Search Results (104)

Background and Objectives: The purpose of this study was to investigate whether high ethmoid sinus volume (ESV) constitutes a risk factor for the formation of orbital blowout fractures (OBFs) after craniofacial trauma and whether it affects the fracture pattern. Materials and Methods: This retrospective case–control study included patients aged ≥15 years who presented with craniofacial trauma to the emergency department of a Turkish university hospital between 1 October 2022 and 1 September 2023. The predictor variable was the presence of OBF (yes/no). The primary outcome variable was mean ESV, measured on computed tomography using the fully automated 3D Slicer software. Statistical analyses were performed with a significance level set at p < 0.05. Results: The case group consisted of 108 (median age: 41.5 years; 76 males, 70.38%), and the control group consisted of 122 (median age: 38 years; 84 males, 68.85%) subjects. OBFs were more frequent in males (69%), most commonly detected in the orbital floor (68.2%), and were bilateral in two (1.8%) subjects. The mean ESV in the case group (3.91 ± 1.39 cm³) was significantly higher than that in the control group (2.82 ± 0.94 cm³) (p < 0.001). Unlike the cases with medial wall fractures and those with orbital floor fractures, there was no significant difference in mean ESV between the cases with medial wall and orbital floor fractures and the control group (p = 0.562). Conclusions: A large ethmoid sinus not only increases the risk of orbital blowout fracture but also has an impact on the fracture pattern. Based on the data obtained from our study, we demonstrated a significant association between ethmoid sinus volume and the incidence of orbital blowout fracture. Full article

Background: Auricular defects resulting from congenital anomalies, trauma, or oncologic resection pose significant functional and psychosocial challenges. When autologous reconstruction is not feasible or not desired, implant-retained auricular prostheses represent a reliable alternative with high patient satisfaction. This study aimed to systematically evaluate the clinical performance of craniofacial implants used for auricular prosthetic rehabilitation, focusing on implant survival, prosthetic outcomes, workflow typologies, and complications. A secondary objective was to illustrate the long-term validity of a minimally invasive navigation technique through a clinical case with 6-year follow-up. Methods: A systematic review was conducted according to PRISMA guidelines. Clinical studies published between 2005 and 2025 reporting outcomes of implant-retained auricular prostheses were searched in PubMed and Scopus databases. Data were extracted on implant type, survival rates, prosthetic performance, workflow, and complications. Risk of bias was assessed using appropriate tools based on each study design. Results: A total of thirty-two studies were included, comprising fifteen case reports, fifteen case series, one cohort study, and one prospective observational study. Implant survival was consistently high across all workflow categories, with failures predominantly associated with irradiated or anatomically compromised bone. Prosthetic outcomes were favorable, showing excellent esthetics, stable retention, and high patient satisfaction irrespective of manufacturing method, although digital and navigation-assisted workflows improved reproducibility, symmetry, and planning precision. Complication rates were low and generally limited to mild peri-abutment inflammation manageable with conservative care. The clinical case confirmed these findings, showing stable osseointegration, healthy soft tissues, and uncompromised prosthetic function at 6-year follow-up. Conclusions: Implant-retained auricular prostheses show predictable long-term success, independent of whether traditional, hybrid, or fully digital workflows are employed. Digital technologies enhance surgical accuracy, minimize morbidity, and streamline prosthetic fabrication, although high-quality comparative studies remain limited. Full article

This case report describes mandibular distraction osteogenesis (DO) in a six-year-old patient with first and second branchial arch syndrome and obstructive sleep apnea, in whom 3D surgical planning was combined with ultrasonography (US) for postoperative monitoring. The aim was to illustrate how patient-specific 3D modeling and a structured ultrasonography protocol can support safe mandibular advancement while limiting radiation exposure in a pediatric patient with complex craniofacial deformity. Preoperatively, a 3D-printed model of the mandible, generated from a cone beam computed tomography (CBCT) scan, was used to guide precise osteotomy planning and vector orientation. The surgical procedure was conducted using a Risdon approach and piezoelectric tools to ensure minimal trauma. Postoperative monitoring incorporated serial panoramic radiography and US at predefined time points to assess gap size, callus formation, and vascularity during distraction and consolidation. US identified early callus formation, progressive cortical bridging, and preserved callus vascularity, and, together with radiographic findings, guided the timing of distraction termination and distractor removal at 16 weeks. This case adds to the limited literature on pediatric mandibular DO by demonstrating the feasibility of integrating patient-specific 3D virtual planning with US-based follow-up to improve the safety, precision, and radiation-conscious management of DO in pediatric patients with complex craniofacial deformities. Full article

