Craniomaxillofacial Trauma & Reconstruction

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

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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)

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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

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13 pages, 6850 KB

Open AccessTechnical Note

Preoperative Near-Infrared (NIR) Vein Visualization in Zygomatic Implant Perforated (ZIP) Flap

by Yoram Fleissig, Jhonatan Elia, Nir Hirshoren, Amalia Sabato, Eleonora Ginzburg, Jawad Abu Tair, Jeffrey M. Weinberger and Shay Sharon

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 19; https://doi.org/10.3390/cmtr19020019 - 1 Apr 2026

Abstract

Zygomatic implant perforated (ZIP) flap reconstruction offers immediate surgical rehabilitation following maxillectomy, integrating oncologic zygomatic implants with a fascio-cutaneous free flap. A critical technical challenge is safely perforating the free flap skin paddle to accommodate implants’ abutments without damaging its vasculature. Near-infrared (NIR) [...] Read more.

Zygomatic implant perforated (ZIP) flap reconstruction offers immediate surgical rehabilitation following maxillectomy, integrating oncologic zygomatic implants with a fascio-cutaneous free flap. A critical technical challenge is safely perforating the free flap skin paddle to accommodate implants’ abutments without damaging its vasculature. Near-infrared (NIR) vein visualization technology provides real-time mapping of subcutaneous vessels and has been widely investigated in settings such as pediatric intravenous (IV) cannulation. By projecting vein pathways onto the skin, NIR visualization facilitates precise vascular identification, potentially reducing complications. We describe a case of ZIP flap reconstruction in a 25-year-old patient utilizing NIR vein visualization to preemptively locate flap vasculature and minimize the risk of vessel puncture. Our discussion places these findings within the context of the existing literature on NIR devices, underscoring their benefits of non-invasive operation, rapid imaging, and minimal need for advanced operator skills, and highlighting their utility in microvascular reconstructive surgery. Full article

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

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20 pages, 40764 KB

Open AccessReview

Innovations in Clinical Maxillofacial Tissue Engineering and Reconstruction: Cellular Bone Matrix Allografts, Autografts, and Growth Factors

by Jeffrey S. Marschall

Craniomaxillofac. Trauma Reconstr. 2026, 19(2), 18; https://doi.org/10.3390/cmtr19020018 - 24 Mar 2026

Abstract

Reconstruction of craniomaxillofacial (CMF) bony defects requires individualized strategies based on defect characteristics and graft bed biology, with traditional approaches relying on autogenous non-vascularized bone grafts or vascularized free flaps that, while reliable, are associated with donor-site morbidity and operative complexity. Biologically driven [...] Read more.

Reconstruction of craniomaxillofacial (CMF) bony defects requires individualized strategies based on defect characteristics and graft bed biology, with traditional approaches relying on autogenous non-vascularized bone grafts or vascularized free flaps that, while reliable, are associated with donor-site morbidity and operative complexity. Biologically driven reconstructive strategies, including tissue engineering, cellular bone matrix allografts (CBMs), and growth factor adjuncts, have emerged as alternatives or complements to autograft-based reconstruction. This review introduces and details these new innovations with emphasis on the current literature, thus empowering surgeons to enhance their clinical armamentarium. Full article

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

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16 pages, 655 KB

Open AccessArticle

A Prospective, International, Multicentre Registry of Patients Undergoing Segmental Mandibular Defect Reconstruction After Mandibular Resection for Tumours and Drug-Induced Osteonecrosis: A Study Protocol

by Rüdiger M. Zimmerer, Tabea Pankow, Max Heiland, Julius Moratin, Wenko Smolka, Ali Modabber, Philippe Korn, Maria Mejia Nieto, Andreas Naros, Florian Thieringer, Rui Fernandes, Roderick Kim, Ashleigh Weyh, Eppo B. Wolvius, Mohemmed Khan, Andreas Thor, Marcel Ebeling, Takahiro Kanno, Alberto Pereira, Henrique Messias and Nils-Claudius Gellrich Show full author list Hide full author list

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 17; https://doi.org/10.3390/cmtr19010017 - 23 Mar 2026

Abstract

Segmental mandibular resection may be indicated as a treatment in, for example, advanced stages of oral squamous cell carcinoma (OSCC). Osseous reconstruction of these defects is a fundamental part of static and dynamic masticatory rehabilitation, particularly when dental implants are required. The Segmental [...] Read more.

