Craniomaxillofacial Trauma & Reconstruction

13 pages, 10281 KB

Open AccessTechnical Note

Expanding Horizons in Craniomaxillofacial Reconstruction: The Role of Exoscopic Microsurgery in Head and Neck Surgery

by Khalid Abdel-Galil and Kemal Mustafa Tekeli

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 10; https://doi.org/10.3390/cmtr19010010 - 3 Feb 2026

Exoscopic systems are increasingly used as an alternative to the operating microscope in microsurgical reconstruction, offering high-definition visualisation, shared operative viewing, and greater flexibility in surgeon positioning. This retrospective case series describes the use of exoscopic visualisation during microsurgical reconstruction in five illustrative [...] Read more.

Exoscopic systems are increasingly used as an alternative to the operating microscope in microsurgical reconstruction, offering high-definition visualisation, shared operative viewing, and greater flexibility in surgeon positioning. This retrospective case series describes the use of exoscopic visualisation during microsurgical reconstruction in five illustrative head and neck and reconstructive cases. Different commercially available exoscopic platforms were utilised, and feasibility, workflow integration, and surgeon-perceived ergonomic aspects were assessed descriptively. Exoscopic visualisation was feasible for completion of microvascular anastomoses across a range of complex reconstructions. From the surgeons’ perspective, exoscopy allowed a more flexible working posture during prolonged microsurgical tasks and may offer advantages in training environments, particularly for junior surgeons. Further studies incorporating objective outcome measures are required to better define the role of exoscopy in microsurgical practice. Full article

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

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9 pages, 959 KB

Open AccessArticle

Finite Element Analysis of Low-Profile Reconstruction Plates for Atrophic Mandibles—Part II: A Comparison of Customized Plates with 3D Grid-Type and Conventional Designs

by Bianca Pulino, Robert Sader, Guilherme Louzada, Majeed Rana, Gabriele Millesi, Geraldo Prestes de Camargo Filho and Raphael Capelli Guerra

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 9; https://doi.org/10.3390/cmtr19010009 - 23 Jan 2026

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Abstract

Objectives: The aim of this study was to compare the stiffness-related mechanical response and peak von Mises stress distribution of low-profile 2.4 mm mandibular reconstruction systems (a conventional reconstruction plate, a 3D grid-type plate, and a customized plate) in a virtual atrophic mandible [...] Read more.

Objectives: The aim of this study was to compare the stiffness-related mechanical response and peak von Mises stress distribution of low-profile 2.4 mm mandibular reconstruction systems (a conventional reconstruction plate, a 3D grid-type plate, and a customized plate) in a virtual atrophic mandible model with a 5 cm segmental defect. Materials and Methods: A CT-based three-dimensional mandible model was created and instrumented with three plate configurations (G1–G3). Linear static finite element analyses were performed under a 300-N masticatory load combined with literature-based muscle force vectors. Peak von Mises stresses were recorded for plates and screws, and the locations of maximum stress concentration were identified. Results: Peak plate stress was highest in the conventional reconstruction plate (G1: 695.5 MPa), followed by the 3D grid-type plate (G2: 595.6 MPa), and lowest in the customized plate (G3: 185.2 MPa). The peak screw stress was 692.9 MPa (G1), 898.0 MPa (G2), and 595.6 MPa (G3). The 3D grid-type plate increased construct stiffness but shifted stress concentration toward the mandibular angle and adjacent screws, whereas the customized plate reduced the peak plate stress and limited the extent of the high-stress region across the defect. Conclusions: Within the limitations of a linear static FEA (stiffness/stress distribution rather than failure load or fatigue resistance), the customized plate (G3) demonstrated the most favorable biomechanical performance (lowest peak plate stress). The 3D grid-type plate (G2) reduced peak plate stress compared with the conventional design (G1) but produced the highest peak screw stress. Practical considerations such as manufacturing lead time and resource requirements may favor off-the-shelf plates; however, a formal cost or operative-time analysis was not performed. Full article

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

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23 pages, 10017 KB

Open AccessArticle

Over a Decade of Maxillofacial PEEK Patient-Specific Innovation: A Retrospective Review of the Evolution from In-House Craft to Virtual Design and Remote Manufacturing

by Nicholas J. Lee, Gareth Honeybone, Mohammed Anabtawi, Mathew Thomas and Sachin M. Salvi

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 8; https://doi.org/10.3390/cmtr19010008 - 21 Jan 2026

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Abstract

Maxillofacial skeletal reconstruction presents significant challenges due to anatomical complexity, functional requirements, and aesthetic demands. Traditional materials such as titanium and autogenous bone grafts have limitations, prompting interest in Polyetheretherketone (PEEK), a versatile thermoplastic polymer with advantages like biocompatibility, radiolucency, and elasticity similar [...] Read more.

