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Maxillo-Facial Surgery: New Insights and Technologies in Head and Neck
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Maxillo-Facial Surgery: New Insights and Technologies in Head and Neck

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 3006

Special Issue Editor

Dr. Federica Ruggiero

E-Mail Website
Guest Editor
Oral and Maxillo-Facial Unit, AUSL Bologna Bellaria-Maggiore Hospital, 40139 Bologna, Italy
Interests: orthognathic surgery; maxillofacial surgery; oral surgery; oral and maxillo-facial surgery; finite element modeling; augmented reality; virtual surgical planning; craniofacial surgery; cleft surgery

Special Issue Information

Dear Colleagues,

The recent technological progress achieved in the head and neck field has been remarkable.

This Special Issue will focus on the cutting-edge innovations that are transforming the field of oral and maxillo-facial surgery. The featured topics—augmented reality (AR), virtual surgical planning (VSP), patient-specific implants (PSIs), and finite element modeling (FEM)—will highlight the incorporation of advanced technologies aimed at improving surgical precision, outcomes, and patient care.

  1. Augmented Reality (AR): AR offers the real-time visualization and overlay of anatomical structures during surgery, enhancing the surgeon's spatial understanding and accuracy. This technology enables minimally invasive procedures, reducing the surgical time and improving the precision in complex cases such as orthognathic surgeries and tumor resections.
  2. Virtual Surgical Planning (VSP): VSP allows surgeons to pre-plan complex procedures using 3D models derived from patient-specific imaging data. This approach improves surgical outcomes by enabling the precise manipulation of bone structures and soft tissues before entering the operating room, streamlining complex reconstructions and deformity corrections.
  3. Patient-Specific Implants (PSIs): The development of PSIs, created through 3D printing and customized to fit the patient's anatomy, has revolutionized reconstructive surgery. These implants offer a better anatomical fit, reduced surgery time, and improved functional and aesthetic outcomes, particularly in facial trauma, reconstruction, and maxillo-facial deformities.
  4. Finite Element Modeling (FEM): FEM is used to simulate and predict the biomechanical behavior of tissues and bones under various conditions. This tool helps surgeons better understand the forces involved in surgical procedures, allowing them to optimize techniques and improve patient-specific treatment plans, particularly in cranio-facial reconstruction and orthognathic surgery.

These are just a few of the innovations that are currently contributing to oral and maxillo-facial surgery and are becoming a vital part of the toolkit of the modern surgeon.

Together, these innovations are redefining the landscape of oral and maxillo-facial surgery by improving precision, customization, and patient-specific care. This Special Issue will explore how these advancements are shaping the future of surgical practice and their potential to further enhance patient outcomes.

Dr. Federica Ruggiero
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • oral and maxilla-facial surgery
  • orthognathic surgery
  • cranio-facial surgery
  • head and neck surgery
  • augmented reality
  • navigation
  • finite element modeling
  • virtual surgical planning
  • patient-specific implants

