Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19020023

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

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19020022

Authors: Graciela Ana Giannunzio Jose Mariano Astigueta Sthefania Johana Lucero Ariana Gimena Labachuk Carlos Alberto Isnado Bolivar

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19020021

Authors: Tsung-yen Hsieh Mary Roz Timbang Edward Bradley Strong

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19020020

Authors: Alexander R. Engelmann Kailash Singh Jiachen Zhuo Néha Datta Alfredo A. Sadun Michael P. Grant Shannath L. Merbs

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19020019

Authors: Yoram Fleissig Jhonatan Elia Nir Hirshoren Amalia Sabato Eleonora Ginzburg Jawad Abu Tair Jeffrey M. Weinberger Shay Sharon

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19020018

Authors: Jeffrey S. Marschall

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010017

Authors: 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 Nils-Claudius Gellrich

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010016

Authors: Andrei Krasovsky Boaz Frenkel Michal Even Almos Yair Israel Dekel Shilo Amir Bilder Tal Capucha Omri Emodi

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010015

Authors: Matthias Ureel Benjamin Denoiseux Katrien Brijs Pieter-Jan Boderé Nicolas Dhooghe Renaat Coopman

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010014

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

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010013

Authors: Jokin Zubizarreta Oteiza Dominik Haenggi Yannick Simon Krieger Lukas Schuebel Daniel Seiler Florian Markus Thieringer Neha Sharma

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010012

Authors: Jane Chen Anton Sklavos Mustafa Mian Ricky Kumar

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010011

Authors: Shervin Eskandari Gianluca Ramirez Benjamin Aderinwale Robel Yohannes David Zabel

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010010

Authors: Khalid Abdel-Galil Kemal Mustafa Tekeli

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010009

Authors: Bianca Pulino Robert Sader Guilherme Louzada Majeed Rana Gabriele Millesi Geraldo Prestes de Camargo Filho Raphael Capelli Guerra

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010008

Authors: Nicholas J. Lee Gareth Honeybone Mohammed Anabtawi Mathew Thomas Sachin M. Salvi

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010007

Authors: Jeffrey Mella François E. Proulx Alan W. Johnson

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010006

Authors: Mustafa Mohammad Ali Saffar E. Krabbendam E. B. Wolvius J. T. van der Tas

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010005

Authors: Khalid Abdel-Galil Ammar Khalafalla Mohamed Amir

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010004

Authors: Nicholas A. Frisco Nicholas W. Clark Kayla W. Kilpatrick Maragatha Kuchibhatla David B. Powers Charles R. Woodard Nosayaba Osazuwa-Peters Dane M. Barrett

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010003

Authors: Alexander De Crem Constantijn Bogaert Frederik Piccart Matthias Ureel Benjamin Denoiseux Lisa De Kock Marieke Brands Olivier Lenssen Renaat Coopman

Background: Three-dimensional facial anthropometry is increasingly used in orthodontics and orthognathic surgery. Conventional face scanning systems such as Vectra® and 3dMD® are well validated but remain costly and technically demanding. The MetiSmile® 3D face scanner provides a more affordable and portable alternative, yet its accuracy and reproducibility have not been rigorously evaluated. Methods: Validation was performed on a standardized mannequin head in two phases. Phase 1 assessed mesh reproducibility under artificial lighting (AL), natural lighting (n-AL), and after mesh-refinement (AL-F). Landmark-based pre-registration with Iterative Closest Point refinement was applied; root-mean-square error (RMS) and distance maps were calculated. In phase 2, three observers (student, resident, consultant) performed 14 predefined linear measurements by direct anthropometry (DA) and digital anthropometry (DiA). Intra- and inter-observer reliability was evaluated using intraclass correlation coefficients. Results: Phase 1 yielded mean RMS values of 0.041 mm (AL), 0.043 mm (n-AL), and 0.030 mm (AL-F), with largest deviations near eyes, alar regions, and lip commissures. Phase 2 showed excellent ICCs (≥0.997) and mean absolute DA–DiA differences of 0.25–0.33 mm, with only few differences > 2 mm. Conclusion: The MetiSmile® scanner generates highly reproducible meshes and clinically acceptable linear measurements on mannequin models. Further validation on live subjects is warranted before routine clinical application.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010002

Authors: Gabriel Conceição Brito Márcio de Moraes Leonardo Faverani Sergio Olate

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr19010001

Authors: George Cove Declan Hughes Christopher Zerafa Simon Holmes

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040053

Authors: Preston Leader Kelsey Karnik Anthony Mangino Clayton Bobo Thomas Gal

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040052

Authors: Turki Bin Mahfoz

Background: Although orbital fractures are common in trauma care, age-specific mechanisms and admission physiology-based risk stratification have not been systematically characterized. This study aimed to identify age–mechanism interaction patterns and develop an admission-based physiological risk score for orbital fracture patients. Methods: This retrospective cohort study analyzed 41,464 adult orbital fracture patients from the National Trauma Data Bank (2018–2020). A three-component physiological risk score was developed using admission vital signs: severe hypotension (<90 mmHg, 2 points), tachycardia (>100 bpm, 1 point), and severe traumatic brain injury (GCS ≤ 8, 1 point). Risk stratification performance was validated against composite adverse outcomes. Results: Distinct age–mechanism patterns emerged: 74.0% of elderly patients (≥65 years) sustained falls, while young adults demonstrated a bimodal distribution with motor vehicle crashes (31.2%) and violence (28.4%). Violence-related injuries occurred in younger patients (40.3 vs. 55.0 years) but had lower injury severity scores (10.0 vs. 14.4) and mortality (2.8% vs. 5.2%) than accidental mechanisms. High-/critical-risk patients (8.4% of the cohort) had 16.2% mortality versus 2.1% in stable patients. Complex facial injuries demonstrated 11-fold higher mortality (7.7% vs. 0.7%). The physiologic risk score achieved AUC 0.79 (95% CI: 0.78–0.80). Conclusions: Age–mechanism interactions revealed distinct bimodal injury patterns in young adults. Admission physiologic parameters effectively identify 8.4% of patients requiring intensive resources, while violence-related injuries paradoxically demonstrate better outcomes than accidental mechanisms.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040051

Authors: Arya Sherafat Aishwarya Suresh Ian Waldrop Jared Inman

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040050

Authors: Saša Mijatov Ivana Mijatov Denis Brajković Dušan Rodić Jagoš Golubović

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.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040049

Authors: Kathleen Fan Yiu Yan Leung Florian M. Thieringer

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

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040048

Authors: Martin Bengtsson Aron Naimi-Akbar Joakim Johansson-Berggren Sebastian Dybeck-Udd Mikael Magnusson Bodil Lund

This meta-review evaluated the possibility of more specified recommendations in antibiotic treatment through a narrowed focus on facial trauma. The aim was to analyze the effect of different regimens of antibiotic in treatment of skeletal trauma to the face. The knowledge mapping was based on existing systematic reviews (SRs) on trials specified in a PICO: Participants (P): Adults and children, diagnosed with fractures to the facial skeleton. Interventions (I): Antibiotic intervention. Comparator (C): Placebo, no antibiotics. Outcomes (O): Postoperative infection, pain, re-operation, other complications, healing deficiencies, (Oral) Health related Quality of Life, removal of osteosynthesis, adverse reactions. The literature search in PubMed, The Cochrane Library, and Web of Science according to PRISMA resulted in 1487 records. A COVIDENCE selection process resulted in 29 articles retrieved and read in full text revealing 10 articles eligible for evaluated according to ROBIS. Three SRs were considered to have low risk of bias and constituted the final evidence evaluation. The meta-review of these SRs did not provide sufficient support for prolonged antibiotic treatment after surgical intervention of midfacial fractures in comparison with antibiotics only the first day postoperatively. No support for antibiotic treatment for conservatively managed fractures alone was found. This review is limited by a relatively low number of included SRs. However, tendencies in outcomes suggests a restricted duration of antibiotics in treatment of facial fractures.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040047

Authors: Noriko Sakata Masako Fujioka-Kobayashi Yuhei Matsuda Reon Morioka Erina Toda Shinji Ishizuka Michitaka Somoto Rie Sonoyama-Osako Hiroto Tatsumi Takahiro Kanno

Background: The high perimandibular approach (HPA) is a feasible surgical technique for open reduction and internal fixation (OR-IF) of mandibular condylar fractures, offering reduced complication rates. In this study, we retrospectively evaluated the treatment outcomes and complications associated with HPA use. Patients and Methods: Patients who underwent OR-IF for mandibular condylar fractures using the HPA at three hospitals in Shimane between June 2019 and March 2024 were included. Data collected included the mechanism of injury, AO classification of the fracture site, fracture type and mode, surgical duration, mouth-opening range at 6 months post-operatively, and peri- and post-operative complications. Results: A total of 42 patients (46 condylar fractures; 18 males and 24 females; mean age, 63.0 years) were included. The fracture pattern included dislocations in 18 cases (42.8%). The mean surgical duration was 75.0 min. Post-operative trismus occurred in 16 patients (38.1%) at 6 months. Longer surgical duration and dislocated fractures were significantly associated with post-operative trismus (p < 0.05). Conclusions: The HPA is safe and effective for managing mandibular condylar fractures. However, post-operative trismus may be influenced by longer surgical duration and fracture types, warranting further investigation and potential post-surgical management.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040046

Authors: Ming Yan Cheung Ankit Nayak Xing-Na Yu Kar Yan Li Yu-Xiong Su Jingya Jane Pu

Computer-assisted surgery (CAS) and virtual surgical planning (VSP) have transformed jaw reconstruction, allowing immediate insertion of dental implants during surgery for better rehabilitation of occlusal function. However, traditional planning for optimal location and angulation of dental implants and fibula relies on experience and can be time-consuming. This study aimed to propose a function-driven workflow and develop an automatic computer program for optimal positioning of simultaneous dental implants and fibula segments. A customized computer program was developed using MATLAB. Computed tomography (CT) of the lower limbs of ninety-one Southern Chinese individuals was retrieved and cross-sections of three-dimensional (3D) fibula models were comprehensively investigated for implant installation. Our research proves that the accuracy of the program in identifying the anatomical orientation of the fibula was 92%. The ideal location, angulation and length of implant could be automatically generated based on any selected implant diameter, with a surgical feasibility of 94%. To the best of our knowledge, this is the first study to develop and validate a customized automatic computer program for osseointegrated implant design in fibula flap surgery. This program can be incorporated into the current workflow of CAS to further the development of reliable and efficient surgical planning for function-driven jaw reconstruction.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040045

Authors: Abdulmalik Alyahya Saud Bin Jasser

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, and the occlusal plane. Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: Phase One involves correcting frontal deformity and various asymmetries, Phase Two involves correcting chin anterior–posterior deformity, Phase Three involves correcting anterior–posterior and vertical MMC position, and Phase Four involves correcting MMC rotation. Results: The T concept provided a structured approach to plan MMC as a whole and integrate all structures into harmony. Conclusions: The T concept provides a logical approach to MMC positioning in orthognathic surgery, addressing functional and aesthetic concerns. It acts as a checkpoint to verify MMC position, helping surgeons achieve better results and avoid compensatory procedures.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040044

Authors: Akruti Desai Gautam Dendukuri Milind Naik

The aim of this paper is to report “Globe Intussusception” as an extreme form of globe dislocation outside the orbital pyramid, and provide a literature review. A single-center, retrospective, interventional case series of three patients is presented. A review of the English-language literature from the years 1971 to 2024 was performed using the search terms “traumatic globe dislocation”, “maxillary sinus” and “ethmoid sinus”. Three cases of globe intussusception are reported. Computed tomography imaging revealed orbital fracture, and globe prolapse into the maxillary sinus with or without involvement of ethmoid sinus. This was associated with complete intussusception of the globe through the conjunctiva, giving an “empty socket” appearance. In all three cases, fracture repair along with retrieval of the eyeball from the sinus was carried out surgically. Reduction of the intussusception, and bringing the eyeball out of the conjunctival pouch was a special additional challenge in these cases. The review of 35 cases reported in world literature till date is presented. We suggest retrieval of the intussuscepted eyeball via a 360° peritomy and suture tagging of extraocular muscles to ensure safe repositioning of globe with intact extraocular muscles.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18040043

