Craniomaxillofacial Trauma & Reconstruction

12 pages, 778 KB

Open AccessArticle

A Retrospective Cohort Outcome Study Comparing Gingival Margin and Buccal Sulcus Incisions for Mandibular Fracture Access

by Nivetha Saravanan, Millie Windram and Rory O’Connor

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 38; https://doi.org/10.3390/cmtr19030038 - 31 Aug 2026

Abstract

(1) Background: The main intraoral incisions used in the operative management of mandibular fractures are gingival margin incisions and buccal sulcus incisions. The aim of this retrospective cohort study was to compare postoperative outcomes between incision types and guide future operative protocols. (2) [...] Read more.

(1) Background: The main intraoral incisions used in the operative management of mandibular fractures are gingival margin incisions and buccal sulcus incisions. The aim of this retrospective cohort study was to compare postoperative outcomes between incision types and guide future operative protocols. (2) Methods: Data was collected from Queen’s Medical Centre in Nottingham, a level I major trauma centre. BlueSpier was used to identify mandibular fracture patients operated on between January 2023 and January 2025. Digital health records were used to obtain patient demographics and postoperative outcomes. Primary outcome measures were postoperative infection and wound dehiscence. Secondary outcome measures were return to theatre and new numbness or paraesthesia. (3) Results: In this cohort, 138 patients underwent operative management for a mandibular fracture through an intraoral incision; 60 patients had a gingival margin incision and 78 patients had a buccal sulcus incision. No statistically significant difference was found between the gingival margin and buccal sulcus incision groups for the primary and secondary outcome measures. (4) Conclusions: Incision choice is dependent on mandibular fracture location and surgeon preference. Both incisions were used by most of the operating surgeons. This study was not designed as an equivalence or non-inferiority study. Further larger-scale studies are needed to identify superior outcomes of one approach. Full article

► Show Figures

Figure 1

12 pages, 1060 KB

Open AccessArticle

Individual Factors Associated with Health-Related Quality of Life in Facial Cutaneous Squamous Cell Carcinoma—A Pilot Study

by Oliver Wagendorf, Forogh Miethe, Jonas Wüster, Meikel Vesper, Steffen Koerdt, Carsten Rendenbach, Max Heiland, Susanne Nahles and Norbert Neckel

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 37; https://doi.org/10.3390/cmtr19030037 - 25 Aug 2026

Abstract

Purpose: Facial expressions and aesthetics are vital for communication, self-expression, and social interaction. Therefore, this study aimed to evaluate the impact of localization and size of facial cutaneous squamous cell carcinoma (cSCC) on changes in perceived pre- and postoperative health-related quality of life [...] Read more.

Purpose: Facial expressions and aesthetics are vital for communication, self-expression, and social interaction. Therefore, this study aimed to evaluate the impact of localization and size of facial cutaneous squamous cell carcinoma (cSCC) on changes in perceived pre- and postoperative health-related quality of life (HR-QoL). Methods: This retrospective study included patients who had undergone surgery for facial cSCC. Size, localization and stage were assessed. Pre- and postoperative HR-QoL were evaluated using the Skindex-29. Statistical analyses, including descriptive statistics, the X2 Test, Wilcoxon Test, and repeated-measures ANOVA, were performed to analyze demographic data, tumor characteristics, and changes in HR-QoL. Results: Forty patients (mean age of 78.5 years) were included. Postoperatively, significant improvements were observed in the overall, emotional, and symptomatic HR-QoL. Tumor dimensions had an impact on presurgical emotional distress. For tumor sizes from 6 to 15 mm, significant release in symptom burden and improvement in general HR-QoL were observed. While women experienced notable improvement only in emotional distress, men also exhibited improvement in symptoms, and overall HR-QoL. All age groups showed improvements in emotional distress, symptoms and overall HR-QoL. No significant differences were found in terms of age or localization. Conclusions: This study suggests that sex, tumor localization, and tumor size may interact in influencing postoperative HR-QoL outcomes in patients with cSCC. While surgical treatment by experienced specialists was associated with an overall improvement in HR-QoL following successful tumor eradication, these findings should be interpreted with caution given the limited sample size. The results indicate that surgery remains an important first-line treatment option, particularly for medium-sized tumors. In this cohort, TNM classification was not associated with postoperative HR-QoL changes; however, interpretation is limited by the predominance of early-stage tumors. Further studies with larger patient populations are required to confirm these observations and to better elucidate the relationship between clinical staging and HR-QoL outcomes. Full article