Pediatric craniofacial fractures represent a significant diagnostic challenge due to age-dependent anatomical variability, subtle fracture lines, and the limited availability of specialists during emergency care. Computed tomography (CT) remains the gold standard for fracture assessment; however, small or non-displaced fractures may be easily overlooked. Advances in artificial intelligence offer opportunities for automated support in injury detection. In this study, we developed a 2.5D deep learning model that uses multiplanar CT reconstructions (axial, coronal, sagittal) as a three-channel input to a ResNet-18 network with transfer learning. A total of 63 high-quality CT examinations were included and split into a training set (n = 44) and a validation set (n = 19). The preprocessing pipeline included isotropic resampling, bone-window normalization, and the generation of 384 × 384 images. Model performance was evaluated using ${\mathrm{AUC}}_{ROC}$, ${\mathrm{AUC}}_{PR}$, sensitivity, specificity, precision, F1-score, and threshold optimization using Youden’s index. The proposed model achieved ${\mathrm{AUC}}_{ROC}$ = 0.822 and ${\mathrm{AUC}}_{PR}$ = 0.855. At the optimal decision threshold (t = 0.54), sensitivity reached 0.556, specificity 1.000, and F1-score 0.714. Grad-CAM visualizations correctly highlighted fracture-related structures, which was confirmed in an independent clinical assessment. The results demonstrate the potential of the proposed model as a decision-support tool for pediatric craniofacial trauma, providing a foundation for future extensions toward radiomics and hybrid deep-radiomic pipelines. Full article

Background: Pediatric craniofacial fractures represent a distinct clinical entity characterized by unique anatomical and developmental factors that differentiate them from adult facial trauma. Despite their relative rarity, these injuries pose diagnostic and therapeutic challenges due to the presence of active growth centers and the potential for long-term functional and esthetic sequelae. Methods: A retrospective observational study was conducted among pediatric patients aged 0–17 years treated for craniofacial fractures between 2020 and 2024 at the Department of Cranio-Maxillofacial Surgery, University Hospital in Kraków, Poland. Demographic data, injury mechanisms, fracture distribution, treatment modality, and associated injuries were analyzed. Multivariate logistic regression was applied to identify predictors of surgical intervention. Results: Ninety-eight patients met the inclusion criteria. The mean age was 12 years, with a male predominance. Midfacial fractures were most common, with orbital floor fractures representing the single most frequent injury. Surgical management was performed in 72 cases, predominantly using the transconjunctival approach and autologous bone grafting. Orbital floor fractures were identified as the only independent predictor of operative treatment (p < 0.05). Central nervous system trauma was the most frequent concomitant injury. No significant changes in etiology or fracture distribution were observed during the COVID-19 pandemic. Conclusions: Pediatric craniofacial trauma follows a reproducible, age- and mechanism-dependent pattern. Effective management requires individualized, growth-preserving, and function-oriented treatment strategies. Standardization of care protocols and multicenter prospective studies are essential to optimize outcomes and develop evidence-based, age-specific guidelines for the management and prevention of pediatric facial fractures. Full article

Background/Objectives: In recent years, electric scooters have gained widespread popularity as an easy and affordable mode of transport in urban areas worldwide. Simultaneously, trauma centers have observed an increasing number of associated injuries to users. While injury patterns associated with other vehicles are now well-researched, electric-scooter-related injuries are a new topic in the literature. Our study aims to investigate the differences in injury patterns and other critical crash characteristics among riders of bicycles, electric scooters, and scooters. Methods: This one-year retrospective observational study examined patients who sustained injuries while riding bicycles, electric scooters, or scooters between April 2021 and March 2022 at Hungary’s largest trauma center in Budapest. During this one-year period, we identified 1938 patients, 1378 cyclists, 370 electric scooter users, and 190 scooter users. Basic demographic information, recorded injury type and severity, time of day the injury occurred, and alcohol usage were recorded as outcome measures. Results: While 4.6% of cyclists and 5.8% of scooter riders had consumed alcohol, 26.8% of electric scooter riders were under the influence of alcohol at the time of their crash. Of electric-scooter-related injuries, 45.8% occurred at night, compared to only 9.2% and 14.1% of bike and scooter-related injuries, respectively. E-scooter crashes constituted 19.1% of total cases but surged to 52.3% at night. Patients under the influence of alcohol were much more likely to experience mild head injuries (p < 0.0001) and severe head injuries (p < 0.0001), but less likely to suffer mild limb injuries (p < 0.0001) and severe limb injuries (p < 0.0001) compared with sober patients. Cyclists had significantly 3 times fewer cases of severe head trauma than those injured while using electric scooters (p = 0.0166). Conclusions: The study highlights a significant risk of severe craniofacial injuries in e-scooter users after consuming alcohol, exceeding that in sober riders and cyclists. Predominantly occurring at night, these injuries are closely linked with alcohol use. The findings advocate for mandatory helmet laws and stricter regulations on e-scooter use to enhance safety, especially at night. Full article

