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Craniomaxillofac. Trauma Reconstr., Volume 19, Issue 3 (September 2026) – 5 articles

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13 pages, 894 KB

Open AccessArticle

From Lockdown to Knockdown: The Return of Violence and Sport in Post-COVID Nasal Fractures

by Anna Aydin, Lawik Revend, Doha Revend, Thomas Beikler, Oliver Schuck, Manfred Giese and Florian Dudde

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 34; https://doi.org/10.3390/cmtr19030034 - 7 Aug 2026

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Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic altered nasal fracture epidemiology, with fewer outdoor injuries and more domestic accidents. This study compared intra-pandemic and post-pandemic nasal fracture patterns and their prevention implications. Materials and Methods: This retrospective study included patients treated for nasal fractures during February 2020–January 2021 (intra-pandemic) and February 2023–January 2024 (post-pandemic). The post-pandemic cohort was identified using the same eligibility criteria, variable definitions, coding framework, and electronic-record retrieval procedure as the previously published intra-pandemic cohort. The predefined objective was a direct comparison of these two matched periods; no pre-pandemic control group was included. Results: A total of 290 patients were analyzed (184 post-pandemic and 106 intra-pandemic). In exploratory unadjusted comparisons, sports accidents occurred in 29/184 (15.8%) post-pandemic versus 7/106 (6.6%) intra-pandemic cases (p = 0.023), road traffic incidents in 31/184 (16.8%) versus 7/106 (6.6%) (p = 0.041), interpersonal violence in 60/184 (32.6%) versus 20/106 (18.9%) (p = 0.009), and alcohol-related events in 37/184 (20.1%) versus 7/106 (6.6%) (p = 0.009). Falls, virus- or flu-associated syncope, and accidents at home were more frequent intra-pandemic. Because multiple comparisons were performed, findings with p-values near 0.05 should be regarded as nominal and hypothesis-generating. The unadjusted mean hospital stay was shorter post-pandemic; however, the study period was not independently associated with length of stay after adjustment. The post-pandemic period showed a borderline, non-significant association with violence-related fractures (odds ratio 1.76, 95% confidence interval 0.99–3.12; p = 0.051). Conclusion: The observed changes are compatible with a return of social, recreational, and traffic-related trauma patterns, although the absence of a pre-pandemic control group and the exploratory nature of subgroup analyses limit causal interpretation. Differences in hospital stay appear to be more closely related to patient-level characteristics than to the study period itself. Full article

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19 pages, 10392 KB

Open AccessReview

From Computer-Assisted Surgery to Extended Reality: Research Trends, Global Collaboration, and Future Directions in Craniomaxillofacial Surgery

by Neha Sharma, Sylvia Kempter, Jokin Zubizarreta Oteiza and Florian M. Thieringer

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 33; https://doi.org/10.3390/cmtr19030033 - 29 Jul 2026

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Abstract

Background: Extended reality (XR) technologies, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), are increasingly used in craniomaxillofacial (CMF) surgery; yet, no study has systematically mapped the global development of this research. This study provides the first comprehensive evidence mapping of XR and related computational technologies in CMF surgery, identifying research trends, collaborative networks, and future directions. Methods: A systematic search of the Web of Science (WoS) Core Collection (data extracted April 2025) combined XR terms (AR, MR, VR, image-guided surgery, and computer-assisted surgery) with CMF surgery terminology. After applying the inclusion criteria, 778 English-language articles published between 1988 and 2024 were analyzed using performance analysis and science mapping tools, including HistCite and VOSviewer. Results: Publication output grew exponentially, accelerating markedly after 2010. The Journal of Cranio-Maxillofacial Surgery led in both volume and internal citation impact. The USA, Germany, and China accounted for most of the output, with Germany showing a disproportionately high internal citation impact relative to its publication volume. Three developmental phases were identified: foundational computer-assisted surgery (1990s–2000s), technological development and validation (2000s–2010s), and clinical application optimization centered on AR and VR (2010s–present). Co-authorship networks revealed strong regional clusters with limited cross-cluster connectivity. No publications were identified from African countries other than Egypt. Conclusions: XR research in CMF surgery has grown substantially over 36 years, with a clear shift toward AR and VR applications. Geographic concentration limited international collaboration, and a focus on technical rather than patient-centered outcomes remains a key challenge. Future work should prioritize global participation, comparative clinical evidence, and patient-reported outcomes to support wider surgical adoption. Full article

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14 pages, 1842 KB

Open AccessSystematic Review

Epidemiology of Craniomaxillofacial Trauma in Chile: A Systematic Review and 24-Year Nationwide Interrupted Time-Series Analysis

by Gustavo Sáenz-Ravello, Paula Carrasco García, Laura Sáenz-Ravello and Elda L. Fisher

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 32; https://doi.org/10.3390/cmtr19030032 - 3 Jul 2026