► Show Figures

Graphical abstract

2 pages, 135 KB

Open AccessEditorial

Editorial for the Special Issue “Innovation in Oral- and Cranio-Maxillofacial Reconstruction”

by Susana Heredero, Richard Yuxiong Su and Satyesh Parmar

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 36; https://doi.org/10.3390/cmtr19030036 - 19 Aug 2026

Abstract

We are delighted to present this Special Issue on Innovations in Oral and Cranio-Maxillofacial Reconstruction, which collects a broad range of contemporary research and emerging technologies shaping the future of reconstructive surgery and improving patient care [...] Full article

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

9 pages, 519 KB

Open AccessArticle

Alcohol-Only and Drug/Medication-Only Product-Associated Facial Injury Encounters Across COVID-19 Periods: A Public CPSC NEISS Study, 2019–2023

by David M. Kachar, Christopher T. George, Andrea Ziegler and Eric Thorpe

Craniomaxillofac. Trauma Reconstr. 2026, 19(3), 35; https://doi.org/10.3390/cmtr19030035 - 14 Aug 2026

Abstract

Previous analyses of substance-involved craniofacial trauma have often combined alcohol and drug/medication involvement. We conducted a cross-sectional analysis comparing alcohol-only and drug/medication-only facial injury encounters in the public Consumer Product Safety Commission National Electronic Injury Surveillance System (NEISS), 2019–2023. Primary facial injuries (Body_Part [...] Read more.

Previous analyses of substance-involved craniofacial trauma have often combined alcohol and drug/medication involvement. We conducted a cross-sectional analysis comparing alcohol-only and drug/medication-only facial injury encounters in the public Consumer Product Safety Commission National Electronic Injury Surveillance System (NEISS), 2019–2023. Primary facial injuries (Body_Part = 76) were classified using the released Alcohol_Involved and Drug_Involved fields. Survey-weighted estimates and Taylor-linearized 95% confidence intervals incorporated the released PSU, stratum, and weight variables; design-based logistic regression evaluated code-4 hospitalization. Among 146,857 observed facial injury encounters, 4117 were alcohol-only and 2302 were drug/medication-only. Weighted annual alcohol-only proportions were stable (trend odds ratio [OR] per year, 0.99; 95% CI, 0.96–1.03; p = 0.716), whereas drug/medication-only proportions increased (OR, 1.15; 95% CI, 1.04–1.27; p = 0.009). Compared with alcohol-only encounters, drug/medication-only encounters involved older patients (weighted mean age, 63.1 vs. 47.6 years) and a lower weighted male proportion (55.6% vs. 67.5%). Weighted code-4 hospitalization was 23.1% versus 11.8%; the adjusted OR was 1.91 (95% CI, 1.45–2.53; p < 0.001). Adult-only and alternative-period sensitivity analyses supported the main conclusions. Separate classification of alcohol and drug/medication involvement revealed distinct demographic, temporal, and disposition patterns among NEISS-captured product-associated ED encounters. Full article

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

► Show Figures

Figure 1

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

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 [...] Read more.

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

► Show Figures

Figure 1

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

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 [...] Read more.

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

► Show Figures

Figure 1

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

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 [...] Read more.

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

► Show Figures

Figure 1

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

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 [...] Read more.

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)

► Show Figures

Figure 1

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

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 [...] Read more.

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

12 pages, 238 KB

Open AccessArticle

An Exploratory Study on Injury Patterns and Clinical Characteristics of Sports-Related Oral and Maxillofacial Trauma: A Single-Center Retrospective Study

by Kentaro Ayasaka, Yuhei Matsuda, Hiroto Tatsumi, Masako Fujioka-Kobayashi, Shota Norioka, Reon Morioka, Michitaka Somoto, Rie Sonoyama-Osako and Takahiro Kanno

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 29; https://doi.org/10.3390/cmtr19020029 - 22 Jun 2026

Abstract

Sports-related oral and maxillofacial trauma exhibits distinct injury mechanisms depending on the type of sport; however, comprehensive analyses integrating these characteristics remain limited. This study aimed to elucidate the clinical features of sports-related oral and maxillofacial trauma. This single-center retrospective study included 1615 [...] Read more.