Maxillofacial skeletal reconstruction presents significant challenges due to anatomical complexity, functional requirements, and aesthetic demands. Traditional materials such as titanium and autogenous bone grafts have limitations, prompting interest in Polyetheretherketone (PEEK), a versatile thermoplastic polymer with advantages like biocompatibility, radiolucency, and elasticity similar to human bone. This multi-year case series evaluates the clinical outcomes of PEEK implants used in 56 cases on 53 patients for maxillofacial reconstruction, primarily for trauma (44 patients) and deformity (9 patients). PEEK implants were applied to various facial regions including the orbit, zygoma, mandible, and maxilla. The majority of surgeries utilised virtual surgical planning. Patient-specific implants were fabricated using 3D imaging technologies, allowing customisation for optimal fit and functionality. The mean patient age was 37 years with a split of 37 to 16 females. Some complications were noted such as infection and paraesthesia. However, the majority of patients experienced positive outcomes. The findings support PEEK implants as a safe, effective, and adaptable material for maxillofacial surgery, with potential for further advancements in material properties and surgical technologies to improve long-term outcomes. Full article

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

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10 pages, 2512 KB

Open AccessArticle

Minne Ties Hybrid Arch Bar System vs. Erich Arch Bars: A Cadaveric Comparison Study

by Jeffrey Mella, François E. Proulx and Alan W. Johnson

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 7; https://doi.org/10.3390/cmtr19010007 - 20 Jan 2026

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Abstract

Jaw fracture management significantly advanced with the introduction of Erich Arch Bars (EABs) during World War II, becoming the gold standard for maxillomandibular fixation (MMF). EABs, however, are time-consuming, pose risks of sharps injuries, and hinder oral hygiene and patient comfort. This study [...] Read more.

Jaw fracture management significantly advanced with the introduction of Erich Arch Bars (EABs) during World War II, becoming the gold standard for maxillomandibular fixation (MMF). EABs, however, are time-consuming, pose risks of sharps injuries, and hinder oral hygiene and patient comfort. This study tested the Minne Ties Hybrid Arch Bar System (MTHAB), a novel MMF technology. This cadaveric study used specimens with near-complete dentition to compare MTHAB and EABs. The technologies were applied by trained surgeons to measure occlusal forces, increasing elastic loads, and application and removal times. Surgeons completed structured usability surveys. The results indicated that MTHAB significantly reduced application time (19.8 ± 4.1 min versus 35.2 ± 5.7 min, p = 0.0027) and removal time (1.6 ± 0.4 min versus 5.1 ± 2.1 min, p = 0.0465) compared to EABs, while also being rated higher for ease of use and safety. Both technologies achieved acceptable occlusion forces, although MTHAB needed more elastics to achieve comparable forces to EABs. While MTHAB appears promising, future clinical trials are needed to evaluate long-term outcomes, fixation stability, and patient selection. MTHAB represents a potential advancement in MMF technology, balancing surgical efficiency, safety, and fixation strength. Full article

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

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14 pages, 694 KB

Open AccessSystematic Review

Sterile Versus Non-Sterile Gloves in Dental Extractions: A Systematic Review and Meta-Analysis

by Mustafa Mohammad Ali Saffar, E. Krabbendam, E. B. Wolvius and J. T. van der Tas

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 6; https://doi.org/10.3390/cmtr19010006 - 19 Jan 2026

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Abstract

Healthcare-associated infections remain an ongoing concern across medical and dental practice, prompting continuous evaluation of infection prevention measures. In dental extractions, the necessity of sterile gloves is debated, as the oral cavity represents an inherently contaminated environment. This systematic review and meta-analysis evaluated [...] Read more.