Craniofacial bone defects of critical size, caused by trauma, tumors, infections, or congenital maldevelopment, represent a major challenge in plastic and reconstructive surgery. Autologous bone grafting is considered the gold standard, but limitations such as donor site morbidity and limited availability have prompted the development of artificial bone tissue engineering scaffolds. In recent years, bioactive scaffolds have been increasingly utilized in favor of inert biomaterials due to their immunomodulation and osteoinduction capabilities. This review methodically summarizes loading strategies for the functionalization of scaffolds with bioactive components, including cell regulatory factors, drugs, ions, stem cells, exosomes, and components derived from human tissues or cells to promote bone regeneration. The following mechanisms are involved: (1) the polarization of macrophages (M1-M2 transition), (2) the dynamic regulation of bone metabolism, and (3) the coupling of osteogenesis and angiogenesis. This review focuses on innovative delivery systems, such as 3D-printed scaffolds, nanocomposites and so on, that enable spatiotemporal control of bioactive cargo release. These address key challenges, such as infection resistance, vascularization, and mechanical stability in the process of bone regeneration. In addition, the article discusses emerging technologies, including stem cells and exosome-based acellular therapies, which demonstrate potential for personalized bone regeneration. This review integrates immunology, materials science, and clinical needs, providing a roadmap for the design of next-generation bone tissue engineering scaffolds to overcome critical-sized bone defects. Full article

Orbital wall fractures are a common consequence of trauma-related craniofacial injuries. Multistage treatment and poor functional and aesthetic results render the reconstruction of an orbit extremely challenging. Advances in surgical technologies, imaging software, and biomaterials have continuously improved outcomes. The choice of materials plays a critical role in patient outcomes. Over time, the type of material involved advanced from autografts (autologous tissues such as bone grafts and muscle flaps) to allografts (metals, ceramics, plastic materials, or combinations of these materials). In this study, we provide a comprehensive overview of the latest scientific insights, including the advantages and disadvantages of each material used in terms of stability, cost, safety, biocompatibility, durability, and intraoperative readiness. Bioengineered solutions seem to be the future of orbital wall reconstruction; both material and technological innovations hold promise for further advancements. Full article

The mental eminence (chin) is a uniquely human anatomical feature with critical relevance across multiple domains of biomedical and anthropological research. This transdisciplinary review aims to synthesize current knowledge regarding its morphology, population variability, evolutionary origin, and surgical relevance. A comprehensive scoping review aims to map how the mental eminence has been defined and evaluated in anthropological, forensic research, identifying the main methodological approaches, anatomical landmarks, and sources of morphological variability, as well as the reliability and applicability of current assessment methods in clinical–forensic contexts. The search strategy was performed in October 2025. The authors initially identified 3125 records, and 26 studies were finally included and assessed for qualitative analysis. Moreover, the analysis integrates data from osteological collections, radiographic imaging, and modern morphometric studies. The mental eminence exhibits significant variability across human populations, with pronounced sexual dimorphism and evolutionary distinction from non-human primates. Its emergence in Homo sapiens is a key taxonomic trait. Clinically, the chin serves as a landmark in surgical procedures involving genioplasty, trauma reconstruction, and dental implantology. Recent advances in imaging and biometrics have refined its analysis in both anthropological and diagnostic contexts. Though often overlooked, mental eminence plays a vital role in craniofacial morphology and human evolution. Its study bridges osteology, anthropology, and surgery, offering insight into both phylogenetic development and applied anatomical practice. A multidisciplinary understanding of this structure enhances its diagnostic and therapeutic utility. Full article