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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9 pages, 779 KiB  
Article
Anatomical Changes After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis
by Ameen Biadsee, Rabie Shehadeh, Matan Katz, Tomer Boldes, Taciano Rocha, Brian W. Rotenberg and Leigh J. Sowerby
J. Clin. Med. 2025, 14(7), 2380; https://doi.org/10.3390/jcm14072380 - 30 Mar 2025
Viewed by 334
Abstract
Background: Changes in the bony structures of the nose and sinuses such as the medialization of the lamina papyracea and enophthalmos have been reported after sinus surgery. Evidence for the persistence of inferior turbinate (IT) position after IT outfracture is lacking. Objectives: To [...] Read more.
Background: Changes in the bony structures of the nose and sinuses such as the medialization of the lamina papyracea and enophthalmos have been reported after sinus surgery. Evidence for the persistence of inferior turbinate (IT) position after IT outfracture is lacking. Objectives: To evaluate for anatomical changes of the IT, lamina and the globes, after sinus surgery and the durability of inferior turbinate outfracture. Methods: A total of forty-four patients who underwent revision endoscopic sinus surgery that included complete ethmoidectomy and IT outfracture were matched. Pre- and post-operative computed tomography scans (CT) were used for evaluating and measuring the anatomical changes in different planes. The posterior globe position in the axial plane, the distance between the lamina papyracea (IODAxial, IODCoronal) in coronal and axial planes and the distance from the IT to the septum (ITM) and the lateral nasal wall (ITL) were measured. Results: There were 16 women and 28 men. Mean follow-up time (time from procedure to post-operative CT scan) was 38.9 ± 20.1 months. Statistically significant lateralization of the IT was observed with ITL (95%CI 1.1 mm to 1.5 mm p < 0.0001) and ITM (95%CI −1.5 mm to −1.1 mm; p < 0.0001). No statistically significant differences were seen in IODAxial and IODCoronal in pre-op and post-op CT scans. (p = 0.23 and p = 0.7, respectively) and no significant displacement of the globe in antero-posterior direction was seen (p = 0.915). Conclusions: IT outfracture appears to have a durable effect on IT position that lasts for several years. Ethmoidectomy did not cause the medialization of the laminae nor altered the position of the globes. Full article
(This article belongs to the Special Issue Maxillo-Facial Surgery: New Insights and Technologies in Head and Neck)
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11 pages, 544 KiB  
Article
Translation, Cross-Cultural Adaptation, and Validation of the Chronic Rhinosinusitis Patient-Reported Outcome (CRS-PRO) into Hebrew
by Tomer Boldes, Rabie Shehadeh, Eitan Shavit, Firas Kassem, Benny Nageris, Leigh J Sowerby and Ameen Biadsee
J. Clin. Med. 2025, 14(7), 2347; https://doi.org/10.3390/jcm14072347 - 29 Mar 2025
Viewed by 313
Abstract
Backgrounds: Designed to measure symptoms and quality-of-life impacts, the chronic rhinosinusitis patient-reported outcome (CRS-PRO) questionnaire is a novel instrument tailored to CRS patients. This study aimed to translate the CRS-PRO into Hebrew, adapt it cross-culturally, and assess its reliability and validity. Methods: A [...] Read more.
Backgrounds: Designed to measure symptoms and quality-of-life impacts, the chronic rhinosinusitis patient-reported outcome (CRS-PRO) questionnaire is a novel instrument tailored to CRS patients. This study aimed to translate the CRS-PRO into Hebrew, adapt it cross-culturally, and assess its reliability and validity. Methods: A prospective study was conducted with 127 participants across three groups: CRS, functional endoscopic sinus surgery (FESS), and control groups (healthy individuals). Participants completed the Hebrew CRS-PRO at baseline and one month later. The Hebrew version was developed according to the International Society for Pharmacoeconomics and Outcomes Research guidelines for translation and cross-cultural adaptation. Results: Of the 127 participants (mean age 47.3 ± 17.7 years, range 18–93), 77 were males (60.6%), and 50 were females (39.4%). The Hebrew CRS-PRO demonstrated high internal consistency (Cronbach’s alpha 0.936) and strong discriminant validity among the three groups. Baseline mean scores were 7.2 for the control group, 25.2 for the FESS group, and 27.1 for the CRS group, which subsequently decreased to 6.5, 12.9, and 20.4, respectively, after one month (ANOVA, p < 0.001). Test–retest reliability, supported by Pearson’s correlation (p < 0.01) and intraclass correlation (p < 0.0001), demonstrated the questionnaire’s effectiveness in identifying CRS-related symptoms and monitoring improvement after FESS. Conclusions: The adaptation and validation of the CRS-PRO into Hebrew resulted in a reliable instrument in patients with CRS. It exhibited robust reliability, internal consistency, and strong discriminant validity, effectively differentiating between healthy individuals and CRS patients and those who are pre- and post-FESS. Additionally, the Hebrew CRS-PRO questionnaire may be effective for evaluating patients before and after FESS surgery. Full article
(This article belongs to the Special Issue Maxillo-Facial Surgery: New Insights and Technologies in Head and Neck)
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15 pages, 6819 KiB  
Article
Enhancing Implant Success in Mandibular Reconstruction: A Novel Approach Combining Implant-Retained Splint and Vestibuloplasty—A Case Series
by Louise Van Der Kelen, Matthias Ureel, Benjamin Denoiseux, Pieter-Jan Boderé, Carine Matthys, Hubert Vermeersch and Renaat Coopman
J. Clin. Med. 2025, 14(4), 1298; https://doi.org/10.3390/jcm14041298 - 15 Feb 2025
Viewed by 628
Abstract
Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation [...] Read more.
Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation more difficult. This study introduces a novel approach combining vestibuloplasty with patient-specific implant-retained splints to enhance oral health and improve rehabilitation outcomes. Methods: Three patients underwent mandibular reconstruction with a free vascularized fibula flap (FFF). After 6 months of osseointegration, vestibuloplasty and soft tissue refinement were performed, with a split-thickness skin graft placed on the FFF periosteum. An implant-retained splint was secured to the abutments for two weeks to support soft tissue healing. Implant survival, bone loss, and peri-implant health were evaluated over a 2-year follow-up. Results: A total of 12 implants were placed, primarily in the neomandible (83.3%), with a 100% survival rate. Implant survival was assessed. Implant survival was assessed based on established criteria for clinical success, including stability, presence of pain, bleeding on probing (BOP), pocketdepth, bone loss and lack of peri-implant radiolucency. Functional outcomes included normal mouth opening, laterotrusion, and protrusion. Pocket depths ranged from 3 to 4 mm, except for one implant in cases 1 and 2. The mean BOP was 51.7%. Conclusions: This case series introduces a surgical technique that combines CAD/CAM and vestibuloplasty to optimize dental rehabilitation in mandibular FFF reconstructions, demonstrating safe thinning of soft tissues for improved oral hygiene and survival. Full article
(This article belongs to the Special Issue Maxillo-Facial Surgery: New Insights and Technologies in Head and Neck)
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Review