Healthcare-associated infections remain an ongoing concern across medical and dental practice, prompting continuous evaluation of infection prevention measures. In dental extractions, the necessity of sterile gloves is debated, as the oral cavity represents an inherently contaminated environment. This systematic review and meta-analysis evaluated whether the use of sterile gloves reduces postoperative socket infections compared with non-sterile gloves. A search of MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and Google Scholar identified randomized controlled trials, clinically controlled trials, and observational trials directly comparing sterile versus non-sterile glove use during dental extractions. The primary outcome of this study was extraction socket infection at day 7 post-surgery. A meta-analysis using relative risk (RR) was performed for dichotomous data. Of the initial 7170 publications found, seven articles met inclusion criteria. Infection rates ranged from 0% to 3.9%, with an overall infection rate of 0.3% in the sterile glove group (672 patients) and 1.3% in the non-sterile glove group (758 patients). Three studies qualified for meta-analysis, resulting in an RR of 0.30 (95% CI 0.07–1.24), indicating no significant difference in postoperative infections between sterile and non-sterile glove usage. Given the limitations of small sample sizes, low event rates, incomplete reporting, and lack of subgroup data for surgical versus non-surgical extractions, no difference in postoperative infection was found between sterile and non-sterile glove use. Additional research is needed to determine whether glove sterility influences infection risk, particularly in surgical procedures. Full article

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10 pages, 2137 KB

Open AccessArticle

Professional Perspectives and Research Challenges Among AO CMF Surgeons in the Middle East and North Africa

by Khalid Abdel-Galil, Ammar Khalafalla and Mohamed Amir

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 5; https://doi.org/10.3390/cmtr19010005 - 19 Jan 2026

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Abstract

Purpose: Research drives clinical advancement in oral and craniomaxillofacial surgery by generating evidence that guides practice and innovation. However, limited literature exists describing research engagement among surgeons within AO CMF in the Middle East and North Africa. This study evaluated awareness, participation, and [...] Read more.

Purpose: Research drives clinical advancement in oral and craniomaxillofacial surgery by generating evidence that guides practice and innovation. However, limited literature exists describing research engagement among surgeons within AO CMF in the Middle East and North Africa. This study evaluated awareness, participation, and perceived barriers to research among AO CMF members and affiliated surgeons in the MENA region. Methods: A cross-sectional, questionnaire-based survey was distributed electronically to AO CMF members, affiliates, and professional CMF surgeon networks between October and December 2024. The 14-item survey assessed demographics, research awareness, attitudes, productivity, and barriers. Responses were anonymized and analyzed descriptively using SurveyPlanet analytics. Results: A total of 144 surgeons from 21 countries completed the survey. Pakistan (35%), Morocco (9.8%), Kuwait (7.7%), and the United Arab Emirates (7%) contributed the largest proportions. Most respondents (47.6%) expressed strong interest in research but reported difficulty initiating projects, while 32.2% cited lack of time as a major constraint. The most frequently reported barriers included challenges in research methodology (14.6%), publishing (14.6%), and manuscript writing (14.1%). Only 18.9% of participants had published more than ten articles, while 29.4% had none. Mentorship demand was high (94.4%), but awareness of the AO PEER program remained limited (37.8%). Conclusion: Surgeons expressed strong enthusiasm for research yet face substantial barriers. Strengthening research methodology training, establishing structured mentorship, expanding AO PEER engagement, and facilitating multicenter collaboration are key strategies to enhance research productivity across the region. Full article

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12 pages, 379 KB

Open AccessArticle

Impact of Social Determinants of Health in the Treatment of Closed Nasal Bone Fractures

by Nicholas A. Frisco, Nicholas W. Clark, Kayla W. Kilpatrick, Maragatha Kuchibhatla, David B. Powers, Charles R. Woodard, Nosayaba Osazuwa-Peters and Dane M. Barrett

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 4; https://doi.org/10.3390/cmtr19010004 - 8 Jan 2026

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Abstract

Study Design: Retrospective cohort study. Objective: To determine the association of social determinants of health with rates of closed nasal bone reduction. Methods: A retrospective analysis of the National Trauma Data Bank (NTDB) from 2011 to 2019 was performed, including only adult patients [...] Read more.