Segmental mandibular resection may be indicated as a treatment in, for example, advanced stages of oral squamous cell carcinoma (OSCC). Osseous reconstruction of these defects is a fundamental part of static and dynamic masticatory rehabilitation, particularly when dental implants are required. The Segmental Mandibular Defect Reconstruction (SMDR) Registry aims to generate real-world evidence on SMDR through an international, prospective, multicentre case series designed as a registry. While OSCC is a common indication for segmental mandibular resection, the SMDR Registry also aims to capture outcomes for rarer mandibular conditions and the increasing number of collateral damage cases resulting from systemic medication therapies (antiresorptive drugs, immunotherapeutics) or irradiation, which may likewise lead to medication-related osteonecrosis of the mandible (MRONJ) or osteo(radio)necrosis with tumour-like segmental resection of the mandible, highlighting the value of an international database for these less frequent pathologies. Primary objectives are to describe the patient population and current treatment modalities, describe the outcomes and adverse events (AEs) for different treatment modalities, and identify potential predictors for successful autologous reconstruction of SMDs. Approximately 300 patients with a mandibular lesion resulting from bisphosphonate- and immunomodulatory drug-induced osteonecrosis of the mandible, ameloblastoma or osteosarcoma of the mandible, oral metastases related mandibular lesions indicated for segmental resection, or OSCC undergoing SMDR or intending to undergo one- or two-stage reconstruction will be prospectively recruited over a 36-month period. Baseline information, treatment details, and outcome measures will be documented. All treatments will be per the usual practice at participating sites. Outcome measures include clinical, patient-reported, and radiological outcomes; AEs related to the condition and/or treatment with a possible influence on the outcome will be recorded. Full article

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12 pages, 3924 KB

Open AccessSystematic Review

Accuracy and Safety of Computer-Assisted Surgery (CAS) in the Treatment of TMJ Ankylosis—Report of Several Cases and Review of the Literature

by Andrei Krasovsky, Boaz Frenkel, Michal Even Almos, Yair Israel, Dekel Shilo, Amir Bilder, Tal Capucha and Omri Emodi

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 16; https://doi.org/10.3390/cmtr19010016 - 19 Mar 2026

Abstract

Background: Temporomandibular joint (TMJ) ankylosis is an uncommon condition in the modern world, yet it remains a significant treatment challenge. One of the main intraoperative difficulties is accurately and safely resecting the ankylotic mass. Objective: This study seeks to share our clinical experience [...] Read more.

Background: Temporomandibular joint (TMJ) ankylosis is an uncommon condition in the modern world, yet it remains a significant treatment challenge. One of the main intraoperative difficulties is accurately and safely resecting the ankylotic mass. Objective: This study seeks to share our clinical experience with various types of complications and to review the literature on the clinical and technological evidence regarding the accuracy of surgical detachment of the ankylotic mass from the skull. Methods: A literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Search strategies were categorized into search 1 for evaluating 3D-printed technology and search 2 for computer-assisted surgical navigation. Results: One study was selected for search 1 and 2 for search 2. Also, three cases of intraoperative surgical complications associated with the resection of the ankylotic mass were presented. The 3D surgical cutting guides were found to be accurate in guiding the superior, inferior, and depth of the osteotomy. Angulation control was less than optimal. Navigation guiding proved accurate in maintaining the planned thickness of the skull base and the anterior wall of the external auditory canal. Conclusion: Navigation guiding is a superior method for achieving predictable anatomical resection of the ankylotic mass. Full article

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

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16 pages, 7122 KB

Open AccessTechnical Note

From Resection to Rehabilitation in One Day: Digital Workflow for Mandibular Reconstruction with Fibular Free Flap and Immediate Dental Rehabilitation Using CAD/CAM Guides at the Point of Care

by Matthias Ureel, Benjamin Denoiseux, Katrien Brijs, Pieter-Jan Boderé, Nicolas Dhooghe and Renaat Coopman

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 15; https://doi.org/10.3390/cmtr19010015 - 12 Mar 2026

Abstract

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental [...] Read more.

