Search Results (49)

Background: Despite increased adoption of virtual surgical planning (VSP) in various craniofacial indications, the incorporation of VSP/3DP into facial trauma care remains limited. Therefore, Expedited Preoperative Point of Care for Fracture Reduction to Normalized Anatomy and 3DP to Improve Surgical Outcomes (EPPOCRATIS) was introduced in 2021. This study evaluates our experience with EPPORATIS in craniomaxillofacial trauma over 10 years. Methods: A retrospective review of patients who underwent facial trauma repair between September 2014 and September 2024 was conducted. For each VSP/3DP case, a patient with similar facial trauma patterns, who was treated without VSP, was selected. Evaluation metrics included operative time, blood loss, length of stay, complication rates, and fracture reduction accuracy through 3D heatmap analyses. Operative metrics were normalized by implant (i.e., fracture plates and screws) count to account for fracture complexity. A value of p < 0.05 was deemed statistically significant. Results: The VSP group presented with more complex injuries and higher involvement of various surgical specialties (p < 0.5) and demonstrated longer operative times (p < 0.03). Although the difference was not statistically significant (p = 0.4), when adjusted for implant count, the VSP group had shorter operative times (median: 15.4 vs. 19.3 min/implant) and reduced blood loss compared to non-VSP cases (median: 3.4 mL/implant vs. 4.2 mL/implant). Complications, revision rates, and length of stay showed no significant differences. Conclusions: The use of VSP/3DP (EPPOCRATIS) in craniomaxillofacial trauma reconstruction demonstrated operative efficiency and accurate fracture reduction in complex cases. Further studies are needed to examine the feasibility and cost-effectiveness of point-of-care VSP/3DP in trauma centers. Full article

Background: The purpose of this study was to examine how the COVID-19 pandemic influenced the patterns, distribution, and circumstances of dental trauma (DT) cases at a German cranio-maxillofacial trauma center. Materials and Methods: This retrospective analysis compared DT cases from the PreCovid (PC) period (February 2019–January 2020) with those from the IntraCovid (IC) period (February 2020–January 2021). It included an examination of baseline characteristics, types of DT, circumstances leading to DT, and the treatment approaches applied. Results: In the IC period, there was an increase in the number of DT, a significant increase in uncomplicated crown fractures, crown–root fractures, subluxations, avulsions, alveolar fractures, combined tooth fractures and dislocations, and concomitant soft tissue injuries. There were no differences regarding the location of DT. During the IC period there was a significant reduction in sports accidents, road traffic accidents, interpersonal violence, and alcohol-related DT. Simultaneously, there was a marked increase in falls, syncopal episodes, home accidents, and DT incidents occurring on weekdays. Furthermore, during the IC period, the number of cases of DT increased in the morning and decreased at nighttime. Conclusions: The COVID-19 pandemic significantly affected the types of DT, the treatment approaches, and the circumstances under which DT occurred. Investigating these impacts can help to predict the effects of a future pandemic on DT and/or maxillofacial trauma and possibly reduce these effects through establishing appropriate preventive measures. Full article

Background: The aim of this study was to analyze the impact of the COVID-19 pandemic on midfacial fracture patterns/distributions and circumstances in a German craniomaxillofacial trauma center. Methods: This retrospective study compared the midface fracture patterns (excluding nasal fractures) of patients in the pre-COVID (PC) era (February 2019–January 2020) with patients in the intra-COVID (IC) era (February 2020–January 2021). In addition to baseline characteristics, the type of midface fractures, the circumstances leading to midface fractures, and hospital admissions/treatments were analyzed. Results: During the COVID-19 pandemic, a reduction in the total number of midface fractures was observed (PC = 88 vs. IC = 57). No significant differences were found regarding the midfacial fracture localization between both periods. During the pandemic, there was a significant increase in falls, accidents at home, and virus/flu-associated syncopes. At the same time, a significant decrease in sports accidents, interpersonal violence, and alcohol-related accidents leading to midface fractures was recorded. Furthermore, there was a significant increase in accidents during the morning time with a simultaneous reduction in accidents during the nighttime. In addition to that, a significant delay in days from trauma leading to midface fracture until hospital admission and surgical treatment (ORIF) was revealed. Conclusions: Despite the limitations of a monocentric retrospective study, the current findings lead to the conclusion that the COVID-19 pandemic had a significant impact on the patterns and circumstances leading to midface fractures. Analyzing the specific characteristics of patients suffering from midfacial fractures under the influence of the COVID-19 period can represent added value in order to treat facial fractures in future pandemics. Full article