Study Design: Retrospective cohort study. Objective: To determine the association of social determinants of health with rates of closed nasal bone reduction. Methods: A retrospective analysis of the National Trauma Data Bank (NTDB) from 2011 to 2019 was performed, including only adult patients with isolated nasal bone fractures. Logistic regression modeling was used to estimate the association between closed nasal bone reduction and sociodemographic variables. Results: A total of 149,312 patients were included, with an average age of 50. Most patients were male (68%), White (72%), and non-Hispanic/Latino (77%), with Medicare insurance (25%). Most patients were cared for at non-university (54%) and non-profit hospitals (88%). A total of 39% were cared for at an ACS level 1 trauma center. Finally, 3.3% of the patients in this study underwent closed reduction. The odds of undergoing reduction decreased with increasing age (OR: 0.99, CI: (0.99, 0.99)). Compared to White patients, Asian and Black/African American patients had decreased odds of closed reduction (Asian: OR (CI) 0.71 (0.53, 0.95); Black: OR (CI): 0.71 (0.65, 0.79)). Patients with government insurance or who were uninsured had lower odds of closed reduction compared to private/commercial insurance, with Medicaid, Medicare, and not billed/self-pay odds ratios of 0.83 (CI: (0.76, 0.90)), 0.81 (CI: (0.73, 0.89)), and 0.79 (CI: (0.72, 0.86)), respectively. Conclusions: Social determinants of health are associated with differential rates of inpatient closed nasal bone reduction. Further studies in the outpatient setting are needed to determine if these associations remain consistent. Full article

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13 pages, 1993 KB

Open AccessArticle

Digital vs. Direct Anthropometry with MetiSmile^® 3D Face Scanner: A Validation and Reliability Study on a Mannequin Model

by Alexander De Crem, Constantijn Bogaert, Frederik Piccart, Matthias Ureel, Benjamin Denoiseux, Lisa De Kock, Marieke Brands, Olivier Lenssen and Renaat Coopman

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 3; https://doi.org/10.3390/cmtr19010003 - 30 Dec 2025

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Abstract

Background: Three-dimensional facial anthropometry is increasingly used in orthodontics and orthognathic surgery. Conventional face scanning systems such as Vectra^® and 3dMD^® are well validated but remain costly and technically demanding. The MetiSmile^® 3D face scanner provides a more affordable and [...] Read more.

Background: Three-dimensional facial anthropometry is increasingly used in orthodontics and orthognathic surgery. Conventional face scanning systems such as Vectra^® and 3dMD^® are well validated but remain costly and technically demanding. The MetiSmile^® 3D face scanner provides a more affordable and portable alternative, yet its accuracy and reproducibility have not been rigorously evaluated. Methods: Validation was performed on a standardized mannequin head in two phases. Phase 1 assessed mesh reproducibility under artificial lighting (AL), natural lighting (n-AL), and after mesh-refinement (AL-F). Landmark-based pre-registration with Iterative Closest Point refinement was applied; root-mean-square error (RMS) and distance maps were calculated. In phase 2, three observers (student, resident, consultant) performed 14 predefined linear measurements by direct anthropometry (DA) and digital anthropometry (DiA). Intra- and inter-observer reliability was evaluated using intraclass correlation coefficients. Results: Phase 1 yielded mean RMS values of 0.041 mm (AL), 0.043 mm (n-AL), and 0.030 mm (AL-F), with largest deviations near eyes, alar regions, and lip commissures. Phase 2 showed excellent ICCs (≥0.997) and mean absolute DA–DiA differences of 0.25–0.33 mm, with only few differences > 2 mm. Conclusion: The MetiSmile^® scanner generates highly reproducible meshes and clinically acceptable linear measurements on mannequin models. Further validation on live subjects is warranted before routine clinical application. Full article

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

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14 pages, 2946 KB

Open AccessReview

Facial Contouring in Orthognathic Surgery: The Role of Facial Implants

by Gabriel Conceição Brito, Márcio de Moraes, Leonardo Faverani and Sergio Olate

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 2; https://doi.org/10.3390/cmtr19010002 - 24 Dec 2025

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Abstract

Orthognathic surgery restores functional balance and facial esthetics in patients with dentofacial deformities. The use of adjunctive facial implants—made from materials such as porous polyethylene, titanium, or polyetheretherketone (PEEK)—has increased to enhance contour and projection, although standardized guidelines for their selection and integration [...] Read more.