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24 pages, 613 KiB  
Review
Investigating the Effectiveness of Buccal Flap for Velopharyngeal Insufficiency: A Systematic Review Article
by Amr Youssef Arkoubi
J. Clin. Med. 2025, 14(8), 2593; https://doi.org/10.3390/jcm14082593 - 10 Apr 2025
Viewed by 414
Abstract
Background: Velopharyngeal insufficiency (VPI) is a failure of the sphincter mechanism, causing speech patterns like hypernasality and decreased intelligibility. Causes include structural, neurologic, and mechanical issues. Treatment options include non-surgical and surgical interventions, but complications can arise. A new approach using the [...] Read more.
Background: Velopharyngeal insufficiency (VPI) is a failure of the sphincter mechanism, causing speech patterns like hypernasality and decreased intelligibility. Causes include structural, neurologic, and mechanical issues. Treatment options include non-surgical and surgical interventions, but complications can arise. A new approach using the buccal flap (BF) has been suggested for palatal length augmentation. This systematic review assessed speech outcomes after BF palatal lengthening. Methods: A thorough investigation was conducted by methodically reviewing numerous databases, including PubMed, Scopus, Web of Science, and Embase, until December 2024. The goal of our analysis was to find studies that assess the short- and long-term efficacy of BF on speech outcomes on patients with VPI. We used the NIH Quality Assessment Tool to assess the quality of the evidence, ensuring the dependability of the results reached during these investigations. Results: This systematic review identified 23 studies (total sample size of 995) that assessed the speech outcomes of BF on VPI. The BF significantly improves speech outcomes in patients with VPI. Hypernasality improved significantly post-surgery, with outcomes measured using different scales and methods, including both subjective and objective tools. Benefits were observed within three months postoperatively, with sustained benefits up to 15 months in several studies. Speech intelligibility also improved notably, with mean differences up to 1.09 (p < 0.001). Reductions in audible nasal air emissions were observed, though some variability was noted across studies. Secondary outcomes, including better velopharyngeal closure and decreased facial grimacing, further highlight its efficacy. However, inconsistent findings for nasal turbulence and limited long-term data suggest that benefits may plateau over time. These findings support the BF as an effective intervention, though further research is needed on extended outcomes. Conclusions: BF is an effective surgical intervention for VPI, significantly improving hypernasality, speech intelligibility, and audible nasal air emissions. While benefits are evident across diverse populations, long-term outcomes and secondary features, such as nasal turbulence, show variability, emphasizing the need for individualized approaches and continued follow-up. This technique offers a reliable option for functional and speech rehabilitation, though further research is needed to optimize its long-term efficacy and broader outcomes. Full article
(This article belongs to the Special Issue Maxillo-Facial Surgery: New Insights and Technologies in Head and Neck)
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Other

