Craniomaxillofacial Trauma & Reconstruction

11 pages, 2079 KB

Open AccessArticle

Naso-Orbito-Ethmoid Fractures: Refining the Role of Wires and Plates

by Preston Leader, Kelsey Karnik, Anthony Mangino, Clayton Bobo and Thomas Gal

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 53; https://doi.org/10.3390/cmtr18040053 - 18 Dec 2025

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Background: Naso-orbital-ethmoid (NOE) fractures represent complex midface injuries that challenge aesthetic and functional reconstruction. This study evaluates the efficacy of techniques restoring intercanthal distance following operative repair of NOE fractures. Methods: A retrospective case series was conducted of adults undergoing NOE fracture repair [...] Read more.

Background: Naso-orbital-ethmoid (NOE) fractures represent complex midface injuries that challenge aesthetic and functional reconstruction. This study evaluates the efficacy of techniques restoring intercanthal distance following operative repair of NOE fractures. Methods: A retrospective case series was conducted of adults undergoing NOE fracture repair between 2010 and 2022. CPT codes were used to identify patients, with inclusion based on radiographic confirmation of NOE fractures. Demographic data, fracture classification, operative techniques, and pre- and post-operative CT measurements of intercanthal distance were analyzed by fracture type and type of repair. Results: 191 patients were identified, mostly male (80%), with Type I fractures being most common (66%). Intercanthal wiring was used in 14% of cases, most frequently for Type II and III fractures. Of the 100 patients with post-operative comparison imaging, the median intercanthal distance improved from 34 mm to 31 mm. Intercanthal wiring yielded greater median distance correction. All patients achieved restoration of intercanthal distance within normal limits regardless of repair technique. Conclusions: Operative repair of NOE fractures using either plating or intercanthal wiring effectively restores normal intercanthal distance. While intercanthal wiring remains valuable in severe fractures, it may not be universally necessary. Further study is needed to refine the role of these repair techniques. Full article

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11 pages, 777 KB

Open AccessArticle

Injury Patterns and Physiologic Risk Stratification in Facial Trauma Patients with Orbital Fractures: A National Trauma Database Analysis

by Turki Bin Mahfoz

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 52; https://doi.org/10.3390/cmtr18040052 - 6 Dec 2025

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Abstract

Background: Although orbital fractures are common in trauma care, age-specific mechanisms and admission physiology-based risk stratification have not been systematically characterized. This study aimed to identify age–mechanism interaction patterns and develop an admission-based physiological risk score for orbital fracture patients. Methods: This retrospective [...] Read more.

Background: Although orbital fractures are common in trauma care, age-specific mechanisms and admission physiology-based risk stratification have not been systematically characterized. This study aimed to identify age–mechanism interaction patterns and develop an admission-based physiological risk score for orbital fracture patients. Methods: This retrospective cohort study analyzed 41,464 adult orbital fracture patients from the National Trauma Data Bank (2018–2020). A three-component physiological risk score was developed using admission vital signs: severe hypotension (<90 mmHg, 2 points), tachycardia (>100 bpm, 1 point), and severe traumatic brain injury (GCS ≤ 8, 1 point). Risk stratification performance was validated against composite adverse outcomes. Results: Distinct age–mechanism patterns emerged: 74.0% of elderly patients (≥65 years) sustained falls, while young adults demonstrated a bimodal distribution with motor vehicle crashes (31.2%) and violence (28.4%). Violence-related injuries occurred in younger patients (40.3 vs. 55.0 years) but had lower injury severity scores (10.0 vs. 14.4) and mortality (2.8% vs. 5.2%) than accidental mechanisms. High-/critical-risk patients (8.4% of the cohort) had 16.2% mortality versus 2.1% in stable patients. Complex facial injuries demonstrated 11-fold higher mortality (7.7% vs. 0.7%). The physiologic risk score achieved AUC 0.79 (95% CI: 0.78–0.80). Conclusions: Age–mechanism interactions revealed distinct bimodal injury patterns in young adults. Admission physiologic parameters effectively identify 8.4% of patients requiring intensive resources, while violence-related injuries paradoxically demonstrate better outcomes than accidental mechanisms. Full article