Transorbital penetrating intracranial injuries are a rare but life-threatening subset of penetrating head traumas. While isolated cases caused by bicycle brake handles have been reported, often with fatal outcomes, this is the first documented case of such an injury caused by an electric scooter (e-scooter) brake handle. The objective is to present the unique management and clinical course of this unusual case. A case of a 76-year-old male is presented. The patient sustained a transorbital intracranial injury after a same-level fall onto a parked e-scooter, which resulted in the brake handle penetrating his left orbit and reaching the third ventricle. A combined maxillofacial and neurosurgical team performed a frontal craniotomy for foreign body removal, followed by duraplasty. No cerebrospinal fluid leakage was detected postoperatively. Imaging and clinical follow-up at six months and one year revealed significant post-traumatic encephalomalacia in the frontal lobes, ventricular enlargement, and persistent neurocognitive deficits, including memory impairment and executive dysfunction. Visual acuity in the affected eye was reduced, with associated orbital fat atrophy and mild ptosis. E-scooter brake handles pose a previously unrecognized risk for severe transorbital penetrating intracranial injuries. This case underscores the critical importance of a multidisciplinary surgical approach to manage complex craniofacial trauma. Despite successful acute management, patients can suffer substantial long-term neurological and functional sequelae, necessitating comprehensive follow-up care. Full article

Background/Objectives: This study aims to evaluate the functional characteristics of the temporomandibular joint (TMJ) in patients diagnosed with juvenile idiopathic arthritis (JIA). Specifically, it seeks to determine the prevalence of TMJ involvement and its impact on clinical symptoms and functional limitations. Methods: A total of 40 patients diagnosed with JIA according to the International League of Associations for Rheumatology criteria were included. Exclusion criteria encompassed systemic diseases unrelated to JIA, prior craniofacial surgery, and trauma. Participants were divided into two groups: those with TMJ arthritis (n = 23) and those without (n = 17). Clinical assessments were conducted using the Helkimo anamnestic index (Ai) and dysfunction index (Di) to evaluate TMJ-related symptoms. Results: The Ai revealed that most patients reported no or only mild subjective symptoms. Overall Di distributions did not differ significantly between groups, although mandibular mobility was more impaired in the TMJ arthritis group. A moderate correlation (r = 0.4) was observed between Ai and Di. Conclusions: This pilot study indicates that impaired mandibular mobility may suggest TMJ involvement in JIA. Given the study’s limitations, such as being a single-center study with a small sample size and using a CBCT-based classification, further multicenter studies utilizing validated pediatric protocols are necessary to reinforce these preliminary findings. Full article

Background: Traumatic Brain Injury (TBI) in children is a major cause of morbidity and mortality worldwide. Ocular manifestations are common but often overlooked, despite their potential to cause long-term visual impairment. This study aimed to evaluate the prevalence and characteristics of ocular findings in pediatric TBI patients admitted to the intensive care unit (ICU). Method: We prospectively reviewed records of pediatric patients (≤16 years) with TBI admitted to the Neurosurgery ICU at King Abdullah University Hospital (January 2022–December 2024). TBI was defined using U.S. CDC criteria and confirmed by clinical and radiological findings. Ocular manifestations were identified from ophthalmology consultations, neurosurgical notes, and bedside examinations. Demographics, injury details, and clinical outcomes were recorded. Statistical analyses included Chi-square, Fisher’s exact, and Mann–Whitney U tests, with significance set at p ≤ 0.05. Results: Thirty-eight patients (median age: 8 years; 55.3% male) were included. Ocular findings were present in 20 patients (52.6%). These patients were significantly older (median age 10 vs. 6 years, p = 0.007) and had lower admission GCS scores (11 vs. 14, p = 0.016). Male predominance was higher in the ocular group (75.0% vs. 33.3%, p = 0.030). Ocular findings were significantly associated with surgical intervention (60.0% vs. 22.2%, p = 0.025), orbital fractures (40.0% vs. 5.6%, p = 0.021), basal skull fracture signs (p = 0.036), and extraocular muscle limitation (p = 0.048). On multivariable analysis, orbital fracture remained the only independent predictor of ocular findings (aOR 2.22, 95% CI 1.17–3.57, p = 0.02). Conclusion: Over half of pediatric ICU TBI patients demonstrated ocular manifestations, closely linked to greater injury severity and craniofacial trauma. Routine, comprehensive ophthalmological evaluation should be integrated into the multidisciplinary management of severe pediatric TBI to optimize visual and functional outcomes. Full article

