and Screw Fixation with Three-Dimensional Printing Planning
by Guilherme Pivatto Louzada, Bianca de Fatima Borim Pulino, Camila Cerantula, Gustavo Câmara, Ana Beatriz Goettnauer de Cerqueira, Gines Alves, Guilherme Zanovelli Silva, Thiago Nunes Palhares, Wendell Fernando Uguetto and Raphael Capelli Guerra
Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 26; https://doi.org/10.3390/cmtr18020026 - 24 Apr 2025
Viewed by 347
Abstract
Temporomandibular joint (TMJ) ankylosis compromises essential functions such as chewing, phonation, and breathing. Surgical treatment aims to restore mandibular mobility and prevent the recurrence of joint fusion. This article describes a technical variation based on Puricelli biconvex arthroplasty, using surgical cement, screw fixation, [...] Read more.
Temporomandibular joint (TMJ) ankylosis compromises essential functions such as chewing, phonation, and breathing. Surgical treatment aims to restore mandibular mobility and prevent the recurrence of joint fusion. This article describes a technical variation based on Puricelli biconvex arthroplasty, using surgical cement, screw fixation, and 3D-printed cutting guides based on virtual planning, allowing for greater precision in joint reconstruction. In this work, we present the step-by-step process used in the customization of cutting guides, virtual planning, and the production of the interposition material with PMMA associated with fixation with titanium screws as a hybrid method for the treatment of recurrent TMJ ankylosis. This reported technique is demonstrated to be reproducible, low-cost, and effective. Full article
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28 pages, 1545 KiB  
Systematic Review
Redefining and Identifying Evidence-Based Indications for Open Reduction and Internal Fixation in Mandibular Condylar Fractures: A Comprehensive Systematic Review and Evidence Analysis
by Stephen A. L. Y. Youssef, Iva I. Raghoebar, Renee Helmers, Jan de Lange and Leander Dubois
Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 25; https://doi.org/10.3390/cmtr18020025 - 22 Apr 2025
Viewed by 353
Abstract
A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding [...] Read more.
A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding precise indications for ORIF remain unclear and non-uniform. We aimed to refocus the debate regarding the optimal treatment for CFs by identifying the recent indications for ORIF in the literature and assessing the quality of the existing evidence for each indication. This systematic review searched Medline, Embase and the Cochrane Central Register of Controlled Trials for eligible studies. The included studies consisted of articles from the past 15 years involving patients with any type of CF who underwent ORIF based on specified indications. From 4711 papers, 100 studies were included. In these, 121 indications were identified. The most cited indications for ORIF were those proposed by Zide and Kent, namely displacement/angulation ≥10° and ramus height shortening of ≥2 mm. Evidence supporting these indications is weak, relying mainly on expert opinion rather than robust data, with a focus on treatment comparisons. Clear, evidence-based cutoffs regarding when ORIF is the only viable treatment option are needed for a consensus. Full article
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17 pages, 837 KiB  
Systematic Review
Bioabsorbable Magnesium-Based Materials Potential and Safety in Bone Surgery: A Systematic Review
by Chun Ho Hung, Yui Chit Kwok, Jason Yip, Ho Hin Wong and Yiu Yan Leung
Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 24; https://doi.org/10.3390/cmtr18020024 - 7 Apr 2025
Viewed by 455
Abstract
The goal of this study was to evaluate the clinical outcomes, safety, and clinical applications of bioabsorbable magnesium-based materials for fixation in bone surgeries. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial [...] Read more.
The goal of this study was to evaluate the clinical outcomes, safety, and clinical applications of bioabsorbable magnesium-based materials for fixation in bone surgeries. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases, followed by manual and reference searches. The articles selected were evaluated for patient characteristics, biocompatibility, the need for revision surgery, bone union rates, and the incidence of gas formation associated with implant degradation. Out of the 631 initially identified articles, 8 studies including a total of 386 patients were included in the final qualitative analysis. The magnesium (Mg) group carried a lower rate of revision surgery (1/275) when compared to the titanium (Ti) group (18/111). A high rate of bone union was found in the Mg group and a low infection rate (3/275) was found in the Mg group. The serum level of Mg and calcium (Ca) were not found to be affected. Mg implants are applied in various orthopedic surgeries but they are not applied in in oral or maxillofacial surgeries. Mg implants appear to be a safe alternative for bone fixation and are resorbable. Future research into the application of Mg implants in bone fixation in different anatomical sites is essential to fully harness their potential benefits for patients. Full article
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11 pages, 1051 KiB  
Review
Fracture Patterns in Craniofacial Gunshot Wounds: A Seven-Year Experience
by Gabriela G. Cruz, Sameer H. Siddiqui, David Z. Allen, Kunal R. Shetty, Sean P. McKee, Brady J. Anderson, Mark Knackstedt, W. Katherine Kao and Tang Ho
Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 23; https://doi.org/10.3390/cmtr18020023 - 1 Apr 2025
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Abstract
Objective: To characterize facial fracture patterns and understand predictors of surgical repair and LOS with the objective of assisting providers in managing and understanding these complex injuries. Study Design: This is a retrospective cohort chart review study. Methods: A retrospective review was conducted [...] Read more.