(This article belongs to the Special Issue Advances in Facial Trauma Surgery)

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8 pages, 1500 KB

Open AccessArticle

Impact of Illicit Drug Use on Facial Fracture Patterns and Hospital Resource Utilization

by Arya Sherafat, Aishwarya Suresh, Ian Waldrop and Jared Inman

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 51; https://doi.org/10.3390/cmtr18040051 - 5 Dec 2025

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Abstract

Introduction: Facial trauma is a public health concern, with reports of about 25% of all traumas having a component of facial injury. Alcohol and illicit drug use have previously been shown to exacerbate the severity of trauma injuries. This study investigates the relationship [...] Read more.

Introduction: Facial trauma is a public health concern, with reports of about 25% of all traumas having a component of facial injury. Alcohol and illicit drug use have previously been shown to exacerbate the severity of trauma injuries. This study investigates the relationship between illicit drug use and clinical outcomes amongst patients presenting with facial fracture injuries. Methods: A retrospective multicenter cohort study through the TriNetX database was performed. Drug Involved Facial fracture injury with illicit drug use (DIFFI+) was compared to a Non-Drug Involved Facial Fracture Injury group (DIFFI−). After propensity score matching, measures of hospital burden outcomes, surgical intervention, and underlying psychiatric diagnosis outcomes were compared. Results: A total of 27,863 propensity score-matched DIFFI+ cases were used for analysis. DIFFI+ patients were younger (mean age 33.8 vs. 42.0 years, p < 0.001), more often male (75% vs. 56%, p < 0.001), and more likely to be Black/African American (21% vs. 14%, p < 0.001), with cannabis and opioid use most common. DIFFI+ patients had a significantly higher odds of hospital burden outcomes, including psychiatry services (OR = 8.40), ventilator management (OR = 5.18), and critical care services (OR = 3.83). Conclusions/Discussion: DIFFI+ was significantly correlated with greater hospital burden in all analyzed clinical outcomes. DIFFI+ patients have a higher odds of receiving surgery but lower odds of receiving a fracture diagnosis. Having a psychiatric diagnosis increases risk for DIFFI+ injury. Full article

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11 pages, 524 KB

Open AccessReview

Surgical Management of Isolated Zygomaticomaxillary Complex Fractures: Role of Objective Morphometric Analysis in Decision-Making

by Saša Mijatov, Ivana Mijatov, Denis Brajković, Dušan Rodić and Jagoš Golubović

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 50; https://doi.org/10.3390/cmtr18040050 - 29 Nov 2025

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Abstract

Zygomaticomaxillary complex (ZMC) fractures are among the most common midfacial injuries, with significant implications for both function and facial esthetics. Optimal management requires restoring the normal anatomical alignment and symmetry of the zygomatic region to prevent long-term deformity and functional deficits. However, the [...] Read more.

Zygomaticomaxillary complex (ZMC) fractures are among the most common midfacial injuries, with significant implications for both function and facial esthetics. Optimal management requires restoring the normal anatomical alignment and symmetry of the zygomatic region to prevent long-term deformity and functional deficits. However, the decision-making surrounding surgical intervention, particularly in isolated ZMC fractures with moderate displacement, remains nuanced. This review discusses contemporary surgical approaches for isolated ZMC fractures and examines how objective morphometric analysis can guide critical decisions such as the timing of surgery, choice of surgical approach, and extent of fixation. Conventional assessment tools like computed tomography (CT), cephalometric measurements, and intraoperative imaging provide foundational data on fracture anatomy. Emerging technologies, including three-dimensional (3D) photogrammetry, stereophotogrammetry, artificial intelligence (AI)-based symmetry analysis, and surgical navigation systems, offer advanced means to quantify facial symmetry and bone alignment. By integrating these objective metrics into clinical practice, surgeons can enhance preoperative planning and postoperative outcome evaluation, with a particular focus on achieving facial symmetry for optimal esthetic and functional results. We also outline clinical decision-making frameworks that incorporate quantitative measurements, and we discuss current limitations, future directions, and the potential for standardizing protocols in the management of ZMC fractures. Full article