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. Full article

Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs. Full article

Study Design: This is a retrospective observational study. Objective: To evaluate the clinical outcomes after an open reduction and internal fixation (ORIF) of condylar neck and base fractures (CNBFs) with a trapezoidal shape plate in patients using a less invasive transparotid approach. Methods: Fifteen patients with condylar fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial (AOCMF) classification system, treated by ORIF with a trapezoidal plate. All patients were evaluated by clinical examination (pain, occlusion, and mandibular dynamics) and imaging through computed axial tomography. Postoperative evaluations considered a favourable clinical outcome of fragment stability, stable occlusion, absence of pain, and regular mouth opening ranges. In addition, any signs of local infection, malocclusion, facial nerve damage, or failure of the fixation system were recorded. Results: According to the AOCMF classification for condylar fractures, eight fractures affected the condylar base and seven involved the condylar neck. No patients presented pain or joint sounds in the TMJ. All patients obtained a buccal opening greater than or equal to 35 mm. Two patients showed postoperative malocclusion which was corrected by intermaxillary elastics therapy. In addition, two patients had transient paresis during the postoperative period. One of them had paresis of the frontal and buccal branches of the facial nerve while the second patient had paresis of the zygomatic and buccal branches. Conclusions: Using trapezoidal miniplates provides functionally stable fixation for neck and base condylar fractures and allows for a less invasive surgical transparotid approach (2 cm extension). They also reduce the amount of osteosynthesis material and are easier to adapt and fix in the author’s opinion. Full article

Background: The lack of resources limits the treatment of craniomaxillofacial fractures (CMF) in low-income countries (LIC). Therefore, Barton bandages and/or interdental wiring are considered in these regions. Fracture reduction is maintained by permanent occlusion for 6 weeks, which often leads to limited compliance and dissatisfying results. The aim of this cadaver-based study is to evaluate the feasibility of the use of an external face fixator (EFF) for the treatment of CMF, its biomechanical values and to define the optimal pin insertion points and angles. Materials and Methods: An AO hand fixator was used. CMF of types Le Fort 1–3 with split fractures of the hard palate were treated with EFF on 13 anatomical specimens. Fractures were created using a chisel, and pins were placed in specific anatomical regions. The maximal pull-out force [N] of pins was analysed by a tensile force gauge, and Fmax of the mandibular pins was evaluated. Computer tomography scans were performed on the healthy, fractured and EFF-treated skulls. Results: The pull-out forces for the single pins were mandibular pins (n = 15, median 488.0 N), supraorbital pins (n = 15, median 455.0 N), zygomatic pins (n = 14, median 269.1 N), medial hard palate pins (n = 12, median 208.4 N) and lateral hard palate pins (n = 8, median 49.6 N). Conclusions: The results indicate that the operation technique is feasible, and the stability of the EFF is sufficient for maintaining the reduction. The required pins can safely be inserted into the described areas with good reduction results. Using EFF offers a feasible alternative to the non-surgical treatment of CMF in LIC. Full article