Sports-related oral and maxillofacial trauma exhibits distinct injury mechanisms depending on the type of sport; however, comprehensive analyses integrating these characteristics remain limited. This study aimed to elucidate the clinical features of sports-related oral and maxillofacial trauma. This single-center retrospective study included 1615 patients (mean age 41.04 years; 64.8% male) treated between 2012 and 2025 in Shimane University Hospital, Department of Oral and Maxillofacial Surgery/Maxillofacial Trauma Center, Shimane, Japan. Among them, 239 (14.8%) had sports-related injuries and were significantly younger and more frequently male (p < 0.001). Multivariable analysis showed that nasal bone (odds ratio [OR] 5.900, 95% confidence interval [CI] 3.309–10.521), orbital wall (OR: 8.044, 95% CI: 4.664–13.874), zygomatic and zygomatic arch (OR: 3.239, 95% CI: 1.455–7.213), and naso-orbito-ethmoidal fractures (OR: 6.507, 95% CI: 1.971–21.483), as well as contusions (OR: 2.601, 95% CI: 1.385–4.885), were positively associated, whereas mucosal lacerations (OR: 0.485, 95% CI: 0.290–0.811) and referral from dental/medical clinics (OR: 0.312, 95% CI: 0.178–0.546) were negatively associated (all p < 0.01). However, panfacial fractures occurred less frequently. Sports-related trauma was primarily associated with nasal, orbital wall, zygoma and zygomatic arch, and naso-orbito-ethmoidal fractures. These findings indicate that sports-related oral and maxillofacial trauma is characterized by distinct and predominantly midfacial fracture patterns. Full article

18 pages, 2672 KB

Open AccessArticle

Imaging-Guided Algorithmic Management of Mandibular Condylar Fractures: A 13-Year Institutional Analysis of 495 Joints

by Sonal Anchlia, Hetal Amipara, Zibran Khan, Jigar Barasara, Jigar Dhuvad and Hrushikesh Gosai

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 28; https://doi.org/10.3390/cmtr19020028 - 11 Jun 2026

Abstract

(1) Background: Mandibular condylar fractures continue to be a subject of debate, traditionally framed as a choice between open and conservative management. However, this binary approach fails to adequately account for fracture-level anatomy, Temporomandibular joint (TMJ) involvement, and functional outcomes. (2) Purpose: To [...] Read more.

(1) Background: Mandibular condylar fractures continue to be a subject of debate, traditionally framed as a choice between open and conservative management. However, this binary approach fails to adequately account for fracture-level anatomy, Temporomandibular joint (TMJ) involvement, and functional outcomes. (2) Purpose: To present an imaging-guided, fracture-level-based algorithm that integrates radiologic evaluation, surgical approach selection, fixation biomechanics, and functional rehabilitation. (3) Review Strategy: This invited review combines current evidence with a 13-year institutional experience involving 495 joints. High-resolution Computed Tomography (CT) Imaging was used to assess fracture morphology, displacement, and ramal height, while Magnetic Resonance Imaging (MRI) was selectively employed in intracapsular fractures to evaluate disc–condyle relationships when intra-articular involvement was suspected. Management decisions, including surgical approach and fixation strategy, were guided by an institutional algorithm tailored to fracture characteristics. (4) Results: Implementation of this approach yielded consistent and predictable outcomes. Mouth opening improved from approximately 18.77 mm preoperatively to 40 mm at 6 months. Lateral excursions became symmetrical (~9.6 mm), occlusion was restored in all patients, and bite force returned to near-physiological levels. Pain scores showed near complete resolution within 1 month. Postoperative morbidity remained low, with predominantly transient facial nerve weakness. (5) Conclusions: This imaging-guided, algorithmic framework provides reproducible functional outcomes and signifies a shift toward structured, anatomically driven management of condylar fractures. Full article

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

► Show Figures

Figure 1

11 pages, 6421 KB

Open AccessArticle

Three-Dimensional Assessment of Maxillary Stability Using Customized Plates in Orthognathic Surgery: A Retrospective Cohort Study

by Leonardo Aguilar, Juan Pablo Vargas Buratovic, Valentina Matamala Ibaceta, Felipe Merchan, Alberto Fuhrer and Ximena Toledo

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 27; https://doi.org/10.3390/cmtr19020027 - 9 Jun 2026

Cited by 1

Abstract

Patient-specific implants (PSIs) in orthognathic surgery offer optimal intraoperative accuracy. However, evidence regarding their postoperative skeletal stability, specifically comparing distinct fixation designs and segmentation patterns, remains limited. We present a retrospective cohort study that evaluated 64 adult patients undergoing customized maxillary orthognathic surgery [...] Read more.