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental implant placement and dental prosthesis fixation for mandibular reconstruction was developed at Ghent University Hospital. A follicular ameloblastoma of the left mandible was resected in a 28-year-old male. The defect was reconstructed with a two-segment fibular free flap with immediate placement of three dental implants and immediate implant loading with a screw-retained bridge. A split thickness skin graft and Elemental PerioPlast were used as wound dressing. Comparison of the preoperative planning with the postoperative CT-scan showed a deviation immediately after surgery, which was no longer present at the 6-month follow-up. The patient achieved a stable occlusion and 44 mm mouth opening and reported high satisfaction. This case illustrates that fully digital, immediate mandibular reconstruction with simultaneous implant placement and prosthetic rehabilitation is feasible and accurate and enhances early functional recovery. Future improvements in intraoperative validation may further refine accuracy and reproducibility in complex oncologic reconstructions. Full article

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

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39 pages, 4207 KB

Open AccessSystematic Review

Management Protocol for Ballistic and Other High-Energy Avulsive Facial Injuries—An Update for the 21st Century

by Thomas Pepper, Michele H. Kim, Dane McMillan, Sarah Cantrell, Angel Scialdone, Angelina Nasthas, Ralph Erdmann, Paul N. Manson and David B. Powers

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 14; https://doi.org/10.3390/cmtr19010014 - 3 Mar 2026

Abstract

High-energy ballistic and avulsive injuries to the face represent some of the most complex challenges in modern reconstructive surgery. Since Robertson and Manson’s 1999 management protocol, extensive military experience and technological advancements have transformed the treatment principles while preserving the core tenets of [...] Read more.

High-energy ballistic and avulsive injuries to the face represent some of the most complex challenges in modern reconstructive surgery. Since Robertson and Manson’s 1999 management protocol, extensive military experience and technological advancements have transformed the treatment principles while preserving the core tenets of staged care. This updated review synthesizes evidence from 36 studies published since 2000, encompassing over two decades of global experience in both military and civilian trauma. Advances in damage-control resuscitation, wound decontamination, and early skeletal stabilization have improved survival and functional outcomes. Modern imaging—particularly intraoperative CT and navigation—enables the precise verification of the reduction and removal of retained fragments, while virtual surgical planning and patient-specific implants allow the accurate restoration of facial buttresses. Early vascularized tissue transfer has reduced contracture and infection rates. Adjuncts such as hyperbaric oxygen therapy, permissive hypotension, and advanced hemostatic agents further optimize recovery. The updated four-phase protocol—resuscitation, reconstitution, reconstruction, and rehabilitation—emphasizes early definitive repair, multidisciplinary collaboration, and the integration of digital planning. These refinements extend Robertson and Manson’s foundational principles into the era of precision surgery, achieving superior aesthetic and functional outcomes for patients with devastating facial injuries. Full article

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

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15 pages, 616 KB

Open AccessArticle

Surgical Performance of 3D-Printed Polyetheretherketone (PEEK) Patient-Specific Implants and Titanium Mesh in Clinically Matched Orbital Reconstruction: A Cadaveric Study

by Jokin Zubizarreta Oteiza, Dominik Haenggi, Yannick Simon Krieger, Lukas Schuebel, Daniel Seiler, Florian Markus Thieringer and Neha Sharma

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 13; https://doi.org/10.3390/cmtr19010013 - 2 Mar 2026

Abstract

Orbital reconstruction following trauma remains challenging due to complex three-dimensional (3D) anatomy and limited surgical access. While pre-fabricated titanium mesh is standard, it requires extensive intraoperative manipulation and produces imaging artifacts. The 3D-printed polyetheretherketone (PEEK) patient-specific implants (PSIs) offer potential advantages; however, limited [...] Read more.

Orbital reconstruction following trauma remains challenging due to complex three-dimensional (3D) anatomy and limited surgical access. While pre-fabricated titanium mesh is standard, it requires extensive intraoperative manipulation and produces imaging artifacts. The 3D-printed polyetheretherketone (PEEK) patient-specific implants (PSIs) offer potential advantages; however, limited data exists for the acceptance of PEEK PSIs by surgeons compared to other established techniques. Fourteen surgeons performed simulated orbital reconstructions on nine cadaveric heads comparing titanium mesh and the 3D-printed PEEK PSIs. Titanium mesh was used for Class II orbital floor fractures, while the 3D-printed PEEK PSIs (native and radiopaque formulations) were used for Class IV defects. Surgeons were blinded to the PEEK formulation type. Outcomes included operative efficiency, handling characteristics, fit quality, and mechanical stability using validated 5-point Likert scales and objective timing. The 3D-printed PEEK PSIs demonstrated faster procedure times (9.5 ± 5.3 vs. 11.2 ± 5.1 min) and superior fit quality (2.00 ± 1.04 vs. 2.18 ± 0.60) and mechanical stability (1.67 ± 0.49 vs. 1.91 ± 0.54), with 100% rated stable versus 91% for the titanium mesh. Surgeons could not distinguish between the native and radiopaque PEEK formulations. Most surgeons (64.3%) preferred situation-dependent material selection. The 3D-printed PEEK PSIs demonstrated advantages in handling, fit quality, and mechanical stability for complex defects, while the titanium mesh showed a lower learning curve for simple reconstructions. Radiopaque enhancement expands PEEK’s clinical utility without compromising handling. Full article