Authors: Patrícia Santos Carolina Moreira Nuno Gião Paulo Valejo Coelho

Objective: This study aims to evaluate the management and outcomes over 14 years at a tertiary maxillofacial surgery unit. Methods: Retrospective cohort study of patients from a Portuguese tertiary center of maxillofacial surgery with histopathologically confirmed diagnoses of chronic osteomyelitis of the jaws between January 2010 and December 2023. Demographic and clinical characteristics, treatment, and progression of the disease were evaluated. Results: Fifty-three patients were included—28 women (52.8%), mean age 55 (95% CI 5–90) years. The mandible was affected in 84.9% (n = 45) of cases. Secondary chronic osteomyelitis was diagnosed in 88.7% (n = 47), with medication-related osteonecrosis of the jaw (MRONJ) being the most common etiology (38.3%). Bacteriological samples were contributory in 52% (n = 13) and 46.1% (n = 6) were resistant to amoxicillin. All received antibiotics for a median time of 27.3 days. Surgical treatment included sequestrectomy (n = 40, 75.5%), marginal (n = 5, 9.4%), and segmental mandibulectomy (n = 8, 15.1%). Clinical remission was achieved in 77.4% (n = 41) of cases with higher success in MRONJ (n = 15, 83.3%) than ORN (n = 4, 57.1%). Conclusions: Almost half of the isolates were amoxicillin-resistant, reinforcing the need for susceptibility testing. Surgical management guided by etiology and disease stage remains essential, with more extensive resection needed in MRONJ and ORN.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030042

Authors: Bruno Nifossi Prado Lucas Cavalieri Pereira Bianca Pulino Raphael Capelli Guerra

Background: Genioplasty is a well-established surgical technique for reshaping the chin and enhancing facial harmony. However, conventional fixation methods may present biomechanical and aesthetic limitations. Objective: This study introduces and evaluates a novel Anatomical Chin Plate (ACP), designed to enhance mechanical performance and facial aesthetics compared to the conventional chin plate (CP). Methods: A three-dimensional finite element analysis (FEA) was conducted to compare stress distribution in ACP and CP models under a standardized oblique load of 60 N, simulating muscle forces from the mentalis and digastric muscles. Plates were modeled using Blender and analyzed using ANSYS software 2025 r2. Mechanical behavior was assessed based on von Mises stress, concentration sites, and potential for plastic deformation or fatigue failure. Results: The ACP demonstrated a significantly lower maximum von Mises stress (77.19 MPa) compared to the CP (398.48 MPa). Stress distribution in the ACP was homogeneous, particularly around the lateral fixation holes, while the CP exhibited concentrated stress between central screw holes. These findings indicate that the anatomical geometry of the ACP enhances load dispersion, reduces critical stress concentrations, and minimizes fatigue risk. Conclusions: The ACP design offers superior biomechanical behavior and improved aesthetic potential for genioplasty procedures. Its optimized shape allows for better integration with facial anatomy while providing stable fixation. Further studies are recommended to validate in vitro performance and explore clinical applicability in advanced genioplasty and complex osteotomies.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030041

Authors: Laurence Verstraete Paulien Schillemans Jan Meeus Philippe Vuylsteke Robin Willaert

Background: This study aims to evaluate the use of the endoscopic transorbital approach for reducing frontal sinus fractures and compare its outcomes with the traditional bicoronal approach. Methods: A retrospective comparative analysis of case studies including all patients with frontal sinus fractures treated at our institution between January 2013 and December 2023 was conducted. Patients were categorized based on treatment approach (through traumatic laceration, bicoronal, or endoscopic transorbital). For the comparative analysis, cases with associated maxillofacial fractures or cerebrospinal fluid (CSF) leakage were excluded. Results: Out of 133 patients, 35 underwent surgery, with 6 patients treated using the endoscopic transorbital approach. This group of patients treated with the transorbital endoscopic approach demonstrated significantly shorter operative times compared to the bicoronal approach (mean 102 vs. 168 min, p = 0.021). They also had only minor complications, including temporary hypoesthesia and one transient ptosis. One patient had a minimal residual defect. The technique has been concluded to require endoscopic expertise. Conclusions: The endoscopic transorbital approach is a safe, minimally invasive alternative to the bicoronal approach for selected anterior wall frontal sinus fractures. Proper patient selection and surgical experience are essential to achieving favorable outcomes. Studies with longer follow-up are required to assess potential late complications, such as the development of mucoceles.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030040

Authors: Reinier S. A. ten Brink Bram J. Merema Marith E. den Otter Willemina A. van Veldhuizen Max J. H. Witjes Joep Kraeima

We present a deep learning-based approach for accurate bone segmentation directly from routine T1-weighted MRI scans, with the goal of enabling MRI-only virtual surgical planning in head and neck oncology. Current workflows rely on CT for bone modeling and MRI for tumor delineation, introducing challenges related to image registration, radiation exposure, and resource use. To address this, we trained a deep neural network using CT-based segmentations of the mandible, cranium, and inferior alveolar nerve as ground truth. A dataset of 100 patients with paired CT and MRI scans was collected. MRI scans were resampled to the voxel size of CT, and corresponding CT segmentations were rigidly aligned to MRI. The model was trained on 80 cases and evaluated on 20 cases using Dice similarity coefficient, Intersection over Union (IoU), precision, and recall. The network achieved a mean Dice of 0.86 (SD ± 0.03), IoU of 0.76 (SD ± 0.05), and both precision and recall of 0.86 (SD ± 0.05). Surface deviation analysis between CT- and MRI-derived bone models showed a median deviation of 0.21 mm (IQR 0.05) for the mandible and 0.30 mm (IQR 0.05) for the cranium. These results demonstrate that accurate CT-like bone models can be derived from standard MRI, supporting the feasibility of MRI-only surgical planning.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030039

Authors: Flávio Fidêncio de Lima Tayná Mendes Inácio De Carvalho Bianca Pulino Camila Cerantula Mônica Grazieli Correa Raphael Capelli Guerra

Introduction: Maxillary setback in orthognathic surgery has been extensively discussed regarding its effects on bone healing and facial soft tissue profile; however, its impact on upper airway volume remains unclear. Objective: We evaluate the influence of maxillary setback combined with counterclockwise (CCW) rotation of the occlusal plane on upper airway dimensions. Methods: A retrospective observational case series was conducted with eight patients diagnosed with Class II malocclusion who underwent orthognathic surgery involving maxillary setback and CCW mandibular rotation. All procedures were performed by the same surgeon. Preoperative (T1) and 6-month postoperative (T2) facial CT scans were analyzed using Dolphin Imaging software11.7 to measure airway volume (VOL), surface area (SA), and linear distances D1, D2 and D3. Statistical analysis was performed using the Wilcoxon test with a 5% significance level. Results: Significant skeletal changes were observed, including 10.2 mm of mandibular advancement, 5.2 mm of hyoid advancement, and 4.1° of CCW rotation. Although increases in airway volume and surface area were noted, they did not reach statistical significance (p = 0.327 and p = 0.050, respectively), but suggesting a favorable trend toward airway adaptation. Conclusions: Maxillary setback combined with CCW rotation appears to safely correct Class II skeletal deformities without compromising upper airway space. These preliminary findings highlight the technique’s potential for both functional and aesthetic outcomes, warranting further long-term studies.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030038

Authors: Camilo Mosquera Hisham Marwan

Jaw in a Day (JIAD) reconstruction provides immediate restoration of mandibular form and function through a single-stage procedure that integrates fibula free flap reconstruction, virtual surgical planning (VSP), immediate dental implant placement, and delivery of a prefabricated prosthesis. Although the technique provides significant benefits in reducing rehabilitation time and improving patient outcomes, its adoption has been limited due to perceived technical complexity and unfamiliarity with dental workflow. This manuscript provides a detailed, step-by-step protocol to guide surgeons through their first JIAD case, from patient selection and data acquisition to VSP execution, intraoperative coordination, and implant positioning. Emphasis is placed on accurate osteotomy design, implant placement using guided protocols, fabrication of patient-specific hardware, and precise prosthesis pickup techniques. This guide also addresses essential OR team preparation and sterile handling of non-sterile components. By breaking down the process into actionable stages and highlighting common pitfalls and technical tips, this resource aims to lower the barrier for early adopters and enhance the success of initial JIAD cases.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030037

Authors: Elavenil Panneerselvam Rajkumar Krishnan Jaikumar Velayudham

Alcohol Use Disorder (AUD) is common among patients with maxillofacial trauma. Conventional perioperative care recommends complete abstinence. However, abrupt cessation can lead to Alcohol Withdrawal Syndrome (AWS), negatively impacting psychological well-being and compliance. This randomized controlled pilot study evaluated the effectiveness of Monitored Therapeutic Alcohol Administration (MTAA) in reducing perioperative stress and enhancing quality of life without impairing fracture healing. Twenty-four adult male patients with AUD and isolated facial fractures requiring surgery were enrolled. They were assigned to either an intervention group (n = 12) receiving MTAA—oral alcohol at 0.5 g/kg/day for two weeks—or a control group (n = 12) undergoing complete abstinence. Outcomes were assessed over six weeks, including stress (Zung Self-Rating Depression Scale), quality of life (Oral Health Impact Profile-14), soft tissue healing (Landry’s Index), and hard tissue healing (Moed’s Scale, serum osteocalcin). The MTAA group showed significantly reduced stress and improved quality of life (p < 0.001). Healing outcomes were comparable between groups, with no significant differences in soft tissue indices, osteocalcin levels, or radiographic scores. MTAA appears to be a safe and effective strategy to manage AWS-related distress and improve postoperative recovery, offering a practical alternative to strict abstinence in the surgical management of patients with AUD.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030036

Authors: Jose Román Padilla Luis Ortiz Peces Pol Alavedra Martínez Jose Cebrián Carretero

Auricular avulsion injuries are rare, and microvascular reimplantation is considered the preferred treatment according to current literature. However, when a small skin pedicle is preserved, non-microvascular reattachment techniques may offer comparable outcomes. This systematic review aims to assess whether these techniques could represent a viable alternative. We analyzed 32 cases of pedicled auricular avulsion reported in 16 articles, focusing on patient demographics, injury mechanisms, pedicle characteristics, venous congestion, and postoperative management. Venous congestion occurred in 11 patients, with a significantly higher risk in narrower pedicles (mean width 9.82 mm; 95% CI: 4.75–14.89; p = 0.025). Prophylactic heparin significantly reduced this risk (p = 0.007). Other interventions—leech therapy and hyperbaric oxygen—lacked sufficient data for firm conclusions. Most cases achieved graft survival; necrosis occurred in some, and only two patients required additional surgery. Non-microvascular techniques appear to be a viable alternative to microvascular reimplantation, with similar results and potentially fewer complications. Venous congestion remains the main challenge, requiring active management and hospitalization for monitoring. Limited case series and publication bias still hinder the development of standardized guidelines.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030035

Authors: Radhika Menon Takahiro Kanno Yiu Yan Leung Yeshaswini Thelekkat Gopal Krishnan Kulandaswamy

Conducting scientific research in craniomaxillofacial surgery presents distinct challenges, particularly in the Asia Pacific region. This study aimed to assess research interests, barriers, and support needs among surgeons in the region through an anonymous online survey conducted via Google Forms from 12 to 31 May 2025, with 169 responses collected. The survey included 13 structured questions and an open-ended comment section. Findings were compared with a similar survey done in Latin America in 2024, to identify regional differences. The results revealed a significant gap in research participation, with 18.3% of Asia Pacific respondents having no publications, unlike Latin America, where all had at least one. Familiarity and participation in the Arbeitsgemeinschaft für Osteosynthesefragen Program for Education and Excellence in Research (AO PEER) were lower in Asia Pacific (29% and 6.5%), and greater challenges were reported in establishing topics, research methodology, and data collection. Although interest was high, only 42% conducted research frequently, and 90.5% indicated a need for mentorship. Despite higher awareness of AO grant opportunities (58%), barriers, like inadequate support for scientific research, lack of training, and limited time, persist. These findings highlight the need for AO Craniomaxillofacial surgery (AOCMF) to implement targeted strategies, such as research training, mentorship, promotion of funding opportunities, and support for multi-center collaborations, to enhance research participation across the region.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030034

Authors: Enrique Vargas Rodrigo Díaz Juan Pablo Vargas Andrés Campolo Rodrigo Villanueva Carlos Cortéz Salvador Valladares-Pérez