Objective: To characterize facial fracture patterns and understand predictors of surgical repair and LOS with the objective of assisting providers in managing and understanding these complex injuries. Study Design: This is a retrospective cohort chart review study. Methods: A retrospective review was conducted for patients admitted with gunshot wounds (GSWs) to the head, neck, or face between January 2013 and March 2020 at a level one trauma tertiary care hospital. Univariate and multivariate analysis were performed to identify associations with surgical repair and LOS. Results: Of the 578 patients with head, neck, or facial GSWs, 204 survived and sustained facial fractures. The maxilla (n = 127, 62%), orbit (n = 114, 55%), and mandible (n = 104, 51%) were the most fractured. Operative rates differed by location (p < 0.001) with highest rates for fractures involving the mandible (76%). In univariate analysis, overall facial fracture surgery was associated with transfacial injuries; mandible, palate and nasal fractures; tracheostomy; gastrostomy tube placement; ICU admission; and a longer-than-24 h ICU stay (all p < 0.05). In multivariate analysis, predictors of surgical repair included a length of stay greater than 3 days (OR 2.9), transfascial injury (OR 3.7) and tracheostomy placement (OR 5.1; all p-values < 0.05), while nasal and mandible fractures were also associated with overall operative repair (OR 2.5 and 9.3, respectively; p-value < 0.05 for both). Univariate analysis showed that among patients with GSW injuries who underwent facial plastic reconstructive surgery (FPRS) with comorbid serious polytrauma, the inpatient LOS was predicted solely by the presence of subarachnoid, subdural and intracranial hemorrhage (p-value < 0.005). Subsequent multivariate analysis found that the only predictor for greater hospital LOS for patients who underwent surgical repair was earlier timing to FPRS of less than five days (OR 0.17) and placement of a gastrostomy tube (OR 7.85). Conclusions: Managing facial fractures in GSW patients requires complex medical decision making with a consideration of functional and esthetic outcomes in the context of concomitant injuries and overall prognosis. Certain characteristics such as ICU admission, longer hospital stay, trajectory of GSW, tracheostomy placement, and specific operative locations are associated with higher rates of operative repair. Inpatient hospitalization LOS for patients who underwent FPRS was predicted by timing from admission to surgical repair. Full article
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13 pages, 1940 KiB  
Article
Quantitative and Qualitative Symmetry Analysis of Open Reduction and Fixation of Zygomatic Complex Fractures
by Frederic Van der Cruyssen, Mathilda Wylde, Anthony Campbell, Ali Reza Pourkarim, Zeeshan Ahmad, Nabeel Bhatti and Simon Holmes
Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 22; https://doi.org/10.3390/cmtr18020022 - 27 Mar 2025
Viewed by 637
Abstract
Zygomatic complex (ZMC) fractures are among the most common craniofacial injuries, impacting both function and esthetics. This study evaluates the effectiveness of open reduction and internal fixation (ORIF) in restoring facial symmetry following ZMC fractures. Sixteen patients with unilateral ZMC fractures underwent a [...] Read more.
Zygomatic complex (ZMC) fractures are among the most common craniofacial injuries, impacting both function and esthetics. This study evaluates the effectiveness of open reduction and internal fixation (ORIF) in restoring facial symmetry following ZMC fractures. Sixteen patients with unilateral ZMC fractures underwent a retrospective analysis comparing preoperative and postoperative computed tomography (CT) scans to a control group of ten individuals without facial fractures. Quantitative metrics, including root mean square distance (RMSD) and heatmap analysis, were used alongside a qualitative zygoma fracture scale to assess outcomes. Postoperative results showed significant improvements in facial symmetry, with RMSD values approaching those of the control group. Heatmap analysis revealed that 50% of patients achieved deviations within 2–4 mm and 31% within 2 mm, highlighting the effectiveness of ORIF. More complex fractures exhibited higher residual asymmetry, emphasizing the influence of fracture severity on surgical outcomes. The zygoma fracture scale correlated with heatmap results, supporting its value as a complementary assessment tool. These findings demonstrate ORIF’s capability to restore symmetry while identifying areas for improvement in managing complex fractures. The study underscores the need for enhanced imaging and standardized evaluation methods to optimize surgical precision and outcomes in craniofacial trauma care. Full article
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