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

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16 pages, 1105 KB

Open AccessSystematic Review

Comparison of Reconstructive Materials in Paediatric Orbital Fractures: A Systematic Review

by Jane Chen, Anton Sklavos, Mustafa Mian and Ricky Kumar

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 12; https://doi.org/10.3390/cmtr19010012 - 23 Feb 2026

Abstract

Paediatric orbital fractures require careful reconstruction to prevent long-term functional and aesthetic sequelae. Material selection is critical due to the anatomical and developmental considerations unique to children. Comparative data to guide decision making remain sparse and inconclusive. A systematic search was conducted in [...] Read more.

Paediatric orbital fractures require careful reconstruction to prevent long-term functional and aesthetic sequelae. Material selection is critical due to the anatomical and developmental considerations unique to children. Comparative data to guide decision making remain sparse and inconclusive. A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase (through February 2025), following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Studies reporting outcomes and/or complications associated with implant materials used in the reconstruction of paediatric orbital fractures were included. Outcomes included postoperative diplopia, enophthalmos, restriction of eye movements, removal of material, and return to theatre (RTT). In total, 54 studies encompassing a total of 562 patients and 563 implants were included. Polymers (n = 169), alloplasts (n = 167) and autologous (n = 166) implants were the most commonly used reconstructive material. Late postoperative diplopia occurred in 7% of polymers (12/169), 6% of alloplasts (10/167), 29% of allografts (6/21), 24% of xenografts (6/25) and 33% of metals (2/6). Reported enophthalmos was highest in the autologous group (8%) but was only reported in 34 of the 54 studies. Infection, removal of implant material and RTT were low across all groups (1–4%). No donor site morbidity was reported. Robust studies with standardised outcomes and adequate follow-up are needed to inform evidence-based material selection in paediatric orbital reconstruction. Full article

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

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10 pages, 216 KB

Open AccessArticle

Assessing Patient Satisfaction Following Otoplasty: A Social Media Analysis

by Shervin Eskandari, Gianluca Ramirez, Benjamin Aderinwale, Robel Yohannes and David Zabel

Craniomaxillofac. Trauma Reconstr. 2026, 19(1), 11; https://doi.org/10.3390/cmtr19010011 - 6 Feb 2026

Abstract

Background: Otoplasty is a commonly performed cosmetic ear procedure, yet patient-reported outcome data remain limited. This study analyzes otoplasty reviews on RealSelf, a widely used aesthetic review platform that provides insight into patient experiences and outcomes. Methods: A retrospective review of otoplasty-related posts [...] Read more.

Background: Otoplasty is a commonly performed cosmetic ear procedure, yet patient-reported outcome data remain limited. This study analyzes otoplasty reviews on RealSelf, a widely used aesthetic review platform that provides insight into patient experiences and outcomes. Methods: A retrospective review of otoplasty-related posts on RealSelf from January 2009 to March 2025 was performed. Reviews were manually screened and coded independently by reviewers. Extracted variables included demographics, procedure location, surgeon specialty, anesthesia type, postoperative pain, satisfaction rating (“Worth It,” “Not Worth It,” “Not Sure”), cost, motivations for surgery, and reasons for choosing the surgeon. Results: A total of 615 reviews met inclusion criteria, and 90.7% rated the procedure as “Worth It.” Protruding ears were the most common motivation for surgery (55.1%), followed by ear asymmetry (17.0%). Surgeon selection was most influenced by the consultation experience (34.4%), credentials (24.8%), and online reviews (21.6%). Positive surgeon comments emphasized comfort (32.3%), personality (27.9%), and communication (25.1%). Satisfaction was significantly associated with postoperative pain level (p < 0.001) and improved confidence after surgery (p = 0.032), but not with age, gender, procedure location, anesthesia type, or cost. Improved confidence (38.5%), enhanced ear shape (27.8%), and natural-appearing results (17.4%) were the most frequently cited reasons for being satisfied with otoplasty. Conclusion: Patient-reported satisfaction with otoplasty on RealSelf is high and is associated with favorable aesthetic results, improved self-confidence, and positive surgeon–patient interactions. In this cohort, effective communication, realistic expectation setting, and postoperative pain management were central to optimizing the patient experience. Full article

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

Cited by 1

Abstract

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

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

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

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

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

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

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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