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13 pages, 16948 KiB  
Technical Note
A Novel Virtual Planned-Orthodontic-Surgical Approach for Proportional Condylectomy in Condylar Hyperplasia
by Stefania Perrotta, Emanuele Carraturo, Vincenzo D’Antò, Björn Ludwig, Tecla Bocchino, Luigi Angelo Vaira, Giacomo De Riu, Rosa Valletta and Pasquale Piombino
J. Clin. Med. 2025, 14(3), 752; https://doi.org/10.3390/jcm14030752 - 24 Jan 2025
Viewed by 880
Abstract
Background/Objectives: Condylectomy is a delicate and intricate procedure commonly employed in the management of temporomandibular joint (TMJ) disorders, osteochondromas, condylar hyperplasia, hemimandibular hyperplasia, and other pathologies affecting the condylar region. The advent of surgical cutting guides has introduced a new dimension to condylectomy [...] Read more.
Background/Objectives: Condylectomy is a delicate and intricate procedure commonly employed in the management of temporomandibular joint (TMJ) disorders, osteochondromas, condylar hyperplasia, hemimandibular hyperplasia, and other pathologies affecting the condylar region. The advent of surgical cutting guides has introduced a new dimension to condylectomy procedures as they enable surgeons to plan and execute precise cuts with a heightened level of accuracy. In the literature already exists cases of cutting guide-based condylectomy, but they only depend on the mere mirroring procedure in virtual planning, which has accuracy limitations because it does not consider asymmetry of peri-condylar structures at the level of the ramus, body, and mandibular angle. Methods: CAD-CAM orthodontic preparation through the NEMOFAB Software was performed to correct the canting of the occlusal plane, following the “orthodontic first” technique. The same software was used for VSP of the surgical cutting guide to perform the condylectomy, basing not to the mere mirroring of the opposite side but considering the whole condylar-TMJ-glenoid fossa structure. Results: At 6 months follow-up, the patient showed good occlusion and an almost totally recovered lower third symmetry as median-upper and lower interincisive lines coincide with each other and with the chin median. A good occlusal and masticatory outcome was obtained. The joint structure was preserved with remodeling of the glenoid cavity caused by the presence of the joint disc, which was preserved during surgery. Conclusions: The goal of this study is to propose a method of therapeutic management of condylar hyperplasia that benefits from accurate pre-operative orthodontic treatment (orthodontics first) to maximize the results of proportional condylectomy, reducing post-operative orthodontic care as well as any need for any adjuvant orthognathic surgery. A new virtual surgical planning method is also proposed for creating a cutting guide that not only takes advantage of the mirroring technique to accurately calculate the amount of condyle to be cut but also considers the entire condyle–TMJ complex to perform a condylectomy that is more precise. Full article
(This article belongs to the Special Issue Maxillo-Facial Surgery: New Insights and Technologies in Head and Neck)
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