Patient-specific implants (PSIs) in orthognathic surgery offer optimal intraoperative accuracy. However, evidence regarding their postoperative skeletal stability, specifically comparing distinct fixation designs and segmentation patterns, remains limited. We present a retrospective cohort study that evaluated 64 adult patients undergoing customized maxillary orthognathic surgery between January 2020 and June 2025. The primary predictor variables were fixation design (conventional customized plates vs. minimally invasive plates) and maxillary segmentation (monoblock vs. multisegmental). The outcome variable was 3D skeletal stability, measured as linear displacement between preoperative planning and 6-month postoperative imaging. Non-parametric tests compared displacements and clinical instability rates (defined as ≥2.0 mm). Mann–Whitney tests compared landmark displacements, Fisher’s exact tests compared proportions with ≥2.0 mm displacement, and ORs with 95% CIs were computed (α = 0.05). Analysis of 64 patients revealed that median displacement across landmarks ranged from 0.7 to 4.28 mm and 28.1% exhibited displacement ≥ 2.0 mm, primarily in molar and canine regions. While overall instability rates did not differ significantly between single-segment and multisegmental osteotomies (p = 0.28), multisegmental cases showed significantly higher displacement at the left canine (p = 0.027). Plate design was not associated with skeletal instability (p = 0.88), suggesting that minimally invasive plates provide comparable stability to conventional designs. Customized maxillary plates provide reliable postoperative stability with median displacements within clinically acceptable limits (<2 mm). Minimally invasive PSI designs offer stability comparable to conventional extended designs. However, localized instability in multisegmental cases suggests a need for careful biomechanical management regardless of the fixation method used. Full article

► Show Figures

Figure 1

9 pages, 575 KB

Open AccessArticle

Optimising Patient Safety During the Use of Intraoperative Imaging for the Surgical Management of Facial Fractures: A Pilot Study

by Nicole Garcia, Mohamed Badawy, Jake DiPasquale, Simon Maciburko and Marc Seifman

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 26; https://doi.org/10.3390/cmtr19020026 - 25 May 2026

Abstract

The use of intraoperative computerised tomography (CT) to aid surgical management of facial fractures obviates the need for postoperative surgical scans, decreases return to theatre rates, and subsequently decreases overall hospital stay. This allows for better appreciation of a complex operative landscape in [...] Read more.

The use of intraoperative computerised tomography (CT) to aid surgical management of facial fractures obviates the need for postoperative surgical scans, decreases return to theatre rates, and subsequently decreases overall hospital stay. This allows for better appreciation of a complex operative landscape in almost real time, and may become the gold standard of treatment. As with radiological investigations, decreasing radiation exposure of patients is a key goal. The aim of this study was to examine the effective radiation doses in patients undergoing surgical management of their facial fractures with the aid of a fixed-arm CT. This retrospective study was conducted on patients who underwent surgical fixation of their facial fractures within a hybrid surgical suite equipped with a fixed-arm cone beam CT (CBCT) from July 2023 to November 2024. The CBCT was used to assess adequacy of bony fixation. Data from imaging was collected to assess total effective radiation dose. Data from 30 random patients who underwent standard CT facial bones (CTFB) were collected as control. Data from 24 patients was collected. The majority were male (17/24, 70.8%) with an age range of 20–94 years. The average dose of the effective doses calculated in the CTFB cohort was 0.64 mSv (SD 0.05). This is a more-than-twenty-five-fold reduction in the average effective dose in the CBCT cohort, which was 0.025 mSv (SD 0.01). There was a statistically significant difference between the two cohorts with p < 0.0001 (95% CI 0.60–0.64). This study demonstrates that intraoperative CBCT delivers a significantly lower effective dose to patients compared with postoperative CTFB. Where facilities exist, CBCT offers a safer and more efficient alternative, with future work needed to assess staff dose, wait times, and cost impacts. Full article

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

► Show Figures

Figure 1

10 pages, 1133 KB

Open AccessArticle

Three-Dimensional Globe Repositioning Following Orbital Reconstruction Independent of Bony Landmarks and Fracture Pattern Associations

by Aaron De Poortere, Kathia Dubron, Justine Neyt, Reinhilde Jacobs, Eman Shaheen and Robin Willaert

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 25; https://doi.org/10.3390/cmtr19020025 - 21 May 2026

Abstract

Orbital fractures account for up to 16% of all facial fractures. Surgical intervention for these fractures depends on several factors, including globe displacement. This case-control study aimed to quantify the effects of orbital reconstruction on the three-dimensional globe position after orbital trauma. Pre- [...] Read more.