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Graphical abstract

2 pages, 144 KB

Open AccessEditorial

CMTR—Aims and Scope Update

by Kathleen Fan, Yiu Yan Leung and Florian M. Thieringer

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 49; https://doi.org/10.3390/cmtr18040049 - 27 Nov 2025

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Abstract

The journal Craniomaxillofacial Trauma & Reconstruction (CMTR) (ISSN 1943-3883) was launched in 2008 and officially transferred to MDPI in 2025 [...] Full article

11 pages, 714 KB

Open AccessSystematic Review

The Importance of Antibiotics in Facial Fracture Treatment—A Systematic Meta-Review

by Martin Bengtsson, Aron Naimi-Akbar, Joakim Johansson-Berggren, Sebastian Dybeck-Udd, Mikael Magnusson and Bodil Lund

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 48; https://doi.org/10.3390/cmtr18040048 - 3 Nov 2025

Cited by 1 | Viewed by 4157

Abstract

This meta-review evaluated the possibility of more specified recommendations in antibiotic treatment through a narrowed focus on facial trauma. The aim was to analyze the effect of different regimens of antibiotic in treatment of skeletal trauma to the face. The knowledge mapping was [...] Read more.

This meta-review evaluated the possibility of more specified recommendations in antibiotic treatment through a narrowed focus on facial trauma. The aim was to analyze the effect of different regimens of antibiotic in treatment of skeletal trauma to the face. The knowledge mapping was based on existing systematic reviews (SRs) on trials specified in a PICO: Participants (P): Adults and children, diagnosed with fractures to the facial skeleton. Interventions (I): Antibiotic intervention. Comparator (C): Placebo, no antibiotics. Outcomes (O): Postoperative infection, pain, re-operation, other complications, healing deficiencies, (Oral) Health related Quality of Life, removal of osteosynthesis, adverse reactions. The literature search in PubMed, The Cochrane Library, and Web of Science according to PRISMA resulted in 1487 records. A COVIDENCE selection process resulted in 29 articles retrieved and read in full text revealing 10 articles eligible for evaluated according to ROBIS. Three SRs were considered to have low risk of bias and constituted the final evidence evaluation. The meta-review of these SRs did not provide sufficient support for prolonged antibiotic treatment after surgical intervention of midfacial fractures in comparison with antibiotics only the first day postoperatively. No support for antibiotic treatment for conservatively managed fractures alone was found. This review is limited by a relatively low number of included SRs. However, tendencies in outcomes suggests a restricted duration of antibiotics in treatment of facial fractures. Full article

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14 pages, 3809 KB

Open AccessArticle

Postoperative Complications Following Open Reduction and Internal Fixation of Mandibular Condylar Fractures Using the High Perimandibular Approach: A Multicenter Retrospective Study

by Noriko Sakata, Masako Fujioka-Kobayashi, Yuhei Matsuda, Reon Morioka, Erina Toda, Shinji Ishizuka, Michitaka Somoto, Rie Sonoyama-Osako, Hiroto Tatsumi and Takahiro Kanno

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 47; https://doi.org/10.3390/cmtr18040047 - 25 Oct 2025

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Abstract

Background: The high perimandibular approach (HPA) is a feasible surgical technique for open reduction and internal fixation (OR-IF) of mandibular condylar fractures, offering reduced complication rates. In this study, we retrospectively evaluated the treatment outcomes and complications associated with HPA use. Patients and [...] Read more.