Orbitozygomatic fractures represent a complex surgical challenge. Given the urgent need for validated educational tools that surpass traditional learning models, this multicenter study developed and validated a novel synthetic advanced simulation model for the reconstruction of these fractures. The model integrates platinum-cured silicones and 3D-printed bony structures with prefabricated fractures, accurately replicating the anatomy and tactile properties of soft and hard tissues, including simulated herniation of orbital contents. To our knowledge, it is the only available synthetic model combining both tissue types for this training. Ten participants (faculty and residents) completed simulated procedures. Technical performance was assessed using a hand motion tracking system, the global OSATS (Objective Structured Assessment of Technical Skills) scale, and a task-specific error measurement (Specific Fault Measurement, SFM) scale. Statistically significant differences (p = 0.021) were observed in operative time and error count between novices and experts, confirming the model’s construct validity. Faculty completed the surgery in significantly less time (mean 18.16 min vs. 37.01 min for residents) and made fewer errors (mean 12.25 vs. 53.25). Face and content validity were strongly supported by participant surveys, with 100% stating they would use the simulator to practice before real surgery. A strong inverse correlation (r = –0.786, p = 0.021) between OSATS and SFM scores demonstrated concurrent validity. This model enables ethical, repeatable, and cost-effective training, supporting its implementation into surgical curricula to enhance competence and provide objective skill assessment in orbitozygomatic trauma surgery.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030033

Authors: Carl-Peter Cornelius Paris Georgios Liokatis Timothy Doerr Damir Matic Stefano Fusetti Michael Rasse Nils Claudius Gellrich Max Heiland Warren Schubert Daniel Buchbinder

Study design: Trends in the utilization of Mandibulo-Maxillary Fixation (MMF) are shifting nowadays from tooth-borne devices over specialized screws to hybrid MMF devices. Hybrid MMF devices come in self-made Erich arch bar modifications and commercial hybrid MMF systems (CHMMFSs). Objective: We survey the available technical/clinical data. Hypothetically, the risk of tooth root damage by transalveolar screws is diminished by a targeting function of the screw holes/slots. Methods: We utilize a literature review and graphic displays to disclose parallels and dissimilarities in design and functionality with an in-depth look at the targeting properties. Results: Self-made hybrid arch bars have limitations to meet low-risk interradicular screw insertion sites. Technical/clinical information on CHMMFSs is unevenly distributed in favor of the SMARTLock System: positive outcome variables are increased speed of application/removal, the possibility to eliminate wiring and stick injuries and screw fixation with standoff of the embodiment along the attached gingiva. Inferred from the SMARTLock System, all four CHMMFs possess potential to effectively prevent tooth root injuries but are subject to their design features and targeting with the screw-receiving holes. The height profile and geometry shape of a CHMMFS may restrict three-dimensional spatial orientation and reach during placement. To bridge between interradicular spaces and tooth equators, where hooks or tie-up-cleats for intermaxillary cerclages should be ideally positioned under biomechanical aspects, can be problematic. The movability of their screw-receiving holes according to all six degrees of freedom differs. Conclusion: CHMMFSs allow simple immobilization of facial fractures involving dental occlusion. The performance in avoiding tooth root damage is a matter of design subtleties.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030032

Authors: Carl-Peter Cornelius Paris Georgios Liokatis Timothy Doerr Damir Matic Stefano Fusetti Michael Rasse Nils Claudius Gellrich Max Heiland Warren Schubert Daniel Buchbinder

Study design: The advent of the Matrix WaveTM System (Depuy-Synthes)—a bone-anchored Mandibulo-Maxillary Fixation (MMF) System—merits closer consideration because of its peculiarities. Objective: This study alludes to two preliminary stages in the evolution of the Matrix WaveTM MMF System and details its technical and functional features. Results: The Matrix WaveTM System (MWS) is characterized by a smoothed square-shaped Titanium rod profile with a flexible undulating geometry distinct from the flat plate framework in Erich arch bars. Single MWS segments are Omega-shaped and carry a tie-up cleat for interarch linkage to the opposite jaw. The ends at the throughs of each MWS segment are equipped with threaded screw holes to receive locking screws for attachment to underlying mandibular or maxillary bone. An MWS can be partitioned into segments of various length from single Omega-shaped elements over incremental chains of interconnected units up to a horseshoe-shaped bracing of the dental arches. The sinus wave design of each segment allows for stretch, compression and torque movements. So, the entire MWS device can conform to distinctive spatial anatomic relationships. Displaced fragments can be reduced by in-situ-bending of the screw-fixated MWS/Omega segments to obtain accurate realignment of the jaw fragments for the best possible occlusion. Conclusion: The Matrix WaveTM MMF System is an easy-to-apply modular MMF system that can be assembled according to individual demands. Its versatility allows to address most facial fracture scenarios in adults. The option of “omnidirectional” in-situ-bending provides a distinctive feature not found in alternate MMF solutions.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030031

Authors: Abdullah Saleh Alhudaithi Faris Jaser Almutairi Abdullah Saleh Almansour Abdurrahman Abdurrazzaq Aljeadi Shaul Hameed Kolarkodi

Objective: This review aimed to examine and highlight the treatment protocols and optimal duration of antibiotic regimens used in managing maxillofacial space infections of odontogenic origin, along with the associated clinical outcomes. Materials and methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42024621000). A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for studies from January 2003 to October 2024 using relevant MeSH terms. Studies were selected based on PEO criteria, focusing on the antibiotic treatment protocols and duration for odontogenic maxillofacial space infections, with inclusion of original human research and exclusion of non-relevant or unclear studies. Two independent reviewers performed study selection, data extraction, and risk of bias assessments using the Cochrane RoB 2 and ROBINS-I tools, resolving disagreements through discussion. Results: After data extraction, 277 papers were initially identified. Following the removal of duplicates, 141 articles were screened, of which 64 were selected for full-text assessment and 55 were excluded with justification. Ultimately, nine studies met the inclusion criteria for this review. These included two prospective double-blinded randomized clinical trials (RCTs), two prospective RCTs, four retrospective studies, and one prospective study, all involving patients with dentoalveolar orofacial infections. Risk of bias (RoB) assessment using RoB 2 indicated that two RCTs had a high risk of bias, one had a low risk, and one raised some concerns. ROBINS-I assessment showed moderate risk of bias in three studies, while two were not evaluated. Conclusion: This review concludes that prompt incision and drainage combined with a short-course antibiotic regimen of two to five days is generally effective for managing odontogenic maxillofacial space infections, though further high-quality randomized trials are needed to standardize treatment protocols.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18030030

Authors: Rathindra Nath Bera Richik Tripathi

Background: A number of factors might affect survival in oral squamous cell carcinoma. Nodal status is one of the most important prognosticators affecting survival. Studies have shown that pattern of invasion is an important aspect related to survival. Study design: retrospective single-center study (original article). Objectives: Our study aimed at evaluating the factors affecting mandibular invasion, lymph node metastasis, and extracapsular spread in oral squamous cell carcinoma and the survival factors associated with it. Methods: Patient records were evaluated to identify factors influencing primary outcome and survival. Cox regression analysis and Kaplan Meir were applied to evaluate the outcomes. Youden’s index was used to determine a cut-off value for depth of invasion and lymph node size affecting outcome. A p value of <0.05 was considered statistically significant. Results: The study evaluated 162 patients with oral cancer. The cut-off value for DOI was 6.5 mm, significantly affecting mandibular invasion and cervical metastasis. The cut-off value for lymph node size was 2.95 cm, significantly affecting extracapsular spread and overall survival. An aggressive pattern of invasion significantly affects mandibular invasion, cervical metastasis, and survival. Conclusion: An aggressive pattern of invasion and depth of invasion are independent risk factors for cervical lymph node metastasis and mandibular invasion. The independent risk factor for extracapsular spread is lymph node size. Lymph node metastasis and nodal size, pattern of invasion, mandibular invasion, and extracapsular spread are independent risk factors affecting overall survival.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020029

Authors: Layton Vosloo

Objective: Trauma is a leading cause of enophthalmos, typically resulting from an increase in the volume of the bony orbit. The general consensus is that post-traumatic primary deformity repair should aim to restore the premorbid volume, shape, and cosmesis of the orbitozygomatic complex (OZC). This study aims to utilise novel three-dimensional (3D) printed patient-specific moulds to intraoperatively fabricate enophthalmos wedges and onlays using polymethylmethacrylate (PMMA) bone cement to reconstruct the OZC. Methods: A total of seven patients underwent digital surgical planning using Freeform software to virtually correct orbitozygomatic complex deformities guided by a design algorithm. Three-dimensionally printed nylon patient-specific moulds were used intraoperatively to fabricate enophthalmos wedges and/or onlays using an industry-standard PMMA bone cement. Clinical examination and application of the proposed design algorithm determined that enophthalmos wedges were indicated for four patients, with one also requiring an onlay; and periorbital onlays were required for the three remaining patients. Results: Hertel exophthalmometry at a mean follow-up of 19.1 months demonstrated good outcomes in the correction of post-traumatic enophthalmos and hypoglobus and with patients reporting good subjective cosmetic results. Patients 5 and 7 had follow-up three-dimensional computed tomography (3D-CT) to confirm correct placement. Conclusion: The use of patient-specific PMMA wedges and onlays, fabricated intraoperatively with the aid of 3D-printed moulds, offers a reliable and effective approach for correcting post-traumatic enophthalmos and hypoglobus. This method allows for the restoration of orbital volume and anatomical contours, addressing both functional and aesthetic concerns. Our results demonstrate that this technique yields favourable outcomes.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020028

Authors: Lukas B. Seifert Alexander Aigner Sead Abazi Michel Beyer Jokin Zubizarreta-Oteiza Neha Sharma Florian M. Thieringer

Temporal hollowing, which is a depression in the temple region, often results from trauma, surgical interventions, or neurological conditions. This condition is frequently observed after the resection of encephaloceles, where it can cause esthetic and functional challenges due to temporalis muscle atrophy and nerve palsy. We present a case of a 21-year-old female patient who developed temporal hollowing and complete atrophy of the right temporalis muscle following an encephalocele resection in childhood. The patient also suffered from right-sided frontal nerve branch palsy. To address this complex deformity, a patient-specific implant (PSI) made of hydroxyapatite (HA) was digitally designed and produced using 3D printing technology. The postoperative course was uneventful, with the implant securely positioned and the esthetic result highly satisfactory. This case highlights the potential of 3D printed PSIs in craniofacial reconstruction, offering an optimal solution for both functional restoration and esthetic enhancement. HA further ensures the long-term stability and integration of the implant, providing a promising approach for addressing complex craniofacial defects.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020027

Authors: Mauranne Lievens Lisa De Kock Matthias Ureel Geert Villeirs Wim Van Paepegem Renaat Coopman

Additive manufacturing, in combination with virtual surgery planning, leads to the predictability of complex surgical cases. To guarantee patient safety, three-dimensional (3D) print quality must be ensured and verified. The aim of this study is to compare the accuracy of an optical white-light desktop scanner (OWLDS) and a cone beam CT (CBCT) scanner to that of a multi-slice CT scanner (MSCT) for scanning and digitizing 3D anatomical models. Twenty-two removable parts of a CE-certified anatomical skull, used as a patient-specific surrogate in a clinical workflow, were each scanned by MSCT, CBCT, and OWLDS scanners. The accuracy of the scanning modalities was investigated through a part comparison analysis of the stereolithography (STL) files derived from the different scanning modalities. The high-resolution OWLDS STL files show the smallest overall surface match deviation, at 0.04 mm, compared to the MSCT STL files. The CBCT STL files show an overall deviation of 0.07 mm compared to the MSCT STL files. This difference between the scan modalities increases as the volume of anatomical models decreases. The OWLDS is a safe, cost-effective, user-friendly, and highly accurate scanning modality suitable for accuracy evaluation during the manufacturing process of in-house 3D models. For smaller models, high-resolution optical scans are recommended.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020026

Authors: Guilherme Pivatto Louzada Bianca de Fatima Borim Pulino Camila Cerantula Gustavo Câmara Ana Beatriz Goettnauer de Cerqueira Gines Alves Guilherme Zanovelli Silva Thiago Nunes Palhares Wendell Fernando Uguetto Raphael Capelli Guerra

Temporomandibular joint (TMJ) ankylosis compromises essential functions such as chewing, phonation, and breathing. Surgical treatment aims to restore mandibular mobility and prevent the recurrence of joint fusion. This article describes a technical variation based on Puricelli biconvex arthroplasty, using surgical cement, screw fixation, and 3D-printed cutting guides based on virtual planning, allowing for greater precision in joint reconstruction. In this work, we present the step-by-step process used in the customization of cutting guides, virtual planning, and the production of the interposition material with PMMA associated with fixation with titanium screws as a hybrid method for the treatment of recurrent TMJ ankylosis. This reported technique is demonstrated to be reproducible, low-cost, and effective.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020025

Authors: Stephen A. L. Y. Youssef Iva I. Raghoebar Renee Helmers Jan de Lange Leander Dubois