Orbital fractures account for up to 16% of all facial fractures. Surgical intervention for these fractures depends on several factors, including globe displacement. This case-control study aimed to quantify the effects of orbital reconstruction on the three-dimensional globe position after orbital trauma. Pre- and post-operative radiological data of 29 cases (27 patients, with two patients requiring reintervention) with an orbital fracture were analyzed. The contralateral, unaffected orbits of the same patients served as the control group. This study used a recently validated method employing semi-automatic registration algorithms to measure globe displacement after trauma and its post-operative change. The statistical analysis, performed using the Mann–Whitney U test, showed significant globe position restoration in the anterior–posterior (2.15 mm, p ≤ 0.001) and medial–lateral (1.34 mm, p ≤ 0.001) directions, as well as in overall three-dimensional Euclidean distance (3.04 mm, p = 0.014) after surgery. The repositioning was clinically relevant in 62% of the cases, indicating that the three-dimensional globe repositioning was 2 mm or more with a positive clinical impact. Additionally, it was important to note that both the number of fractured walls and fractures of the inferomedial strut significantly affected globe repositioning after trauma. This finding highlights the importance of accurately considering the fracture pattern in surgical planning, as a better understanding of globe displacement following orbital trauma could enhance patient selection, surgical planning, and clinical outcomes. Full article

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

► Show Figures

Figure 1

13 pages, 1676 KB

Open AccessArticle

TMJ Replacement as a System: Results of an International Surgeon Survey on Design, Fixation, Materials, and Digital Workflow

by Sergio Olate, Wenko Smolka, Ricky Kumar, Rüdiger Zimmerer and Zachary S. Peacock

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 24; https://doi.org/10.3390/cmtr19020024 - 19 May 2026

Abstract

The evolution of TMJ-replacements has been driven by advancements in personalization, materials and digital planning technologies. However, there is little data on how surgeons perceive the prosthetic systems and their limitations in practice. The perspective from surgeons is critical to identifying the gap [...] Read more.

The evolution of TMJ-replacements has been driven by advancements in personalization, materials and digital planning technologies. However, there is little data on how surgeons perceive the prosthetic systems and their limitations in practice. The perspective from surgeons is critical to identifying the gap between current technology and clinical need. Using an international, structured survey based on a modified Delphi methodology, including expert validation, pilot testing and global distribution through professional networks, the status of the TMJ-replacement ecosystem was obtained. The questions covered aspects such as the workflow, the integration of components, the design features, the use of materials, the fixation strategy for each component, and usability of surgical guides. The responses were quantitatively analyzed using descriptive statistics. 250 surgeons were included; the majority of surgeons preferred to have all elements of the TMJ-replacement system provided by a single system or company (i.e., the prosthesis and plates), with 86.0% of surgeons indicating this preference and 71.2% of surgeons indicating that having access to STL files for use in surgical navigation is an important feature. Approximately 88.4% of surgeons indicated that flexibility in the design of the prosthesis is important, while 61.6% of respondents indicated that design issues contribute to failures of TMJ prostheses. Issues related to the fixation of the prosthetic components, particularly screw loosening, were also commonly reported by surgeons with respect to failure. Surgeons also indicated concerns with regard to the bulkiness (73.2%) and the fit accuracy (68.4%) of the surgical guides. In terms of material selection, 78.0% of respondents preferred to be able to choose the type of metal alloy for the TMJ replacement system. TMJ replacement is viewed by surgeons as a system-dependent procedure that requires the integration of design, materials, fixation and digital workflow. The currently available prosthetic solutions only partially meet the needs of surgeons. Full article

(This article belongs to the Special Issue Overall Treatments in Temporomandibular Joint (TMJ) Pathologies)

► Show Figures

Figure 1

14 pages, 878 KB

Open AccessArticle

Combined BTX-A and Collagen Membrane in Benign Parotid Enucleation: A Comparative Cohort Study

by Giuseppe Consorti, Enrico Betti, Mariagrazia Paglianiti, Lisa Catarzi, Gabriele Monarchi, Massimiliano Gilli, Stefania Troise, Carlos Miguel Chiesa-Estomba, Luigi Angelo Vaira and Giulio Cirignaco