Background: The high perimandibular approach (HPA) is a feasible surgical technique for open reduction and internal fixation (OR-IF) of mandibular condylar fractures, offering reduced complication rates. In this study, we retrospectively evaluated the treatment outcomes and complications associated with HPA use. Patients and Methods: Patients who underwent OR-IF for mandibular condylar fractures using the HPA at three hospitals in Shimane between June 2019 and March 2024 were included. Data collected included the mechanism of injury, AO classification of the fracture site, fracture type and mode, surgical duration, mouth-opening range at 6 months post-operatively, and peri- and post-operative complications. Results: A total of 42 patients (46 condylar fractures; 18 males and 24 females; mean age, 63.0 years) were included. The fracture pattern included dislocations in 18 cases (42.8%). The mean surgical duration was 75.0 min. Post-operative trismus occurred in 16 patients (38.1%) at 6 months. Longer surgical duration and dislocated fractures were significantly associated with post-operative trismus (p < 0.05). Conclusions: The HPA is safe and effective for managing mandibular condylar fractures. However, post-operative trismus may be influenced by longer surgical duration and fracture types, warranting further investigation and potential post-surgical management. Full article

(This article belongs to the Special Issue Advances in Facial Trauma Surgery)

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15 pages, 2684 KB

Open AccessArticle

Development of an Automatic Computer Program to Determine the Optimal Dental Implant Size and Position for Fibula Free Flap Surgery

by Ming Yan Cheung, Ankit Nayak, Xing-Na Yu, Kar Yan Li, Yu-Xiong Su and Jingya Jane Pu

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 46; https://doi.org/10.3390/cmtr18040046 - 25 Oct 2025

Viewed by 1920

Abstract

Computer-assisted surgery (CAS) and virtual surgical planning (VSP) have transformed jaw reconstruction, allowing immediate insertion of dental implants during surgery for better rehabilitation of occlusal function. However, traditional planning for optimal location and angulation of dental implants and fibula relies on experience and [...] Read more.

Computer-assisted surgery (CAS) and virtual surgical planning (VSP) have transformed jaw reconstruction, allowing immediate insertion of dental implants during surgery for better rehabilitation of occlusal function. However, traditional planning for optimal location and angulation of dental implants and fibula relies on experience and can be time-consuming. This study aimed to propose a function-driven workflow and develop an automatic computer program for optimal positioning of simultaneous dental implants and fibula segments. A customized computer program was developed using MATLAB. Computed tomography (CT) of the lower limbs of ninety-one Southern Chinese individuals was retrieved and cross-sections of three-dimensional (3D) fibula models were comprehensively investigated for implant installation. Our research proves that the accuracy of the program in identifying the anatomical orientation of the fibula was 92%. The ideal location, angulation and length of implant could be automatically generated based on any selected implant diameter, with a surgical feasibility of 94%. To the best of our knowledge, this is the first study to develop and validate a customized automatic computer program for osseointegrated implant design in fibula flap surgery. This program can be incorporated into the current workflow of CAS to further the development of reliable and efficient surgical planning for function-driven jaw reconstruction. Full article

(This article belongs to the Special Issue Innovation in Oral- and Cranio-Maxillofacial Reconstruction)

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11 pages, 8155 KB

Open AccessReview

Optimizing Maxillomandibular Position in Orthognathic Surgery: Introducing the T Concept in Treatment Planning

by Abdulmalik Alyahya and Saud Bin Jasser

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 45; https://doi.org/10.3390/cmtr18040045 - 25 Oct 2025

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Abstract

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, [...] Read more.