A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding precise indications for ORIF remain unclear and non-uniform. We aimed to refocus the debate regarding the optimal treatment for CFs by identifying the recent indications for ORIF in the literature and assessing the quality of the existing evidence for each indication. This systematic review searched Medline, Embase and the Cochrane Central Register of Controlled Trials for eligible studies. The included studies consisted of articles from the past 15 years involving patients with any type of CF who underwent ORIF based on specified indications. From 4711 papers, 100 studies were included. In these, 121 indications were identified. The most cited indications for ORIF were those proposed by Zide and Kent, namely displacement/angulation ≥10° and ramus height shortening of ≥2 mm. Evidence supporting these indications is weak, relying mainly on expert opinion rather than robust data, with a focus on treatment comparisons. Clear, evidence-based cutoffs regarding when ORIF is the only viable treatment option are needed for a consensus.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020024

Authors: Chun Ho Hung Yui Chit Kwok Jason Yip Ho Hin Wong Yiu Yan Leung

The goal of this study was to evaluate the clinical outcomes, safety, and clinical applications of bioabsorbable magnesium-based materials for fixation in bone surgeries. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases, followed by manual and reference searches. The articles selected were evaluated for patient characteristics, biocompatibility, the need for revision surgery, bone union rates, and the incidence of gas formation associated with implant degradation. Out of the 631 initially identified articles, 8 studies including a total of 386 patients were included in the final qualitative analysis. The magnesium (Mg) group carried a lower rate of revision surgery (1/275) when compared to the titanium (Ti) group (18/111). A high rate of bone union was found in the Mg group and a low infection rate (3/275) was found in the Mg group. The serum level of Mg and calcium (Ca) were not found to be affected. Mg implants are applied in various orthopedic surgeries but they are not applied in in oral or maxillofacial surgeries. Mg implants appear to be a safe alternative for bone fixation and are resorbable. Future research into the application of Mg implants in bone fixation in different anatomical sites is essential to fully harness their potential benefits for patients.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020023

Authors: Gabriela G. Cruz Sameer H. Siddiqui David Z. Allen Kunal R. Shetty Sean P. McKee Brady J. Anderson Mark Knackstedt W. Katherine Kao Tang Ho

Objective: To characterize facial fracture patterns and understand predictors of surgical repair and LOS with the objective of assisting providers in managing and understanding these complex injuries. Study Design: This is a retrospective cohort chart review study. Methods: A retrospective review was conducted for patients admitted with gunshot wounds (GSWs) to the head, neck, or face between January 2013 and March 2020 at a level one trauma tertiary care hospital. Univariate and multivariate analysis were performed to identify associations with surgical repair and LOS. Results: Of the 578 patients with head, neck, or facial GSWs, 204 survived and sustained facial fractures. The maxilla (n = 127, 62%), orbit (n = 114, 55%), and mandible (n = 104, 51%) were the most fractured. Operative rates differed by location (p < 0.001) with highest rates for fractures involving the mandible (76%). In univariate analysis, overall facial fracture surgery was associated with transfacial injuries; mandible, palate and nasal fractures; tracheostomy; gastrostomy tube placement; ICU admission; and a longer-than-24 h ICU stay (all p < 0.05). In multivariate analysis, predictors of surgical repair included a length of stay greater than 3 days (OR 2.9), transfascial injury (OR 3.7) and tracheostomy placement (OR 5.1; all p-values < 0.05), while nasal and mandible fractures were also associated with overall operative repair (OR 2.5 and 9.3, respectively; p-value < 0.05 for both). Univariate analysis showed that among patients with GSW injuries who underwent facial plastic reconstructive surgery (FPRS) with comorbid serious polytrauma, the inpatient LOS was predicted solely by the presence of subarachnoid, subdural and intracranial hemorrhage (p-value < 0.005). Subsequent multivariate analysis found that the only predictor for greater hospital LOS for patients who underwent surgical repair was earlier timing to FPRS of less than five days (OR 0.17) and placement of a gastrostomy tube (OR 7.85). Conclusions: Managing facial fractures in GSW patients requires complex medical decision making with a consideration of functional and esthetic outcomes in the context of concomitant injuries and overall prognosis. Certain characteristics such as ICU admission, longer hospital stay, trajectory of GSW, tracheostomy placement, and specific operative locations are associated with higher rates of operative repair. Inpatient hospitalization LOS for patients who underwent FPRS was predicted by timing from admission to surgical repair.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18020022

Authors: Frederic Van der Cruyssen Mathilda Wylde Anthony Campbell Ali Reza Pourkarim Zeeshan Ahmad Nabeel Bhatti Simon Holmes

Zygomatic complex (ZMC) fractures are among the most common craniofacial injuries, impacting both function and esthetics. This study evaluates the effectiveness of open reduction and internal fixation (ORIF) in restoring facial symmetry following ZMC fractures. Sixteen patients with unilateral ZMC fractures underwent a retrospective analysis comparing preoperative and postoperative computed tomography (CT) scans to a control group of ten individuals without facial fractures. Quantitative metrics, including root mean square distance (RMSD) and heatmap analysis, were used alongside a qualitative zygoma fracture scale to assess outcomes. Postoperative results showed significant improvements in facial symmetry, with RMSD values approaching those of the control group. Heatmap analysis revealed that 50% of patients achieved deviations within 2–4 mm and 31% within 2 mm, highlighting the effectiveness of ORIF. More complex fractures exhibited higher residual asymmetry, emphasizing the influence of fracture severity on surgical outcomes. The zygoma fracture scale correlated with heatmap results, supporting its value as a complementary assessment tool. These findings demonstrate ORIF’s capability to restore symmetry while identifying areas for improvement in managing complex fractures. The study underscores the need for enhanced imaging and standardized evaluation methods to optimize surgical precision and outcomes in craniofacial trauma care.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010021

Authors: Giulio Cirignaco Gabriele Monarchi Lisa Catarzi Mariagrazia Paglianiti Enrico Betti Umberto Committeri Alberto Bianchi Paolo Balercia Giuseppe Consorti

Airway management in maxillofacial trauma is a critical and complex challenge, requiring both secure ventilation and optimal surgical access while minimizing risks to vital structures. This study evaluated the efficacy of submental intubation (SMI) as a minimally invasive alternative to tracheostomy in patients with complex maxillofacial fractures. A retrospective analysis of 52 patients treated between 2015 and 2023 was conducted by comparing clinical outcomes between those who underwent SMI (n = 26) and those who underwent tracheostomy (n = 26). The duration of hospitalization, infection rates, and perioperative complications were assessed using t-tests, chi-square tests, and multivariate regression. Results indicated that SMI was associated with significantly shorter hospital stays (11.15 ± 3.29 vs. 23.96 ± 6.47 days, p < 0.001) and lower infection rates (3.8% vs. 30.8%, p = 0.028). Additionally, the SMI group demonstrated fewer intraoperative (p = 0.049) and postoperative complications (p = 0.037). Multivariate analysis identified tracheostomy as an independent predictor of prolonged hospitalization and increased complications. These findings support SMI as a safe and effective alternative to tracheostomy for short-term airway management in maxillofacial trauma, providing a shorter recovery period and fewer complications. Therefore, prospective studies with larger cohorts are warranted to confirm these results and establish comprehensive guidelines.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010020

Authors: Hilde Schutte Robbin Maat Marvick S. M. Muradin Antoine J. W. P. Rosenberg

Study design: literature review. Introduction: Irreversible facial paralysis is a chronic condition characterized by an absence of mimetic muscle tone and function. This disruption of facial expressions not only has functional, but also psychological and social consequences. In facial dynamic reanimation, techniques are proposed partly recovering facial reanimation and function. To date, a vast amount of literature is available on dynamic reanimation techniques. However, no review has yet been published that delineates in detail the musculature and techniques used for dynamic reanimation in irreversible facial paralysis. Objective: the aim of the present paper is to offer a complete overview of possible techniques. Methods: A chapter division is made between the lower, mid-, and upper face. Each chapter is subdivided between local transposition, free muscle flaps, and for the upper face, implantable devices. Results: The literature discussing reanimation of the lower face is limited. In midfacial reanimation, temporalis transposition and gracilis free flap transfer are popular. In upper facial reanimation, no consensus on muscle choice is available, and information is limited too. Suggested techniques include orbicularis oculi transpositioning, temporalis transpositioning, and platysma free muscle transfer. Conclusions: This paper discusses the current techniques for dynamic facial reanimation. Yet, studies comparing different techniques are lacking, setting ground for future research. This paper highlights the importance of a personalized approach in selecting a fitting reconstruction method.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010019

Authors: Hanna Thorén Sami Suojanen Anna Liisa Suominen Tero Puolakkainen Miika Toivari Johanna Snäll

The purpose of the present study was to describe the demographic and clinical features of patients having undergone redo surgery for mandibular and/or midfacial fractures and to identify factors that increase the odds of redo surgery. Included were the files of all patients who had undergone open reduction and fixation of one or more mandibular and/or midfacial fracture or orbital reconstructions at the Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland, between 1 January 2013–31 October 2020. Patients having undergone redo surgery were identified, and descriptive characteristics were calculated. In the data analysis, the association between redo surgery and explanatory variables was analyzed. Altogether, 1176 patients were identified for the analysis. Of these, 25 (2.1%) underwent redo surgery for 28 fracture sites. The most common reasons for redo surgery were inadequate fracture reductions of the zygomatic process or the mandible (19 patients) and inadequate orbital reconstructions (four patients). Compared with surgery of only the mandible, combined surgery of the mandible and midface had almost four times greater odds of redo surgery (95% CI 3.8, 0.8–18.4), but the finding was not statistically significant. Although redo surgery was required fairly infrequently, the findings highlight the relevance of surgical competence to treatment success; suboptimal surgical procedure was the most common reason for redo surgery. The literature supports the use of intraoperative CT scanning as a useful tool in association with the treatment of complex midfacial fractures in general and orbital fractures in particular. The success of orbital reconstruction can be promoted by using patient-specific implants.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010018

Authors: Kyle W. Singerman Megan V. Morisada J. David Kriet John P. Flynn Clinton D. Humphrey

Study design: A retrospective case series. Objective: The management of acute complex maxillofacial trauma is challenging. The intricate maxillofacial anatomy coupled with the significant functional and aesthetic repercussions of traumatic facial injuries necessitate meticulous preoperative preparation and operative precision to minimize patient morbidity. The severe displacement of bone fragments, abnormal occlusion, comminution, and the involvement of multiple skeletal subsites further complicate the restoration of premorbid function and appearance. While previously recognized as a valuable tool for managing oncologic defects, orthognathic surgery, and for the correction of secondary deformities following maxillofacial trauma, virtual surgical planning (VSP) has now emerged as a viable tool for treating select patients following acute complex maxillofacial trauma. Methods: A retrospective chart review of all the complex facial trauma patients treated using VSP services over a 21-month period. Results: Multiple VSP services were used in the primary repair of complex facial trauma, with occlusal splints, pre-contoured plates, and 3D printed models being utilized most frequently. Conclusions: Our experience with VSP for primary maxillofacial trauma repair has helped us to identify specific indications for the use of VSP in this setting.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010017

Authors: Nora A. Alexander Kwasi Enin Jenny Ji Emily Spataro

Background: Similar to patients undergoing rhinoplasty, patients undergoing post-Mohs micrographic surgery (MMS) nasal reconstruction are concerned with both nasal form and function. Objectives: The objectives were to identify patient, defect, and surgical characteristics associated with post-MMS nasal reconstruction outcomes. Methods & Materials: A retrospective single-institution cohort study was conducted of post-MMS nasal reconstruction surgeries occurring between 2015 and 2020. Patient, defect, and surgical details were collected along with nasal aesthetic and functional outcomes. Multivariable logistic regressions were used to analyze data. Results: A total of 167 nasal MMS defects among 160 patients met the inclusion criteria. The median age was 66 years, and 70% were female. A poor aesthetic outcome (n = 20, 12.0%) was associated with diabetes (aOR 6.277, 95% CI 2.193–17.965). Post-operative nasal obstruction (n = 17, 10.2%) was associated with obesity (aOR 20.976, 95% CI 2.406–182.845) and major revision surgery (aOR 12.192, 95% CI 2.838–52.382). Conclusion: Post-MMS nasal reconstruction aesthetic and functional outcomes are associated with obesity, diabetes, and revision surgery. Improved standardization of functional and cosmetic outcomes is important to better understand these results in the future.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010016

Authors: Morgan M. Sandelski Deema Martini Todd M. Kubon Greg G. Gion Amy L. Pittman