We present the clinical course of a 9-year-old female patient with Bloch–Sulzberger syndrome and severe neurological deficit that met the major (classic cutaneous signs) and minor (dental anomalies and retinal pathology) diagnostic criteria of Landy and Donnai. Longitudinal multidisciplinary follow-up was carried out from birth to adulthood. Neurological involvement was assessed with electroencephalographic (EEG) and neuroimaging tests at different times during the patient’s life. Cranio-maxillofacial involvement was evaluated using lateral skeletal facial and cephalometric analyses. The right and left facial widths were measured through frontal face analysis and using the vertical zygomatic–midline distance. Oral rehabilitation was performed through orthodontic treatment and major dental reconstruction using composite resins. This treatment aimed to improve the occlusion and masticatory function, relieve the transversal compression of the maxilla, and reconstruct the fractured teeth. We believe that, due to significant neurological and cognitive impairment, orthognathic surgery was not the best option for restoring function and improving oral health-related quality of life. Full article

Study Design: Survey. Objective: Subcondylar fractures stand out as a particular challenge when treating maxillofacial trauma. The fracture site is often difficult to access and adjacent to critical structures like the facial nerve. Current treatment paradigms vary widely and we endeavored to elucidate these approaches from surgeons across the full breadth of Craniomaxillofacial Surgery. Methods: A survey was designed to gather general background training and experience information, perceived indications for ORIF of subcondylar fractures, options for treating subcondylar fractures, and reasoning for choosing or not choosing a given treatment approach. The survey was sent to members of AO CMF and the American Academy of Facial Plastic Surgery. Responses were collected for 4 weeks. Results: 514 total responses to the survey were obtained (response rate 17%). Of these, 43 (8.4%) identified as Otolaryngology trained, 417 (81.1%) as OMFS trained, and 54 (10.5%) as Plastic Surgery trained. While there was broad agreement in the indications for open repair, surgical approaches differed by specialty background as well as AO faculty member status. Those with less experience were less likely to perform open approaches due to lack of comfort with this skill set. Conclusions: There are some key differences in approaches to treatment of subcondylar fractures based upon specialty background and experience level. This provides an opportunity for further education to ensure optimal treatment for patients. Full article

Our study, “The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland,” published in 2021 (Vol. 14(4), pages 308–316, https://doi.org/10.1177/1943387520983634) in the journal Craniomaxillofacial Trauma & Reconstruction, is an analysis of the HCUP Kid Inpatient Database (KID), a restricted-access, publicly available dataset that is maintained by the Agency for Healthcare Research and Quality (AHRQ) [...] Full article

Study Design: This retrospective cohort study utilized the National Inpatient Sample (NIS) database for the years 2016–2018. Incidences of street fighting were identified using the corresponding ICD-10 codes. Objective: To determine whether alcohol use (measured by blood alcohol content (BAC)) in patients sustaining maxillofacial trauma from hand-to-hand fighting influence hospitalization outcomes. Methods: The primary predictor variable was BAC stratified into six categories of increasing magnitude. The primary outcome variable was mean length of hospital stay (days). The secondary outcome variable was total hospital charges (US dollars). Results: Our final sample consisted of 3038 craniomaxillofacial fractures. Each additional year in age added +$545 in hospital charges (p < 0.01). Non-elective admissions added $14,210 in hospital charges (p < 0.05). Patients admitted in 2018 experienced approximately $7537 more in hospital charges (p < 0.01). Le Fort fractures (+$61,921; p < 0.01), mandible fractures (+$13,227, p < 0.01), and skull base fractures (+$22,170; p < 0.05) were all independently associated with increased hospital charges. Skull base fractures added +7.6 days to the hospital stay (p < 0.01) and each additional year in patient age added +0.1 days to the length of the hospital stay (p < 0.01). Conclusions: BAC levels did not increase length of stay or hospitalization charges. Le Fort fractures, mandible fractures, and skull base fracture each independently increased hospital charges. This reflects the necessary care (i.e., ICU) and treatment (i.e., ORIF) of such fractures.Older adults and elderly patients are associated with increased length of stay and hospital charges—they are likely to struggle in navigating the healthcare system and face socioeconomic barriers to discharge. Full article