Background: Open fractures in pediatric patients are uncommon but clinically relevant, often resulting from high-energy trauma or sports-related incidents. This study analyzes the demographic patterns, types of sports, injury mechanisms, treatment strategies, and outcomes in children and adolescents with sports-related open fractures. Methods: In this retrospective study, 74 pediatric patients with sports-related open fractures treated at a level 1 trauma center between 2002 and 2023 were documented. Parameters such as age, sex, fracture location, sport type, treatment modality, complications, and outcomes were evaluated. Results: The cohort included 74 patients, with a mean age of 13 ± 3.6 years. Open fractures of the upper extremity were most common (seen in 34 patients). Moreover, 10 open craniofacial and 27 open nasal fractures represented 50.0% of injuries, mainly in male athletes involved in contact sports. Soccer was the leading injury-related sport (n = 14; 18.9%). Surgical treatment was required in 28 patients (37.8%), most frequently using elastic stable intramedullary nailing, Kirschner wire fixation in the upper extremities or nasal bone reduction. Antibiotics were administered in 46 patients (62.2%), with a mean documented duration of 2.7 ± 3.1 days. An excellent outcome was documented in 95%. Conclusions: Sports-related open fractures in children primarily affect male adolescents in contact sports and involve the upper extremities and facial region. Conservative management is effective in stable, non-displaced and low-grade injuries. Surgical treatment is frequently indicated in open forearm fractures. The implementation of a structured trauma care protocol, incorporating early debridement, definitive treatment, and antibiotics, has been demonstrated to yield a safe and effective treatment outcome with a favorable prognosis for sports-related open fractures in children. Full article

Background/Objectives: Bilateral symmetry of craniofacial structures is a fundamental principle in clinical application, particularly in procedures involving unilateral trauma or skeletal loss. The zygomaticomaxillary suture (ZMS), located at the articulation between the zygomatic bone and maxilla, is considered a potentially stable midfacial landmark owing to its distinct anatomical position and relevance in surgical planning. This study aimed to evaluate the bilateral symmetry of the ZMS and its surrounding anatomical structures in healthy adults using three-dimensional CT reconstructions and to develop predictive models for contralateral estimation. Methods: Craniofacial CT scans of 200 adult individuals (101 females and 99 males, aged ≥18 years) were retrospectively analyzed. Fourteen morphometric parameters related to the ZMS and adjacent craniofacial structures were measured bilaterally on 3D reconstructions generated from CT data. Statistical analyses included tests for normality, sex and side comparisons, correlation analysis, and linear regression to develop side-predictive formulas. Results: No statistically significant differences were found between the right and left sides for any parameter, confirming a high degree of bilateral symmetry. However, significant sex-based differences were observed in two parameters: the lateral extension of the ZMS (p = 0.024 right; p = 0.046 left) and piriform aperture width (p = 0.017). Regression models developed for each sex provided reliable estimates of contralateral morphometric values based on single-sided measurements. Conclusions: The results confirm high bilateral symmetry of the ZMS and adjacent midfacial structures, supporting its reliability as a reference point in surgical planning and facial reconstruction. Regression models enhance the accuracy of mirror-based approaches in unilateral midfacial defects. Full article

Objectives: The increasing popularity of electric scooters (E-scooters) has led to a rise in trauma-related injuries, particularly in the craniofacial region. This study aims to compare dentoalveolar trauma (DT) patterns between E-scooter and bicycle accidents in a German urban area to identify differences in injury characteristics, risk factors, and treatment approaches. Materials and Methods: This retrospective study analyzed 178 patients treated for DT following E-scooter (n = 56) or bicycle (n = 122) accidents between January 2022 and December 2022 at a single oral and maxillofacial surgery department in a German urban area. Demographic, clinical, temporal, and therapeutic data were collected and statistically compared. Results: E-scooter patients were significantly younger (mean age: 33.6 vs. 47.0 years, p < 0.001) and predominantly female (85.7% vs. 26.2%, p < 0.001) compared to bicycle patients. E-scooter accidents more frequently occurred at night (69.6%) and on weekends (62.5%) and were significantly associated with alcohol consumption (55.4%) and low helmet use (8.9%). Clinically, E-scooter accidents resulted in more complex dental injuries, including a higher incidence of root fractures (14.3% vs. 0%, p < 0.001), complicated crown fractures (25.0% vs. 9.0%, p = 0.004), and crown-root fractures (32.1% vs. 9.8%, p < 0.001). Mandibular injuries were more prevalent in the E-scooter group, and concomitant facial fractures (excluding alveolar) were also more common (28.6% vs. 19.7%, p = 0.018). Conclusion: E-scooter accidents are associated with a distinct DT pattern involving younger, often alcohol-intoxicated, and helmetless patients, typically presenting with more severe and complex DT-injuries. These findings highlight the urgent need for targeted prevention strategies, legislative measures on helmet use, and clinician awareness of specific trauma profiles linked to E-scooter use. Full article