Background: Osseointegrated implants outside of dental restoration remain an integral area of facial reconstruction in which more outcomes data is needed. We aimed to describe our 13-year experience using osseointegrated implants for orbital, nasal, and auricular reconstruction, looking at general outcomes, including radiated and surgically manipulated bone. Methods: This retrospective chart review covered demographics and outcomes from January 2008 to August 2021 in patients who underwent an orbital exenteration, partial or total rhinectomy, and partial or total auriculectomy with subsequent osseointegrated implant placement. We hypothesized radiation would increase the failure rate of implants and prostheses. Results: There were 79 implants placed in 27 patients, with over half of the patients requiring implants for reconstruction because of malignancy. The success rate was 86%. Complications were uncommon. Only 2 (7.4%) patients were unable to use their prosthesis. Prior radiation and surgery to the bone were associated with an increased risk of loss of implant (p = 0.008 and p = 0.007, respectively) but not associated with other complications or prosthesis non-viability. Conclusions: Osseointegrated implants are a reliable, permanent option for a realistic prosthesis. Radiation and prior surgery are significantly associated with an increased risk of implant failure but not associated with the inability to use the prosthesis. Regardless of prior treatments, bone-retained implants should be considered in facial reconstruction, especially after failing autologous repair or with concerns for cosmetic outcomes.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010015

Authors: Majeed Rana Daniel Buchbinder Gregorio Aniceto Gerson Mast

Reconstruction of cranio-maxillofacial defects following ablative surgeries requires a comprehensive approach that balances functional restoration with aesthetic outcomes. Advances in computer-aided design and manufacturing (CAD/CAM) technology have revolutionized this field, enabling precise preoperative planning, including 3D modeling, segmentation, and virtual resection planning. These methods allow for the production of patient-specific implants and surgical templates while facilitating the evaluation of treatment outcomes. CAD/CAM technology offers numerous benefits, such as enhanced surgical accuracy, improved aesthetic results, reduced operative times, and the possibility of single-stage resection and reconstruction. However, limitations exist, including high costs, the need for specialized expertise, and dependency on accurate imaging data. This paper provides a surgeon-centric evaluation of the advantages and limitations of CAD/CAM in cranio-maxillofacial reconstruction. The discussion encompasses the technological workflow, clinical applications, and recommendations for optimizing outcomes. Future perspectives highlight ongoing developments, such as integrating non-ionizing imaging techniques and expanding the applicability of virtual and augmented reality. By synthesizing technical advancements and clinical expertise, this review aims to establish practical guidelines for implementing CAD/CAM technology in routine surgical practice.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010014

Authors: Edgar Ochoa James Cevallos Ramon Bustos Nina Patel Chase M. Heaton Rahul Seth P. Daniel Knott Andrea M. Park

Study Design: Retrospective cohort study. Objective: To (1) assess post-operative quality of life (QOL) and functional outcomes of fibula free flap (FFF) donor sites, (2) examine the incidence of post-operative claw toe deformities (CTDs) following FFF harvest, and (3) assess the effect of flexor hallicus longus (FHL) muscle preservation on the incidence of post-operative CTDs. Methods: Patients aged 18 years or older and at least 6 months from FFF reconstructive surgery completed the Manchester–Oxford Foot Questionnaire (MOXFQ)and the Short-form 36 (SF-36) Questionnaire. The incidence of post-operative CTDs reported by respondents was calculated. We assessed the associations between FHL preservation at time of surgery and QOL and functional outcomes, including the development of post-operative CTDs. Results: Sixty patients completed questionnaires at a mean of 38.3 months from surgery. The cohort consisted of 28 patients in whom the FHL muscle and nerve were preserved and 32 patients in whom they were not. Among respondents, 23.3% (14/60) reported post-operative CTDs. FHL status was not associated with post-operative CTDs or with worse scores in the domains of pain (p = 0.612), walking/standing (p = 0.431), or social functioning (p = 0.400). Overall, majority reported high post-operative QOL. Conclusions: While majority of patients who undergo FFF reconstruction can expect good long-term donor site QOL and functional outcomes, there are risks of functional impairment, including post-operative CTDs. Preservation of FHL muscle did not affect post-operative QOL outcomes or the incidence of CTDs. These data can inform patient QOL expectations following FFF harvest.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010013

Authors: Sam Boroumand Ismail Ajjawi Tara Boroumand Omar Allam Lioba Huelsboemer Viola A. Stögner Martin Kauke-Navarro Siba Haykal Michael Alperovich Bohdan Pomahac

The purpose of this study is to provide a comprehensive overview of the epidemiology of traumatic craniofacial injuries in the U.S. that occur in the context of drugs and/or alcohol. The National Electronic Injury and Surveillance System (NEISS) database was queried from 2019 to 2022 to identify all emergency department (ED) patients with reported traumatic injuries involving craniofacial anatomy. Clinical and demographic variables were assessed between cases that involved drugs/alcohol and those that did not, utilizing two-proportion z-tests. In total, 441,764 patients with traumatic craniofacial injuries were identified, with 20,285 cases involving drugs and/or alcohol. Cases involving drugs/alcohol had a significantly higher frequency of internal injuries (45.3% vs. 34.9%, p < 0.001), fractures (7.0% vs. 3.4%, p < 0.001), and hematomas (4.6% vs. 2.5%, p < 0.001) than those that did not. Craniofacial injuries involving drugs/alcohol also had a significantly higher frequency of falls to the floor (19.2% vs. 11.8%, p < 0.001) and down stairs/steps (18.3% vs. 6.6%, p < 0.001) and resulted in a significantly greater odds of hospital admission after ED presentation (OR 3.75, 95% CI: 3.63–3.88, p < 0.001). Ultimately, these epidemiological findings can be leveraged to provide clinicians invaluable qualitative context for the most frequent presentations of craniofacial injuries they can anticipate to treat among intoxicated patients.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010012

Authors: Alf Nastri Isaac Liau Jaewon Heo Alexander Schramm

This document outlines guidelines for the use of three-dimensional virtual surgical planning in orthognathic surgery, with relevance to data acquisition, clinical diagnosis, data workflow sequencing, and operative considerations. A detailed description regarding fundamental principles of orthognathic assessment and planning is beyond the scope of this paper.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010011

Authors: Rodrigo dos Santos Pereira Rafael Vago Cypriano Carlos Gaete Garcia Juan José Larrañaga Nicolas Homsi

This manuscript presents an exploratory evaluation of the challenges and opportunities in scientific research among craniomaxillofacial surgeons in Latin America. It focuses on initiatives introduced by the AO Foundation’s Research and Development (R&D) Committee to assess the current state of research involvement among AO Foundation members in the region and identify barriers to research. A survey conducted in 2023 among Latin American members of the AO Foundation gathered data on their interest in research, obstacles faced, and awareness of available opportunities, such as grants, fellowships, and mentorship programs. The outcomes revealed a strong interest in research, with 96.5% of respondents expressing a desire to engage. However, key barriers included limited time (46.5%), difficulties in project structuring and scientific writing (32.6%), and challenges in publishing (30.2%). Notably, 54.7% of respondents were unaware of the AO PEER program, and 65.6% were unfamiliar with the foundation’s research grant opportunities. The AO Foundation aims to enhance scientific development in Latin America by promoting multicenter research studies, training opportunities, and developing research group leaders. These strategies seek to support and encourage surgeons in advancing their scientific activities.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010010

Authors: Bert Rombaut Matthias Ureel Benjamin Van der Smissen Nicolas Dhooghe Renaat Coopman

Study Design: This is an experimental feasibility study. Objective: The objective was to analyze the potential of open-source freeware (OSF) to train residents in virtual surgical planning (VSP) and compare this workflow with commercially available software (CAS). Methods: A workflow for mandibular reconstruction with a fibular free flap (FFF) was developed in 3D-Slicer® and Blender® and compared to our clinical workflow in Materialise Mimics Innovation Suite version 25 (Materialise InPrint®, ProPlan CMF® and 3-Matic®). Five CMF residents, inexperienced in VSP, were trained to use both the OSF and CAS workflows and then performed four planning sessions on OSF and CAS. The duration (minutes) and the amount of mouse clicks (MCs) of every step in the workflow were recorded. Afterwards, the experience with VSP was investigated with the System Usability Scale (SUS) and a self-developed questionnaire. Results: The total VSP time with CAS took 91 ± 15 min and needed 2325 ± 86 MCs compared to 111 ± 26 min and 1876 ± 632 MCs for OSF, respectively. The questionnaire had an 80% response rate. The SUS for CAS was 67.5 compared to 50 for OSF. The participants believe it is extremely valuable to learn VSP during their training and to be able to perform VSP as a surgeon. Conclusion: We believe OSF can be a cost-effective alternative compared to CAS for the training of surgical residents to gain insight in complex surgeries and to better understand CAD limitations and possibilities.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010009

Authors: Ahmad K. Alnemare

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data Bank (NTDB) for the years 2013 to 2016. Main outcome measures: Trauma mechanism and mortality rates between closed and open fractures were conducted. Results: This study involved 122,574 closed and 9704 open nasal fractures to elucidate demographic, hospital, and clinical characteristics. Significant risk factors for open nasal fractures included a higher injury severity score, self-inflicted intent, unintentional causes, and firearm mechanism compared to assault injuries. Conclusions: Significant factors associated with open nasal fractures include injury severity, self-inflicted intent, trauma type, and firearm mechanisms, which notably increase the likelihood of open fractures. Findings highlight the need for targeted prevention, efficient resource allocation, and risk screening to enhance the management of complex facial traumas in the national trauma system.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010008

Authors: John M. Le John Hofheins Myra Rana Jay Ponto Anthony B. Morlandt Yedeh P. Ying

The purpose of this study was to analyze computer-aided surgical planning (CAS) and margin status following oncological reconstructive surgery of the jaws. A retrospective study was conducted on patients who underwent microvascular reconstructive surgery from 2014 to 2021. The predictor variable was the use of CAS. The primary and secondary outcomes were histopathological bone margin status, local recurrence, and disease-free survival (DFS). Covariates included demographic, operative, pathological, and clinical outcomes. Thirty-five CAS and fifty-two non-CAS subjects were included for analysis. Demographic characteristics such as age, sex, and comorbidities were comparable between the study groups, with all p-values > 0.05. For operative variables, the osteocutaneous radial forearm flap was more commonly used in the non-CAS group (34.6%) compared to the CAS group (2.9%) (p < 0.01). The mean follow-up period was shorter in the CAS group (31.9 months) than in the non-CAS group (42.6 months) (p < 0.01). CAS was not associated with margin status (p = 0.65) or local recurrence (p = 0.08). DFS was comparable between the study groups (p = 0.74). Bone margin involvement was not associated with any covariates. The use of CAS in oncological reconstructive jaw surgery was not associated with increased bone margin involvement.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010007

Authors: Wenko Smolka Carl-Peter Cornelius Katharina Theresa Obermeier Sven Otto Paris Liokatis

Background: The purpose of the study was to describe proportional condylectomy in patients with condylar hyperplasia using a titanium 3D-printed ultrathin wire mesh cutting guide placed below the planned bone resection. Methods: Eight patients with condylar hyperplasia underwent proportional condylectomy using an ultrathin titanium 3D-printed cutting guide placed below the planned bone resection. The placement of the guide was facilitated by the incorporation of anatomical landmarks. The accuracy of bone resections guided by such devices was evaluated on postoperative radiographs. The mean postoperative follow-up was 30 months. Results: Surgery could be performed in all patients in the same manner as virtually planned. The fitting accuracy of the cutting guides was judged as good. Postoperative radiographs revealed that the virtually planned shape of the newly formed condylar head after condylectomy could be achieved. Conclusions: In conclusion, the use of virtual computer-assisted planning and CAD/CAM-based cutting guides for proportional condylectomy in unilateral condylar hyperplasia of the mandible offers high accuracy and guarantees very predictable results.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010006

Authors: Milton Chin Mona Haj Sarah L. Versnel Henriette H. W. de Gier Eppo B. Wolvius

Study design: Systematic review. Objective: Obstructive sleep apnea (OSA) is a possible complication following secondary velopharyngeal insufficiency surgery in patients with repaired cleft palate. Various surgical techniques are used to treat secondary velopharyngeal insufficiency after cleft palate repair, but the optimal procedure remains debatable. This review provides an overview of the incidence of airway obstructive outcomes related to different surgical modalities. Methods: A systematic search was performed on the 1st of February following the PRISMA guidelines and registered on PROSPERO (CRD42022299715). The following databases were reviewed: Medline, EMBASE, Web of Science, Google Scholar, and the Cochrane Library databases. Studies that included data on the occurrence of OSA following velopharyngeal surgery in children with a repaired non-syndromic cleft palate were included. Non-English articles and studies that included syndromic cleft palate patients were excluded. Results: Twenty-eight articles met the inclusion criteria. The surgical procedures are classified into three groups: pharyngeal flap procedure (PF), sphincter pharyngoplasty (SP), and palatal muscle repositioning (PMR). Incidence of post-operative OSA and symptoms of OSA were lowest after PMR compared to SP and PF (3%; 34%; 29%, respectively). Pharyngeal flap procedures resulted in the best speech outcomes. Conclusions: PMR results in fewer postoperative complications in terms of OSA and achieves a satisfactory reduction in hypernasal speech. PF procedure carries a higher risk of developing OSA postoperatively but seems to be superior in the reduction in hypernasality.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010005