Orthognathic surgery restores functional balance and facial esthetics in patients with dentofacial deformities. The use of adjunctive facial implants—made from materials such as porous polyethylene, titanium, or polyetheretherketone (PEEK)—has increased to enhance contour and projection, although standardized guidelines for their selection and integration remain scarce. Following PRISMA-ScR guidelines, a systematic search of PubMed, Scopus, Embase, and LILACS identified studies reporting facial implants placed concomitantly with orthognathic surgery. Eligible studies included case reports, case series, observational studies, clinical trials, and reviews involving human patients, without language or date restrictions. Seventeen studies published between 1998 and 2025 met the inclusion criteria, comprising retrospective and prospective designs, case series, and one technical note. Implants were used in the malar, infraorbital, paranasal, chin, mandibular body, and angle regions. Materials included PEEK, porous polyethylene, silicone, hydroxyapatite, polymethylmethacrylate, and titanium. PEEK was mainly used for patient-specific implants, while porous polyethylene was commonly used as stock implants. Follow-up time, outcome reporting, and study design varied widely, reflecting substantial methodological heterogeneity and predominantly observational evidence. As a result, outcomes were primarily reported qualitatively, limiting comparative assessment and long-term inference. Overall, the available literature suggests that alloplastic facial implants may serve as useful adjuncts to orthognathic surgery for contour enhancement, with outcomes influenced by implant design, surgical expertise, fixation, and soft tissue conditions. However, the current evidence base remains limited, underscoring the need for standardized outcome measures, comparative studies, and longer follow-up to better inform clinical decision-making and future research. Full article

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

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11 pages, 975 KB

Open AccessArticle

Frontal Sinus Fractures: An Evaluation of Injury Parameters and Operative Variables on Surgical Outcomes

by George Cove, Declan Hughes, Christopher Zerafa and Simon Holmes

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 1; https://doi.org/10.3390/cmtr19010001 - 23 Dec 2025

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Abstract

Background: Frontal sinus (FS) injuries carry high morbidity; however, currently, there is no universally agreed-upon treatment approach for frontal sinus and frontobasal trauma. Objective: This study sets out to evaluate surgical outcomes in frontal reconstruction, looking at how fracture patterns and operative variables [...] Read more.

Background: Frontal sinus (FS) injuries carry high morbidity; however, currently, there is no universally agreed-upon treatment approach for frontal sinus and frontobasal trauma. Objective: This study sets out to evaluate surgical outcomes in frontal reconstruction, looking at how fracture patterns and operative variables impact complication rates. Methods: This was a retrospective cross-sectional study which identified a cohort of 137 patients between the years 2015 and 2022 who sustained frontal sinus fractures at a level one major trauma centre in Central London. The electronic patient record (EPR) and pre-operative computed tomography (CT) were analysed to assess the following factors: patient demographics, injury parameters, surgical technique, and complications. Statistical tests included Pearson’s chi square for categorical variables/nominal data. Mann–Whitney U and Kruskal–Wallis H tests were also used to analyse continuous variables. Results: Overall, 12 of the 91 patients who were treated surgically had major complications (n = 12, 13.2%). In total, 5.5% (n = 5) had return to theatre (RTT) for cerebrospinal fluid (CSF) leaks, 5.5% for infection and 2.2% (n = 2) for haematoma or bleeding. FS fracture complexity was predictive of RTT (p = 0.015) and CSF leak (p = 0.015). Frontobasal complexity was predictive of post-operative infection (p = 0.047). Neurosurgical operative involvement and cranialisation was predictive of post-operative infection, CSF leak, and RTT. Conclusions: Understanding risk profiles in the management of FS fractures is vital in order to help clinicians mitigate these risks and also to better educate patients, including during the consent process. Further research could look at the medical and social risk factors that increase complication rates in this patient cohort. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 19, Issue 1 (March 2026) – 10 articles

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