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 23; https://doi.org/10.3390/cmtr19020023 - 24 Apr 2026

Abstract

Benign parotid tumors are increasingly treated with parenchyma-sparing extracapsular enucleation, yet postoperative salivary collections and Frey syndrome can still generate clinically relevant morbidity; we evaluated whether a standardized intraoperative bundle combining intraparotid botulinum toxin A (BTX-A) and bovine collagen membrane interposition is associated [...] Read more.

Benign parotid tumors are increasingly treated with parenchyma-sparing extracapsular enucleation, yet postoperative salivary collections and Frey syndrome can still generate clinically relevant morbidity; we evaluated whether a standardized intraoperative bundle combining intraparotid botulinum toxin A (BTX-A) and bovine collagen membrane interposition is associated with fewer complications than standard enucleation alone. In this retrospective comparative cohort at a tertiary Head and Neck Surgery Unit, consecutive adults undergoing extracapsular enucleation for pleomorphic adenoma or Warthin tumor (2010–2025) were allocated by institutional era-based protocol to Group A (2010–2017, standard enucleation) or Group B (2018–2025, enucleation plus intraoperative intraparotid BTX-A 50 IU and bovine collagen membrane placement over the repaired parotid fascia). Prespecified endpoints were sialocele/salivary fistula, surgical-site infection (SSI) within 30 days, and clinically recorded Frey syndrome within 6 months; effect sizes with 95% confidence intervals were reported. A total of 188 patients were analyzed (94 per group). Sialocele occurred in 20/94 (21.3%) in Group A versus 2/94 (2.1%) in Group B [Relative Risk (RR) 0.10]. SSI occurred in 14/94 (14.9%) versus 2/94 (2.1%) (RR 0.143), and clinically recorded Frey syndrome in 18/94 (19.1%) versus 4/94 (4.3%) (RR 0.222). This combined protocol was associated with lower complication rates through 6 months; prospective controlled studies with standardized Frey assessment and longer follow-up are warranted. Full article

► Show Figures

Figure 1

9 pages, 415 KB

Open AccessArticle

Association Between Trauma Mechanism and Mandibular Fracture Pattern: A 13-Year Retrospective Analysis at a Regional Trauma Center

by Graciela Ana Giannunzio, Jose Mariano Astigueta, Sthefania Johana Lucero, Ariana Gimena Labachuk and Carlos Alberto Isnado Bolivar

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 22; https://doi.org/10.3390/cmtr19020022 - 9 Apr 2026

Abstract

The mandible, due to its anatomical position, mobility, and functional role, is one of the bones most frequently involved in maxillofacial trauma, with fracture patterns influenced by impact mechanisms and anatomical characteristics. This study aimed to analyse the relationship between trauma mechanisms and [...] Read more.

The mandible, due to its anatomical position, mobility, and functional role, is one of the bones most frequently involved in maxillofacial trauma, with fracture patterns influenced by impact mechanisms and anatomical characteristics. This study aimed to analyse the relationship between trauma mechanisms and affected anatomical subsites in patients with isolated mandibular fractures treated at a regional public hospital in Buenos Aires Province. A retrospective cross-sectional observational study was conducted using medical records, surgical reports, and diagnostic imaging of patients treated between 2011 and 2024. Isolated mandibular fractures were included, while pathological fractures, dentoalveolar injuries, and cases with incomplete data were excluded. Trauma mechanisms were classified as interpersonal aggression, vehicular accidents, falls from height, contact sports, and blows with blunt objects. Interpersonal aggression was the most frequent trauma mechanism, followed by falls from height and vehicular accidents. The mandibular angle, parasymphysis, and condyle were the most commonly affected anatomical sites. Multivariable analysis showed a higher probability of condylar fractures in falls from height (OR = 4.75; 95% CI: 2.24–10.3; p < 0.001) and vehicular accidents (OR = 3.02; 95% CI: 1.28–7.13; p = 0.01). Falls were also associated with a lower probability of mandibular angle fractures (OR = 0.16; 95% CI: 0.06–0.36; p < 0.001), while blunt object trauma showed a positive association with mandibular body fractures (OR = 3.12; 95% CI: 1.04–8.95; p = 0.04). These findings indicate that trauma mechanisms influence the anatomical distribution of mandibular fractures, providing relevant information for diagnostic assessment and surgical planning. Full article