Authors: Sebastiaan W. R. Dalmeijer Tom C. T. van Riet Jean-Pierre T. F. Ho Eddy (A. G.) Becking

Study design: Systematic review. Objective: This systematic review examines the existing literature concerning the objective and subjective evaluations of osseous genioplasty outcomes. Methods: A comprehensive search was conducted in databases including PubMed, Embase, and Web of Science, yielding 2563 references, which were screened by two independent reviewers. We included 105 articles originating from 25 different countries. Data were systematically extracted, categorized, and documented. Results: Genioplasty was performed in 5218 patients, either independently (3560 cases) or in combination with other orthognathic procedures (1696 cases), with a predominant focus on female patients (64%). Objective evaluation primarily focused on surgical accuracy, relapse, and neurosensory disturbance, while subjective assessments were largely related to aesthetics and patient satisfaction. Despite significant advancements in three-dimensional surgical planning and assessment, the review highlights a lack of standardized methods for evaluating isolated genioplasty outcomes. Conclusions: The findings emphasize the need for improved and validated instruments that specifically assess the functional and aesthetic results of genioplastic surgery. Future research should prioritize patient-centered prospective studies and the development of assessment tools to ensure more comprehensive and reliable outcome evaluations.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010004

Authors: Joshua Lewis Manav Patel Nangah Tabukumm Wei-Chen Lee

Study Design: Qualitative analysis study. Introduction: Social media has been pivotal in the dissemination of medical knowledge to the public. The aim was to identify the demographics of individuals posting about cleft lip and palate on YouTube Shorts and Instagram, to characterize the content of these posts, and to highlight factors that could aid surgeons in better educating patients with cleft lip and palate. Methods: Instagram posts and YouTube Shorts with “#cleftlip”, “#cleftawareness”, “#cleftpalate”, “#cleftplipandpalate”, and “#cleftproud” were searched on 8 June 2024. Postings were subclassified and analyzed for content, including topics of posts, authors, media type, tone of the post, and year of post. Results: A total of 3321 posts were analyzed, with 2698 coming from Instagram and 623 from YouTube Shorts. The majority of content creators were patients and their family members (n = 2054, 61.8%), cleft lip and palate foundations (n = 384, 11.6%), and companies (n = 381, 11.5%). Only 167 posts were authored by physicians (5.1%). Among the educational and informational posts, patients and family members accounted for the majority of the posts (409 posts, 57.7%). Physicians contributed to a small fraction of the educational content (37 posts, 5.2%). Conclusions: Physician participation in the cleft lip and palate social media realm on Instagram and YouTube Shorts was found to be limited. Moreover, there was a scarcity of educational content on both platforms, indicating a significant opportunity for physicians to engage more actively in cleft lip and palate social media discussions.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010003

Authors: Patrick Wong Antonio Atte David Powers Paul Tiwana

Study Design: A literature review of relevant publications regarding panfacial fracture sequencing. Objective: To review the current landscape of sequencing of panfacial trauma and propose the utilization of the Major Fragment Theory when conventional sequencing techniques are inadequate. Methods: We conducted a review of existing literature on panfacial fracture management, focusing on sequencing techniques. Additionally, we analyzed unique fracture patterns to identify instances where conventional sequencing may be insufficient. Results: Existing literature emphasizes directional-based sequencing techniques for panfacial fracture reduction. However, unique fracture patterns often necessitate deviation from these sequences. The Major Fragment Theory suggests prioritizing the reduction of larger fragments over conventional sequencing, particularly when dealing with complex fractures. Conclusions: While directional-based sequencing techniques provide a valuable framework for panfacial fracture management and almost any approach can be utilized successfully, the Major Fragment Theory offers a complementary approach for cases where conventional sequencing falls short. Incorporating this theory into practice may enhance outcomes in the treatment of panfacial fractures.

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010002

Authors: Peter Roth

We are excited to welcome the Journal of Craniomaxillofacial Trauma and Reconstruction (CMTR) to the MDPI family [...]

Craniomaxillofacial Trauma & Reconstruction doi: 10.3390/cmtr18010001

Authors: Yiu Yan Leung Kathy Fan Florian M. Thieringer

Craniomaxillofacial Trauma and Reconstruction (CMTR) [...]

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241272436

Authors: Nils-Claudius Gellrich Michael Grant Damir Matic Philippe Korn

Study Design: This study presents a review of the evolutionary development in reconstructive orbital surgery over the past 3 decades. Additionally, it proposes the Orbital Assessment Algorithm (OA2) to enhance decision-making for intraorbital reconstruction of post-traumatic orbital deformities. Objective: The objective of this paper is to provide insights into modern post-traumatic orbital reconstruction from a surgeon’s perspective, with a specific focus on adult patients. It aims to highlight the advancements in computer-aided design and manufacturing techniques, particularly in the field of reconstructive orbital surgery, and to introduce the OA2 as a tool for improved decision-making in this context. Methods: The study conducts a comprehensive review of the evolution of reconstructive orbital surgery, focusing on the integration of 3D technology into surgical practices. It also outlines the development and rationale behind the proposed OA2, emphasizing its potential to enhance the accuracy and efficacy of intraorbital reconstruction procedures for posttraumatic deformities. Results: The review demonstrates the significant progress made in reconstructive orbital surgery, particularly in leveraging 3D technology for virtual modeling, navigation, and the design and manufacturing of patient-specific implants. The introduction of the OA2 provides a structured approach to assessing and addressing post-traumatic orbital deformities, offering potential benefits in decision-making and surgical outcomes. Conclusions: In conclusion, this paper underscores the pivotal role of computer-aided design and manufacturing in advancing reconstructive orbital surgery. It highlights the importance of integrating innovative design concepts into implant manufacturing processes and emphasizes the potential of the OA2 to guide surgeons in the management of post-traumatic orbital deformities, ultimately contributing to improved patient outcomes.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241296681

Authors: Mike Leung Kathleen Fan Florian Thieringer

As we present this issue of Craniomaxillofacial Trauma and Reconstruction (CMTR), we are filled with a sense of profound gratitude and anticipation [...]

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241292164

Authors: Khalil Issa Nicholas Frisco Kayla Kilpatrick Maragatha Kuchibhatla Dane Barrett David Powers Charles Woodard

Study Design: Single-institution retrospective financial analysis. Objective: Trauma care is consistently linked to inadequate reimbursement, posing a significant financial burden for large trauma centers. Data show that declining Medicare reimbursement rates have indirectly led to declining payment for all procedures covered by insurance. The goals of this study are to investigate the opportunity cost associated with contemporary surgical management of CMF trauma at our institution and to evaluate longitudinal financial trends. Methods: Patients with operative facial fractures between 2015 and 2022 at Duke University Medical Center were included and compared to patients undergoing general otolaryngology, plastic surgery and oral surgery operations in the same period. Procedural codes, payor type, charges billed, collections, relative value units (RVUs) and other financial data were obtained and analyzed among the 2 patient populations. Comparative analysis was performed to assess the financial trends in data reported previously from 2007–2015. Results: The collection rate at Duke University Medical Center for operatively managed CMF fractures remains significantly lower than non-CMF counterparts. Interestingly, the collection rate gap between CMF and non-CMF surgeries has narrowed when comparing to the data from 2007–2013. This is largely due to a decrease in collection rates for non-CMF procedures from 29.61% (2007–2013) to 26.57% (2015–2022) [p = 0.0001] and an increase in collection rates for CMF procedures from 17.25% (2007–2013) to 18.05% (2015–2022) [p = 0.0001]. Conclusions: Despite a slight improvement of the gap in reimbursement rates for CMF and non-CMF surgeries over the last several years, trauma care continues to have a negative financial impact on health care institutions.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241286544

Authors: Samin Rahbin Ola Sunnergren Ellen McBride Hatef Darabi Babak Alinasab

Study Design: Retrospective with follow-up. Objective: To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods: Patients with unilateral ZMC fractures between 2007–2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018–2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results: The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions: Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241272437

Authors: Anne Radermacher Dominik Horn Michael Fehrenz Karl Semmelmayer Oliver Ristow Michael Engel Jürgen Hoffmann Kolja Freier Julius Moratin

Study Design: Retrospective cohort study. Objective: A major risk factor for oral squamous cell carcinoma (OSCC) is advanced age. Ablative surgery combined with microvascular reconstruction has become routine for OSCC. Nevertheless, there is an interdisciplinary debate about the appropriateness of surgery combined with prolonged general anesthesia in the elderly. In the present study, the ablative and microvascular strategies in OSCC were evaluated in terms of oncologic safety and surgical morbidity in relation to age. Methods: A total of 345 patients with primary OSCC who underwent ablative tumor surgery and neck dissection according to the German national guideline for OSCC together with microvascular reconstruction from September 2010 to October 2017 were examined. General clinical data was analyzed descriptively with a special focus on perioperative morbidity of an elderly (≥70y) subgroup of 56 patients. Oncological outcome was estimated using Log Rank testing and Kaplan Meier plotting. Results: Estimated 5 year overall survival (OS) and disease-free survival (DFS) was 69.6% (≥70y) vs. 76.7% (<70y) and 62.9% (≥70y) vs. 78.2% (<70y) respectively with no significant difference between the 2 age groups. In multivariate cox regression, only initial stage of disease revealed significant impact on OS. Analysis of perioperative death/complications, flap loss, operation time, dependence on tracheostomy and hospitalization revealed no significant differences between the 2 groups. Conclusions: Tumor surgery including neck dissection in combination with primary microvascular reconstruction is a safe therapy in patients of advanced age. This results in excellent oncological outcome with no significant disadvantages in terms of perioperative morbidity, hospitalization or flap failure.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241288138

Authors: Jeffrey Marschall Stephen Davis Oscar Rysavy George Kushner

Study Design: Retrospective Cohort Study. Objective: Reconstruction of maxillary bone defects can be completed with vascularized and non-vascularized autografts. Cellular bone matrix allografts (CBMs), which have lineage committed bone cells, has risen as an alternative. The purpose of this study was to describe our experience and to determine the success of CBM based maxillary reconstruction in a variety of clinical scenarios. Methods: A retrospective cohort study was designed and implemented using data from subjects who presented to the University of Louisville and were treated with a CBM for maxillary reconstruction from 2019 to 2023. Subjects were excluded if they were not treated with a CBM, data were not complete, or postoperative follow-up time was less than 3 months. Descriptive statistics were calculated for each variable. To measure the associations between the risk factors and graft success, Fisher’s exact test was implemented. A p-value of <0.05 was considered significant. Results: The sample included 48 subjects. The mean age of all subjects was 43 ± 24 years. Overall, 42 (87.5%) cases were successful. The perioperative antibiotic administered (p = 0.02), etiology (p = 0.021), and the addition of platelet rich fibrin or autograft as an adjunct influenced CBM success (p = 0.039). Conclusions: CBMs are a viable option for reconstruction of maxillary bone defects. CBMs may be an alternative to autografts.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241286628

Authors: Florian Thieringer Kathy Fan Mike Leung

Dear readers, colleagues, and friends of our journal [...]