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Abstract

Craniomaxillofacial trauma (CMFt) poses a significant burden, yet in many countries the evidence base is fragmented across single-center hospital series without specialized registry. Using Chile as a case study, we demonstrate a dual-synthesis approach to construct a national CMFt profile. Six databases were searched through February 2026 (PROSPERO: CRD420261290860). Two reviewers independently screened studies. Risk of bias was assessed with the JBI critical appraisal tool. Fracture-site proportions were pooled via random-effects meta-analysis and synthesized using GRADE. DEIS trauma discharges (2001–2024) were analyzed with negative binomial interrupted time-series. Nineteen studies were included. CMFt represented 2.6–6.1% of emergency consultations. CMFt admissions were 54.2/1000 trauma discharges; this rate dropped during 2020–2021 and rebounded post-2022. Pooled fracture-site distributions were highest for mandibular (45.3%) and zygomatic (24.2%) fractures. CMFt disproportionately affected males across both hospital series and national discharge data. According to DEIS, low-energy accidental injuries were the predominant etiology, followed by transport-related high-energy injuries and interpersonal violence, contrasting with hospital series where interpersonal violence predominated among adult surgical cohorts. Fracture admissions had longer length of stay (LOS) than soft-tissue CMFt (+0.94 days), with mean LOS ranging from 2.08 (nasal) to 8.35 days (multiple skull/facial fractures). These findings support prioritizing surgical preparedness and training in common fracture patterns, while strengthening trauma surveillance, referral pathways, and service planning in health systems without dedicated CMFt registries. Full article

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10 pages, 2343 KB

Open AccessArticle

Influence of Traumatic Brain Injury on Bone Healing Rate in Mandibular Fractures: A Prospective Comparative Study Using Ultrasonographic Assessment

by Kannan Balaraman, Vimal Kumar Kummari and S. Raja Sabapathy

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 31; https://doi.org/10.3390/cmtr19030031 - 2 Jul 2026

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Abstract

Background: Accelerated bone healing in patients with traumatic brain injury (TBI) is well documented in long bone fractures but remains poorly studied in mandibular fractures. This study compared mandibular fracture healing rates in patients with and without TBI using high-frequency ultrasonography. Methods: A prospective comparative study was conducted from June 2020 to November 2021 at a single tertiary care center. All patients with mandibular fractures were enrolled in the study. They were divided into two groups as Group 1—with TBI—and Group 2—without TBI. All patients underwent either open reduction and internal fixation or intermaxillary fixation. Fracture healing was assessed weekly for four weeks using high-frequency ultrasonography (6–15 MHz) to evaluate callus formation patterns. Results: A total of 77 patients were enrolled in the study, of which 22 were in Group 1 and 55 in Group 2. Groups were comparable for age (33.23 ± 13.48 vs. 35.80 ± 13.65 years, p = 0.391) and gender distribution (p = 0.977). Mean time to initial callus formation was significantly shorter in Group 1 (15.45 ± 1.96 days) compared to Group 2 (19.98 ± 3.04 days, p < 0.001). By the second week, soft callus was evident in 27.3% of TBI patients versus 9.1% without TBI (p = 0.007). By the fourth week, 72.7% of Group 1 showed hard callus formation compared to 27.3% in Group 2 (p < 0.001). Glasgow Coma Scale scores showed significant inverse correlation with callus formation timing (p < 0.001). Conclusions: Mandibular fractures demonstrate accelerated healing in patients with TBI, with callus formation occurring approximately 4.5 days earlier. Ultrasonography provides an effective, radiation-free method for serial fracture assessment. These findings may inform surgical timing and follow-up protocols in polytrauma patients. Full article

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

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7 pages, 201 KB

Open AccessCommunication

Outcomes in Frontal Sinus Fracture Repair: A Comparative Analysis Between Plastic Surgery and Otolaryngology (ENT)

by Lasya P. Marla, Caroline E. Baker, Macy E. Mitchell, Samuel Girian, John A. Girotto and Anna R. Carlson

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 30; https://doi.org/10.3390/cmtr19030030 - 23 Jun 2026

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Abstract

This study conducts a comparative analysis of surgical outcomes in patients who underwent FSF repair by a plastic surgeon versus an ENT using a national database. A retrospective analysis was conducted on patients who underwent surgical treatment of FSFs by a plastic or ENT surgeon using the de-identified American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patients were identified based on surgical CPT codes. Data extracted included primary surgeon specialty and patient demographics, comorbidities, and surgical outcomes. Statistical analysis was performed using Fisher’s Exact test and the Wilcoxon Rank-Sum test, with a p-value < 0.05 representing statistical significance. A total of 111 patients were analyzed, of which 85.6% were male. The mean age was 30.0 years [22.0, 48.0]. There were 70 patients (63.1%) treated by an ENT and 41 (36.9%) by a plastic surgeon. The median operative time was 131.0 min for ENT and 115.0 min for plastic surgery (p = 0.19). The median length of postoperative stay was 1.0 day for both groups. Postoperative complications included surgical site infection (SSI), wound disruption, and sepsis in five patients (4.5%). There was no statistically significant difference in the rate of complications between patients who underwent surgery with an ENT surgeon versus a plastic surgeon (p = 0.16). There were no statistically significant differences in operative time, length of stay, or complications between patients who underwent FSF repair by an ENT or by a plastic surgeon. Surgeon specialty training does not appear to influence intraoperative or postoperative outcomes. Studies with larger sample sizes may demonstrate statistically significant differences in outcomes. Full article

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