► Show Figures

Figure 1

15 pages, 5019 KB

Open AccessReview

Current Concepts in Frontal Sinus Fracture Management

by Tsung-yen Hsieh, Mary Roz Timbang and Edward Bradley Strong

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 21; https://doi.org/10.3390/cmtr19020021 - 8 Apr 2026

Abstract

Frontal sinus fractures typically reflect high-energy trauma and must be evaluated and treated carefully to avoid long-term problems including contour deformity, sinus dysfunction, cerebrospinal fluid (CSF) leakage, chronic sinusitis, and mucocele formation. This article outlines frontal sinus anatomy, diagnostic pathways, and evolving treatment [...] Read more.

Frontal sinus fractures typically reflect high-energy trauma and must be evaluated and treated carefully to avoid long-term problems including contour deformity, sinus dysfunction, cerebrospinal fluid (CSF) leakage, chronic sinusitis, and mucocele formation. This article outlines frontal sinus anatomy, diagnostic pathways, and evolving treatment concepts in detail. An anatomically driven treatment algorithm is emphasized, with a focus on preservation of sinus function whenever possible and preference for conservative management. Advanced procedures, such as endoscopic sinus surgery and cranialization, are reviewed in the context of managing more severe injuries. Key points: (1) Clinical decision-making in the management of frontal sinus fractures is best guided by evaluating the status of the anterior table, posterior table, and nasofrontal outflow tract, with treatment options ranging from nonoperative care to open or endoscopic surgery. (2) Improvements in endoscopic techniques, combined with evidence supporting less aggressive strategies, have shifted management toward more conservative approaches, reserving open procedures for higher-grade injuries. (3) Extended follow-up is essential to identify delayed problems such as mucoceles, chronic sinusitis, frontal bone osteomyelitis, and contour irregularities. Full article

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

► Show Figures

Figure 1

11 pages, 1928 KB

Open AccessArticle

Characterization of Inferior Rectus Muscle Action in Normal Subjects Using Real-Time Magnetic Resonance Imaging of the Orbit

by Alexander R. Engelmann, Kailash Singh, Jiachen Zhuo, Néha Datta, Alfredo A. Sadun, Michael P. Grant and Shannath L. Merbs

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 20; https://doi.org/10.3390/cmtr19020020 - 5 Apr 2026

Abstract

Orbital floor fractures may cause long-term functional and esthetic impairments. Diplopia due to impaired function of the inferior rectus muscle is frequently an indication for surgical repair, but some cases, such as those where the diagnosis has been delayed or a previous attempt [...] Read more.

Orbital floor fractures may cause long-term functional and esthetic impairments. Diplopia due to impaired function of the inferior rectus muscle is frequently an indication for surgical repair, but some cases, such as those where the diagnosis has been delayed or a previous attempt at repair has been made, may not always be amenable to surgical correction. It is advantageous for the surgeon to know whether the proper function of the inferior rectus muscle can be restored for the purposes of surgical planning and prognostication. The authors hypothesized that real-time MRI could be used to characterize the appearance of the inferior rectus muscle in a way that would facilitate future analysis of inferior rectus function in patients with diplopia due to orbital floor fractures. Real-time MRI was performed on 10 volunteer participants with normal ophthalmic function and orbital anatomy to assess inferior rectus appearance during vertical duction testing. ImageJ software was used to measure and record characteristics of the inferior rectus muscle, viewed in a quasi-sagittal plane. The ratios evaluated included inferior rectus muscle length in upgaze versus downgaze (UDR, mean 1.58) as well as inferior rectus muscle length versus distance from inferior rectus origin to inferior rectus inflection point in upgaze (LIR, mean 1.30) and downgaze (mean 1.20). These values were found to be conserved between orbits and individuals. This data offers quantitative insight regarding inferior rectus muscle appearance across the full arc of vertical gaze in healthy individuals. We plan to use this normative baseline dataset as a comparison for future phases of this project, using real-time MRI to evaluate traumatized orbits with diplopia and derangement of the inferior rectus muscle. Full article

► Show Figures

Figure 1

Journal Description

Craniomaxillofacial Trauma & Reconstruction

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Further Information

Guidelines

MDPI Initiatives

Follow MDPI