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241280780

Authors: Adeeb Derakhshan Hunter Archibald Harley Dresner David Shaye Peter Hilger Sofia Lyford Pike Shekhar Gadkaree

Study Design: A retrospective study. Objective: Facial trauma is a prevalent cause of morbidity and mortality with increasing incidence over recent decades. Few studies have examined the prevalence of mental health and substance abuse disorders at the time of diagnosis. Herein we investigate the psychosocial demographics associated with facial trauma. Methods: The 2016 State Inpatient Database (SID) was used to identify patients with facial trauma from all hospitals in New York, Florida, and Maryland. A non-trauma control group undergoing elective same-day surgeries at ambulatory surgical centers in Florida, Kentucky, Nevada, North Carolina, New York, and Maryland was identified using the State Ambulatory Surgery and Services Database (SASD) from the Healthcare Cost and Utilization Project (HCUP). 777 patients were identified with facial trauma and compared to 500 patients without facial fractures. Results: Patients with facial fractures were statistically significantly more likely to have a substance abuse disorder (OR 34.78, p < 0.001) or mental health disorder (OR 2.75, p < 0.001) compared to controls. Patients with facial fractures were significantly more likely to be black than white (OR 4.80, p < 0.001). Patients with facial fractures were significantly more likely to have Medicaid compared to Medicare (OR 2.12, p = 0.005). Conclusions: Patients with facial fractures are more likely to have premorbid substance abuse and mental health disorders as compared to controls.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241280781

Authors: Jesse Menville Luke Soliman Nidhi Shinde Carole Spake Stephanie Francalancia Josue Marquez-Garcia Nikhil Sobti Vinay Rao Albert Woo

Study Design: A retrospective study. Objective: The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly affect symptomatology and management. We hypothesize that NOE fractures will present differently based upon their severity: Type I injuries are likely to present with medial nasal bone displacement (in-fracture), whereas Type III fractures will be more prone to lateral displacement (out-fracture). Methods: A retrospective review was performed for all patients with NOE fractures who were evaluated by the plastic surgery department at a level 1 trauma center over a 6-year period. Computed tomography data were evaluated to assess for directionality of fracture segment displacement. Frequencies of medial, lateral, and non-displacement across NOE types were compared by Chi-Squared Goodness of Fit and Fisher’s Exact Tests. Results: 111 patients met inclusion criteria. The patient population was 73.9% male and averaged 51.2 years old. When bilateral fractures were counted independently, there were 141 cases in total: 115 Type I, 20 Type II, and 6 Type III. Type I fractures were most commonly in-fractured (48.7%), while Type III injuries were consistently out-fractured (100%) (p < 0.001). Conclusions: While Type II and III NOE fractures have dominated clinical focus, this study highlights the prevalence of impaction within Type I fractures. These findings advocate for a more comprehensive approach to the evaluation of Type I NOE fractures and their potential risks, including traumatic hypotelorism and nasal airway obstruction.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241280214

Authors: Avery Wright Madison Hinson Amelia Davidson Caitrin Curtis Christopher Runyan

Study Design: Retrospective chart review. Objective: Socioeconomic status (SES) greatly impacts one’s health status and the type of trauma that a patient experiences due to increased risk of exposure and varying availability of resources to treat emergent conditions. There is a need for large-scale databases of pediatric facial trauma to identify discrepancies in occurrence and identify risk factors. Methods: This retrospective examination uses a multi-center database to evaluate pediatric facial trauma patients (n = 644) visiting Atrium Heath Wake Forest Baptist (AHWFB) hospital from 2020 to 2022. Data collected included demographic information, past medical and surgical history, trauma history, interventions, and long-term outcomes such as scarring, deformities, and sensory or motor deficits. The number of incidents for each zip code surrounding AHWFB was compared with SES data including unemployment rate, mean household income, and poverty level. Results: Thirty-five percent of patients sustained a high-energy injury, and 65% sustained a low-energy injury. Within the surrounding counties of AHWFB, there were more incidents of pediatric facial trauma in areas with greater rates of poverty (p = 0.006). Additionally, there were more incidents due to high-energy injuries in areas with lower income (p = 0.044) and more poverty (p = 0.002). Specifically, motor vehicle accidents were more common in areas with lower income (p = 0.017) and more poverty (p = 0.001). Conclusions: These findings in the central Piedmont region of North Carolina are consistent with previous research of SES’s effect on health inequalities and serve as evidence of the need to take steps to prevent pediatric facial trauma in areas of low SES.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241278797

Authors: Amit Mahajan Sharvari Daithankar Pratesh Dholabhai Aniruddh Singh Aditya Shah Nirvani Shah

Study Design: Submental intubation is and underutilized alternative to traditional techniques of intubation. Complications associated can indeed deter surgeons and anesthesiologist from performing it. Surgeons may opt for submental intubation if they believe that its advantages outweigh the potential risks of the procedure. Identifying the reasons of complications and implementing of proper strategies to address them can help mitigate risks. Objective: This study aims to compare and analyze the complications experienced during and after submental intubation to comment on its safety, efficacy. Revisiting literature, will help us to comment on diagnosis in trauma and associated perioperative and intraoperative complication with it. It will also help us deduce most preferred way of performing submental intubation and various methods to manage complications. Methods: Submental intubation in patients experiencing craniofacial trauma was reviewed retrospectively for 9 years from January 2015 to August 2023. Common diagnosis sites were analyzed for perioperative and postoperative complications. Results: It was found that there were no much complications faced perioperatively and also notes methods used for management of complications. Most commonly encountered postoperative complication was scar. Literature of past years was reviewed, during process we also came out with novel method for safe extubation for which we have got copyright from Government of India. Conclusions: Submental intubation is a safe and efficient intraoperative airway management technique for patients with craniomaxillofacial injuries when there is concurrent facial trauma. This study findings would underscore the safety and efficacy of SEI, making it a promising unparalleled method of airway management worth considering.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241278796

Authors: Jin-yong Cho Jaeyoung Ryu

Study Design: A retrospective study. Objective: This retrospective study aims to analyze the results of Le Fort I fracture treatment, with a focus on addressing malocclusion related to the fractures. Methods: The study included 43 patients diagnosed with Le Fort I fractures who underwent open reduction and internal fixation. Demographic data, causes of trauma, accompanying facial bone fractures, treatment methods, and complications were analyzed. Fisher’s exact test was employed to assess the association between fractures and malocclusion. Results: Postoperative complications included occlusal disorder (6 cases), sensory disturbance (4 cases), and facial deformation (6 cases). Condylar fractures showed a statistically significant association with occlusal disorders (p = 0.044). Surgeon variability did not significantly impact occlusal outcomes (p = 0.25). Conclusions: Proper management of Le Fort I fractures requires a thorough understanding of surgical principles and consideration of concomitant fractures. Achieving anatomical reduction based on occlusion is crucial for successful outcomes, and additional Le Fort I osteotomy may be considered in challenging cases.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241275102

Authors: Aayma Irfan Nihal Punjabi Aishwarya Suresh Ian Waldrop Jared Inman Nicholas Sheets

Study Design: Retrospective database review. Objective: This study aims to characterize and compare the epidemiological factors of orbital trauma between life stages by utilizing the National Electronic Injury Surveillance System (NEISS), a nationally representative database. Methods: The NEISS was queried for orbital injuries from 2013 to 2022. Demographic data, injury type, injury location, and product related to injury were compared across life stages defined as 0–5 years (young children), 6–17 years (adolescents), 18–64 years (working adults), and >65 years (elderly adults). Results: 7846 orbital injuries were reported in the NEISS from 2013–2022. Incidence increased in all age groups over the study period but was highest in elderly adults. There was a bimodal distribution in the frequency of orbital trauma, with peaks occurring at age<20 and around age 80. Adolescents were most likely to be injured by sports-related products while young children and elderly adults were more likely to be injured by household products. Orbital fractures were the most common type of injury across all age groups (40.6%), with the highest rate observed in working adults. Elderly adults were more likely to be admitted to the hospital compared to working adults (RR 1.62 [1.49–1.77]). Conclusions: The rate of orbital trauma is increasing over time, especially in elderly adults, highlighting the need for increased and improved preventative and education measures. The age-specific epidemiological factors identified in this study may help improve detection and management of injuries and guide public health initiatives.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241272435

Authors: Akhilesh Pandey Gigi PG Harshitha Rajanna Abhishek Anil Pravin Kumar Ankita Chugh

Study Design: Prospective pre-post study. Objective: Maxillofacial trauma presenting to the emergency department (ED) are often accompanied with complex concomitant injuries, thereby making thorough diagnosis and treatment plan quite an exacting task owing to the demanding conditions of the ED. The use of a structured maxillofacial trauma template helps in documenting the injuries comprehensively, aids in treatment planning, avoids medical negligence thereby improving the quality of care given to the patient. The study introduced a structured maxillofacial trauma template to improve the quality of the ED documentation. Methods: A total of 220 patients were evaluated for the quality of their ED documentation from September 2023 till February 2024. The group A included 110 patients where complete medical documentation was done routinely on a blank A4 sized paper, group B included 110 patients where the documentation was done using the structured oral and maxillofacial trauma template. The ED notes were thoroughly evaluated by the 2 independent authors for record completeness and documentation rate of history and examination findings. Results: The introduction of trauma template demonstrated a significant improvement of 18.95% in record completeness. Significant improvement was seen in documentation rate among the covariates like place of injury, time of evaluation, primary care given, wound classification, dento-alveolar injury, ophthalmic evaluation, nerve injury evaluation, comorbidities with p = 0.001, and referral with p = 0.03. The ophthalmic evaluation showed significant improvement among covariates (loss of visual acuity, reflexes, diplopia, enophthalmos, subconjunctival haemorrhage, chemosis, periorbital oedema, periorbital ecchymosis, ocular dystopia) with p = 0.001, and extraocular muscle restriction with p = 0.004. Conclusions: The study demonstrated that the use of a structured oral and maxillofacial trauma template can significantly improve the quality of the ED documentation and contributes to better patient care in the ED.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241272430

Authors: Madison Hinson Avery Wright Amelia Davidson Samuel Kogan Christopher Runyan

Study Design: Retrospective chart review. Objective: The management of pediatric facial fractures presents distinctive considerations compared to adults. This study aims to provide a unique perspective on the correlations between the mechanism of injury, types of facial fractures, and fracture interventions and management utilized in 2 North Carolina Level 1 Trauma Centers to determine the optimal management options for this patient population. Methods: An IRB-approved retrospective chart review was performed of pediatric facial trauma patients ages <18 years old between January 2020 and December 2022 at Atrium Health Wake Forest Baptist Medical Center and Atrium Health Charlotte Medical Center. Data on patient demographics, mechanism of injury, facial fractures, interventions, and outcomes were collected. Results: Of 2977 pediatric facial trauma patients, 582 patients sustained at least 1 facial fracture at the time of injury. Adolescents were significantly less likely to be transferred from outside institutions and to be admitted for further care (p = 0.002). Adolescents experienced higher levels of residual symptoms following initial discharge (p = 0.001) and were less likely to have a symptom resolution within 1 year (p < 0.0001). Neonates and infants were significantly more likely to receive conservative interventions and to sustain calvarium and skull base fractures (p < 0.0001). Conclusions: This study identifies differences in pediatric age groups related to transfers, admittance, fracture type, management, and outcomes. Our data suggests adolescent patients may experience a higher incidence of residual symptoms with lower levels of symptom resolution within 1 year. Further investigation into these differences may elicit optimized methods of fracture management in pediatric age groups and allow for effective, individualized care with improved long-term outcomes.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241272441

Authors: Wen-Bo Zhang Chao-Fei Wang Yao Yu Shuo Liu Lei-Hao Hu Hui Soh Jie Zhang Xin Peng

Study Design: Prospective and retrospective studies. Objective: The aim of this study was to evaluate the clinical effects and accuracy of three-dimensionally (3D)-printed patient-specific surgical plates used for mandibular defect reconstruction. Methods: This study included patients who underwent mandibular defect reconstruction with vascularized autogenous bone grafts between January 2012 and August 2021. They were divided into experimental (fixation with 3D-printed surgical plates) and control (fixation with conventional surgical plates) groups. Flap survival rate, postoperative complications and patient self-evaluated facial appearance were compared. Mandibular reconstruction accuracy evaluation included postoperative position deviation of the whole mandible, transplanted bone graft, lower mandibular border, mandibular condyle, and mandibular angle on the reconstructed side compared to baseline. Results: This study included 20 patients (14 males, six females; age, 39.45 ± 11.69 years), ten each in the experimental and control groups. The mean follow-up was 16 ± 22.05 (range, 6–99) months. All procedures were successful, no plate-related complications (breakage, loosening, or exposure of the surgical plates) were reported, and all patients were satisfied. The groups were statistically similar in th e position deviation of the whole mandible, transplanted bone graft, mandibular condyle, and mandibular angle, but the position and morphology of the lower mandibular border on the reconstructed side in the experimental group were better than those in the control group (p = 0.016). Conclusions: 3D-printed patient-specific surgical plates could be applied in mandibular reconstruction safely and effectively, simplifying the surgical procedure, shortening the preoperative preparation times, achieving satisfactory outcomes, and improving the clinical effects and accuracy of individualized mandibular reconstruction.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241272440

Authors: Carol Wang Daniel Kwon Olachi Oleru Nargiz Seyidova Peter Shamamian Keisha Montalmant Alex Sarosi Peter Taub