Study Design: Cadaveric investigation. Objective: Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF. Methods: Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site. Results: For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-ofeight wiring, and plating respectively (p < 0.001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (p < 0.001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (p = 0.002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (p = 0.29). Conclusions: Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures. Full article

Nonunion is one of the most dreaded complications after operative treatment of mandible fractures or after mandible reconstruction using vascularized and non-vascularized bone grafts. Often diagnosis is made at advanced stage of disease when pain or complications occur. Devices that monitor fracture healing and bone regeneration continuously are therefore urgently needed in the craniomaxillofacial area. One promising approach is the strain measurement of plates. An advanced prototype of an implantable strain measurement device was tested after fixation to a locking mandible reconstruction plate in multiple compression experiments to investigate the potential functionality of strain measurement in the mandibular region. Compression experiments show that strain measurement devices work well under experimental conditions in the mandibular angle and detect plate deformation in a reliable way. For monitoring in the mandibular body, the device used in its current configuration was not suitable. Implant strain measurement of reconstruction plates is a promising methodical approach for permanent monitoring of bone regeneration and fracture healing in the mandible. The method helps to avoid or detect complications at an early point in time after operative treatment. Full article

Study Design: retrospective cohort study. Objective: 3D printing is used extensively in cranio-maxillo-facial (CMF) surgery, but difficulties remain for surgeons to implement it in an acute trauma setting because critical information is often omitted from reports. Therefore, we developed an in-house printing pipeline for a variety of cranio-maxillo-facial fractures and characterized each step required to print a model in time for surgery. Methods: All consecutive patients requiring in-house 3D printed models in a level 1 trauma center for acute trauma surgery between March and November 2019 were identified and analyzed. Results: Sixteen patients requiring the printing of 25 in-house models were identified. Virtual Surgical Planning time ranged from 0 h 08 min to 4 h 41 min (mean = 1 h 46 min). The overall printing phase per model (pre-processing, printing, and postprocessing) ranged from 2 h 54 min to 27 h 24 min (mean = 9 h 19min). The overall success rate of prints was 84%. Filament cost was between $0.20 and $5.00 per model (mean = $1.56). Conclusions: This study demonstrates that in-house 3D printing can be done reliably in a relatively short period of time, therefore allowing 3D printing usage for acute facial fracture treatment. When compared to outsourcing, in-house printing shortens the process by avoiding shipping delays and by having a better control over the printing process. For time-critical prints, other time-consuming steps need to be considered, such as virtual planning, pre-processing of 3D files, postprocessing of prints, and print failure rate. Full article

Introduction: Craniomaxillofacial fractures (CMF) are common in low-income countries (LIC). Due to limited resources, treatment of these fractures usually consists of interdental wiring or immobilization with a Barton bandage to maintain the reduction by permanent occlusion. These non-surgical treatment methods often lead to unsatisfactory results, such as a disturbed dental occlusion and lockjaw. The aim of this study is to present an off-label treatment option for CMF by applying a hand fixator as external face fixator (EFF) and to demonstrate the surgical method in detail. Materials and Methods: The feasibility and postoperative outcomes of this new off-label operation technique were evaluated by analyzing patients with CMF (n = 13) treated at an NGO hospital in Sierra Leone between 2015 and 2019. Results: The application of the EFF was feasible. The biggest advantage compared to the conventional non-operative methods was, that a dynamic occlusion was still possible during the 6 weeks healing period. Hence, patients could eat and drink almost normally and perform dental hygiene with the EFF in place. We did not discover pintrack infections or other complications. Three patients developed an oronasal fistula due to traumatic a palatal bone loss of about 7–8 mm which was treated by a palatal mucoperiosteal flap 15–20 days after the first operation. Discussion and Conclusions: In LIC, where plate osteosynthesis for CMF cannot be performed due to limited resources the application of an EFF is a promising alternative for a better outcome and an improved quality of life for the patients. Full article