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, and the occlusal plane. Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: Phase One involves correcting frontal deformity and various asymmetries, Phase Two involves correcting chin anterior–posterior deformity, Phase Three involves correcting anterior–posterior and vertical MMC position, and Phase Four involves correcting MMC rotation. Results: The T concept provided a structured approach to plan MMC as a whole and integrate all structures into harmony. Conclusions: The T concept provides a logical approach to MMC positioning in orthognathic surgery, addressing functional and aesthetic concerns. It acts as a checkpoint to verify MMC position, helping surgeons achieve better results and avoid compensatory procedures. Full article

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15 pages, 2542 KB

Open AccessArticle

Globe Intussusception Following Orbital Trauma: Case Series and Review of Literature

by Akruti Desai, Gautam Dendukuri and Milind Naik

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 44; https://doi.org/10.3390/cmtr18040044 - 20 Oct 2025

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Abstract

The aim of this paper is to report “Globe Intussusception” as an extreme form of globe dislocation outside the orbital pyramid, and provide a literature review. A single-center, retrospective, interventional case series of three patients is presented. A review of the English-language literature [...] Read more.

The aim of this paper is to report “Globe Intussusception” as an extreme form of globe dislocation outside the orbital pyramid, and provide a literature review. A single-center, retrospective, interventional case series of three patients is presented. A review of the English-language literature from the years 1971 to 2024 was performed using the search terms “traumatic globe dislocation”, “maxillary sinus” and “ethmoid sinus”. Three cases of globe intussusception are reported. Computed tomography imaging revealed orbital fracture, and globe prolapse into the maxillary sinus with or without involvement of ethmoid sinus. This was associated with complete intussusception of the globe through the conjunctiva, giving an “empty socket” appearance. In all three cases, fracture repair along with retrieval of the eyeball from the sinus was carried out surgically. Reduction of the intussusception, and bringing the eyeball out of the conjunctival pouch was a special additional challenge in these cases. The review of 35 cases reported in world literature till date is presented. We suggest retrieval of the intussuscepted eyeball via a 360° peritomy and suture tagging of extraocular muscles to ensure safe repositioning of globe with intact extraocular muscles. Full article

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10 pages, 1259 KB

Open AccessArticle

Chronic Osteomyelitis of the Jaws: Management and Outcomes in a Tertiary Maxillofacial Surgery Unit

by Patrícia Santos, Carolina Moreira, Nuno Gião and Paulo Valejo Coelho

Craniomaxillofac. Trauma Reconstr. 2025, 18(4), 43; https://doi.org/10.3390/cmtr18040043 - 15 Oct 2025

Cited by 3 | Viewed by 3411

Abstract

Objective: This study aims to evaluate the management and outcomes over 14 years at a tertiary maxillofacial surgery unit. Methods: Retrospective cohort study of patients from a Portuguese tertiary center of maxillofacial surgery with histopathologically confirmed diagnoses of chronic osteomyelitis of the jaws [...] Read more.

Objective: This study aims to evaluate the management and outcomes over 14 years at a tertiary maxillofacial surgery unit. Methods: Retrospective cohort study of patients from a Portuguese tertiary center of maxillofacial surgery with histopathologically confirmed diagnoses of chronic osteomyelitis of the jaws between January 2010 and December 2023. Demographic and clinical characteristics, treatment, and progression of the disease were evaluated. Results: Fifty-three patients were included—28 women (52.8%), mean age 55 (95% CI 5–90) years. The mandible was affected in 84.9% (n = 45) of cases. Secondary chronic osteomyelitis was diagnosed in 88.7% (n = 47), with medication-related osteonecrosis of the jaw (MRONJ) being the most common etiology (38.3%). Bacteriological samples were contributory in 52% (n = 13) and 46.1% (n = 6) were resistant to amoxicillin. All received antibiotics for a median time of 27.3 days. Surgical treatment included sequestrectomy (n = 40, 75.5%), marginal (n = 5, 9.4%), and segmental mandibulectomy (n = 8, 15.1%). Clinical remission was achieved in 77.4% (n = 41) of cases with higher success in MRONJ (n = 15, 83.3%) than ORN (n = 4, 57.1%). Conclusions: Almost half of the isolates were amoxicillin-resistant, reinforcing the need for susceptibility testing. Surgical management guided by etiology and disease stage remains essential, with more extensive resection needed in MRONJ and ORN. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 18, Issue 4 (December 2025) – 11 articles

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