Study Design: National database study. Objective: Road traffic accidents (RTAs) are a common and challenging cause of facial fractures in the United States. The present study sought to utilize the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) to investigate national trends, injury patterns and disparities in facial fractures secondary to RTAs. To date, this is the first study to do so. Methods: A retrospective analysis was conducted of patients with primary facial fractures secondary to RTAs using the 2018–2021 HCUP-NIS. Patients were classified into the RTA and non-RTA group. Demographics, injury patterns, and inpatient outcomes were compared. Results: In total, 154,185 primary facial fractures were identified, of which 17% (n = 26,115) were associated with RTAs. RTAs commonly involved cars (41%), followed by motorcycles (15%), pedestrians (11%), and bicyclists (10%). The RTA group was younger (34% vs 24% < 25 years, p < 0.01) and more frequently Hispanic (18% vs 15%, p < 0.01). The most common fracture types were mandibular (23%), frontal (14%), and orbital fractures (14%). The RTA group was 50% more likely to have multiple facial fractures (OR = 1.5, p < 0.01). The RTA group had a longer length of stay (5.3 vs 4.0 days, p < 0.01), admission charge ($127,932 vs $79,414, p < 0.01), and mortality rate (1.9% vs 1.4%, p < 0.01) than the non-RTA group. Conclusions: The present findings provide valuable insights, informing early involvement of craniofacial surgeons for the assessment of combination facial fractures and tailored treatment approaches for RTA patients.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241262616

Authors: Sofia Perez Otero Michael Cassidy Kerry Morrison Hilliard Brydges John Muller Roberto Flores Daniel Ceradini

Study Design: Retrospective observational study. Objective: This study analyzes the epidemiology of pediatric Le Fort fractures and assesses the incidence of concomitant injuries and acute-level hospital course using the largest, national pediatric trauma database to date. Methods: Pediatric midface and Le Fort fractures from 2016–2019 were identified in the National Trauma Data Bank. Descriptive analyses of Le Fort compared to non-Le Fort midface fractures were performed. Multivariable regression assessed whether Le Fort fractures were risk factors for ICU admission, intracranial injury, cervical spine (C-spine) fracture, tracheostomy, and mortality. Results: A total of 1489 patients with Le Fort fractures were identified. There were 520 Le Fort I, 632 Le Fort II, and 609 Le Fort III fractures. Fracture incidence increased with age. Le Fort fractures showed higher rates of concomitant intracranial injury (p < 0.001), ICU admission (p < 0.001), C-spine fracture (p < 0.001), and tracheostomy (p < 0.001). Incidence of all the above increased with higher-grade Le Fort fractures. Le Fort III fractures had higher rates of mortality than non-Le Fort midface fractures (7.6% vs 3.2%). Multivariable regression showed that all Le Fort patterns were independent risk factors for tracheostomy and ICU admission, but only Le Fort I for C-spine fractures. Conclusions: The incidence of Le Fort fractures appears to increase with age. Higher category Le Fort fractures are associated with greater morbidity.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241262619

Authors: Anna Gibson Olivia Speed Jennings Boyette Robert Saadi

Study Design: Systematic review of the literature. Objective: The goal of this study is to review and summarize current literature on local flap reconstruction of external auditory canal (EAC) defects. Methods: PubMed and Ovid databases were queried utilizing search term combinations of “external auditory canal”, “defects”, “flaps”, “local”, and “reconstruction”. References in included articles were subject for review and inclusion. Articles published between 2013 and 2023 were included in the study. Results: A total of 108 articles were screened after duplicates were excluded. Of the 108 articles, 3 were not written or translated to English, 10 were not accessible for review on either database, and 71 were not applicable to our subject of interest. The remaining 24 articles were included in the systematic review. Due to the primary descriptive nature of the surgical techniques and variability of data collection, a formal meta-analysis was not possible. Conclusions: The EAC defect creates a difficult reconstructive dilemma. The armamentarium for repairing these defects can range from healing by secondary intention to free tissue transfer, however, local flap reconstruction proves to be a reliable and versatile option. This article reviews current local flap techniques for EAC defects and compares their advantages and disadvantages. Further, the authors provide a treatment algorithm and indications for choosing each flap in external auditory canal reconstruction.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241259887

Authors: Bao Sciscent Hanel Eberly Tonya King Richard Bavier Jessyka Lighthall

Study Design: Retrospective Chart Review. Objective: The lifestyle of the Amish exposes them to unique mechanisms of injury, making them an important patient population from a facial trauma standpoint. This study analyzes the demographic and clinical risk factors of facial trauma in the Amish. Methods: This retrospective chart review identified all Amish patients presenting with facial trauma at a single institution between 2013–2023. Results: There were 87 Amish facial trauma patients. The median age was 9 years old, and 67.8% were male. Most injuries occurred on the road (41.4%), farm (28.7%), or at home (25.3%). The most frequent mechanisms were buggies (27.6%), falls (26.4%), and animals (18.4%). Fifty-eight patients sustained facial fractures, with orbital (n = 40), maxillary (n = 25), and nasal (n = 19) fractures being the most prevalent. The most common cause of facial fractures was buggy injuries (n = 17). Facial reconstruction was performed in 54.2% of buggy injuries, 31.3% of animal injuries, and 8.7% of falls. Patients with buggy injuries presented with the lowest Glasgow Coma Scale (GCS) scores (median 13.5) and had the longest inpatient hospital stay (median 3 days). Conclusions: Increased injury prevention efforts, especially towards buggy injuries, are necessary.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241259808

Authors: Daniel Caruso Vincent Aquino Jeffrey Hajibandeh

Study Design: This paper presents a case series analysis of 5 patients with Luhr class III mandible fractures treated using virtual surgical planning (VSP) and patient-specific implants (PSI) between October 2020 and February 2023. The study focuses on evaluating the effectiveness of VSP and PSI in managing complex mandibular fractures, particularly in edentulous patients. Objective: The primary objective is to assess the outcomes of using VSP and PSI for reconstructive surgery in patients with Luhr class III mandible fractures. The study aims to determine the accuracy of these techniques in fracture reduction and their impact on surgical complications and overall patient outcomes. Methods: The methodology involves a detailed preoperative planning process using VSP to design customized implants tailored to the specific anatomical needs of each patient. The study tracks the surgical procedures, implant placements, and postoperative outcomes, comparing the preoperative plans with the actual surgical results to evaluate accuracy and effectiveness. Results: The results indicate successful fracture reduction in all 5 patients, with a high degree of accuracy in implant placement and alignment compared to the preoperative virtual plans. The study highlights the benefits of VSP and PSI, including precise screw placement and enhanced potential for prosthetic rehabilitation. Despite the higher costs, the outcomes suggest significant advantages in terms of surgical precision and patient recovery. Conclusions: The use of VSP and PSI in the treatment of Luhr class III mandible fractures provides a tailored approach that enhances surgical accuracy and patient outcomes. While acknowledging the increased costs, the findings support the value of these advanced techniques in managing complex edentulous mandible fractures, advocating for their consideration in similar cases to improve surgical results and patient care. The study adds to the growing evidence of the benefits of VSP and PSI in reconstructive maxillofacial surgery.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241257981

Authors: Jenny Ji Nora Alexander Kwasi Enin Emily Spataro

Study Design: Retrospective cohort study. Objective: To determine patient, defect, and surgical factors associated with facial reconstructive outcomes. Methods: Post-Mohs Micrographic Surgery (MMS) facial reconstructions performed at a single institution between 2015–2020 were reviewed. Patient demographics, comorbidities, defect characteristics, type and timing of reconstruction, and postoperative complications and revisions were collected. Data was analyzed with multivariable logistic regressions. Results: 245 defects in 220 patients (median age 66 years, 143 (65%) female) were included. Most were located on the nose (68%), and median size was 3.0 cm2 (IQR 1.32–7.5 cm2). Defect size over 10 cm2 (OR 5.176, 95% CI 1.353–19.808) and two-staged melolabial flaps (OR 4.021, 95% CI 1.525–10.603) were associated with complications after univariate analysis. Nasal tip defects (OR 2.324, 95% CI 1.076–5.019) were associated with minor revisions. Major revisions were associated with nasal sidewall (OR 2.873, 95% CI 1.125–7.336) and tip (OR 2.780, 95% CI 1.145–6.749) defects, ear cartilage grafts (OR 3.373, 95% CI 1.382–8.231), two-staged paramedian forehead flaps (OR 19.273, 95% CI 6.864–54.112), and delayed reconstruction over 14 days (OR 5.727, 95% CI 1.298–25.281). On multivariable analysis, defect size over 10 cm2 (aOR 4.972, 95% CI 1.286–19.073) and two-staged melolabial flaps (aOR 4.575, 95% CI 1.628–12.857) were independently associated with complications, while two-staged paramedian forehead flaps (aOR 14.421, 95% CI 3.976–52.310) were independently associated with major revisions. Conclusions: More complex reconstructions with larger defects and interpolated flaps were associated with revision surgery and complications of facial reconstruction following MMS.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241257572

Authors: Heather Peluso Kevin Vega Sthefano Araya Lindsay Talemal Civanni Moss Jake Siegel Adam Walchak

Study Design: This is a retrospective study using the Nationwide Emergency Department Sample. Objective: Facial laceration repairs are one of the most common procedures performed in the emergency department (ED). The goal of this study was to describe the patient’s characteristics and healthcare cost associated with ED encounters for facial lacerations using the largest nationally representative database in the United States. Methods: This is a retrospective study using the Nationwide Emergency Department Sample. The data was collected between January and December of 2019. Patients with either a primary or secondary diagnosis of facial laceration were included. The primary outcome was patient characteristics. The secondary outcomes were ED characteristics, number and type of procedures performed and total encounter charges. Diagnoses and procedures were identified using ICD-10 CM codes. Results: There were 2,548,944 ED encounters for facial lacerations in the United States. Of those, laceration was the chief complaint in 75%. 80% of lacerations were unintentional, 8% were due to assaults, and <1% due to suicidal attempts. The most common laceration location was the scalp (21%) followed by the lip (11%) and eyelid (11%). The mean patient age was 38 years. Most patients were adults (69%), male (62%), Caucasian (64%, African American 14%, Hispanic 14%, Other 4%, Asian 2%), from low income levels ($1–$45,999: 29%, $46,000–$58,999: 24%, $59,000–$78,999: 24%, $79,000 or more: 23%), with private insurance (32%, Medicaid 25%, Medicare 24%, self-pay 12%, other 6%). Most encounters were during summer (June, July, August) at large metropolitan areas with at least 1 million residents (52%, small metropolitan: 30%, micropolitan: 10%, other: 7%) at teaching hospitals (65%) located in the southern region of the United States (37%, Midwest: 23%, west: 21%, northeast: 19%). Almost half of the encounters were at non-trauma-designated hospitals (48%, Level 1 trauma center: 21%, Level 2 trauma center: 17%, Level 3 trauma center: 13%). The number of procedures during each encounter was: none: 4%, one: 17%, two: 23%, three: 11%, four: 11%, five or more: 28%. The most frequent laceration repair was a simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes 2.5 cm or less, followed by simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities 2.5 cm or less. Most emergency department visits were billed as a Level 3 encounter, followed by Level 2 then Level 4. CT scan of the head was the most common imaging modality. Of all patients, <1% were admitted to the hospital and 87% were discharged home. The average total emergency department charges were $5733. Conclusions: Facial laceration is a common complaint in the emergency department. It is costly, and disproportionately affects the impoverished. Most lacerations are classified as simple, less than 2.5 cm, involving the scalp, unintentional, with the discharge disposition being home. Thus, exploring pathways to treat facial lacerations outside of the ED can potentially reduce both healthcare cost and ED crowding.

Craniomaxillofacial Trauma & Reconstruction doi: 10.1177/19433875241257737

Authors: Reza Tabrizi Hamidreza Moslemi Shervin Shafiei Ramtin Dastgir Zachary Peacock

Study Design: Randomized Clinical Trial. Objective: Mandibular body fractures may result in inferior alveolar nerve damage. This study examined the effectiveness of platelet-rich fibrin (PRF) application to the inferior alveolar nerve during open reduction and internal fixation (ORIF) of mandibular fractures. Methods: This was a double-blind, split-mouth randomized clinical trial. Patients with bilateral mandibular body fractures with minimal displacement (<5 mm) who underwent ORIF were assessed for enrollment. PRF was placed within the fracture site before reduction and fixation on the studied side. Fixation was performed on the contralateral side (control side) without PRF. The study and control groups were randomized using QuickCalcs software. Neurosensory disturbance (NSD) was assessed through two-point discrimination (TPD), self-reported NSD (SR-NSD), and brush directional stroke discrimination test (BDSD) at 6 and 12 months postoperatively. Results: Twenty-five subjects were enrolled. BDSB recovery was greater in the study group during all time intervals (p < 0.001). There were no differences between TPD and SR-NSD at the follow-up periods (p > 0.05). Conclusions: The results of this split-mouth randomized clinical trial indicate that PRF may enhance the recovery of a damaged inferior alveolar nerve in mandibular body fractures.