Craniomaxillofacial Trauma & Reconstruction

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.

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.

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