Craniomaxillofacial Trauma & Reconstruction

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

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

Background: Naso-orbital-ethmoid (NOE) fractures represent complex midface injuries that challenge aesthetic and functional reconstruction. This study evaluates the efficacy of techniques restoring intercanthal distance following operative repair of NOE fractures. Methods: A retrospective case series was conducted of adults undergoing NOE fracture repair between 2010 and 2022. CPT codes were used to identify patients, with inclusion based on radiographic confirmation of NOE fractures. Demographic data, fracture classification, operative techniques, and pre- and post-operative CT measurements of intercanthal distance were analyzed by fracture type and type of repair. Results: 191 patients were identified, mostly male (80%), with Type I fractures being most common (66%). Intercanthal wiring was used in 14% of cases, most frequently for Type II and III fractures. Of the 100 patients with post-operative comparison imaging, the median intercanthal distance improved from 34 mm to 31 mm. Intercanthal wiring yielded greater median distance correction. All patients achieved restoration of intercanthal distance within normal limits regardless of repair technique. Conclusions: Operative repair of NOE fractures using either plating or intercanthal wiring effectively restores normal intercanthal distance. While intercanthal wiring remains valuable in severe fractures, it may not be universally necessary. Further study is needed to refine the role of these repair techniques.