Search Results (332)

Cannabis use has increased substantially in the United States, driven by broader legalization, decriminalization, and expanding medical and recreational availability. For facial plastic surgeons, the clinical implications remain difficult to define because “cannabis use” encompasses heterogeneous products and routes, including smoked flower, vaping, concentrates, edibles, pharmaceutical cannabinoids, topical cannabidiol (CBD), and frequent co-use with tobacco or nicotine. Current evidence suggests that systemic cannabis use, particularly inhaled or heavy perioperative use, may be associated with increased surgical complications in selected populations; however, existing studies are limited by retrospective design, inconsistent exposure definitions, inadequate dose and route characterization, and confounding by tobacco use and comorbidities. Cannabinoids exert biologic effects through the endocannabinoid system, particularly CB1 and CB2 receptors, which are expressed in the central nervous system, immune cells, vasculature, and skin. These pathways influence inflammation, keratinocyte proliferation, fibroblast activity, angiogenesis, immune surveillance, pain signaling, and tissue remodeling. The net effect of cannabinoid exposure on wound healing is likely context dependent, varying based on receptor expression, wound-healing phase, route of administration, cannabinoid composition, local tissue environment, and patient-specific risk factors. Preclinical and early dermatologic literature suggests potential therapeutic roles for topical cannabinoids, especially CBD, in modulating inflammation and epithelial repair. In contrast, systemic perioperative cannabis use has been associated in several surgical cohorts with infection, delayed healing, hematoma, nonunion, and reoperation. Evidence specific to facial plastic surgery remains sparse. The most directly relevant study evaluated cannabis and tobacco use in patients undergoing operative mandibular fracture repair. Cannabis-only use was not associated with increased complications, although the cohort was small; concurrent cannabis and tobacco use was associated with higher rates of surgical site infection, facial nonunion, abscess, debridement, and malocclusion. To date, no published studies address cannabis-associated outcomes in rhinoplasty, rhytidectomy, blepharoplasty, browlift, or facial rejuvenation. This review summarizes the biologic rationale, available surgical evidence, and clinical considerations for incorporating cannabis use into individualized perioperative risk assessment in facial plastic surgery. Full article

Objectives: To systematically review the evidence on horse-related maxillofacial trauma, with emphasis on horse-kick injuries, anatomical patterns, associated injuries, management, outcomes, and prevention. Methods: This systematic review followed the PRISMA 2020 statement. PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched for original clinical studies reporting facial, craniofacial, orbital, dental, or maxillofacial injuries related to horse-associated activities. Data were extracted on study characteristics, demographics, mechanism, mounted/unmounted status, anatomical site, associated injuries, treatment, complications, outcomes, mortality, and protective equipment. Due to substantial heterogeneity in study design, denominators, and outcome reporting, a structured narrative synthesis was performed without formal meta-analysis. Results: Twenty-eight original clinical studies were included. Maxillofacial-specific series consistently identified horse kicks as a major mechanism, especially among unmounted individuals. Injuries most frequently involved the midface, orbit, zygomaticomaxillary complex, mandible, nasal region, and dentoalveolar structures. Severe presentations included optic nerve avulsion, orbitocranial penetrating trauma, naso-orbito-ethmoid and frontal sinus fractures, airway compromise, intracranial injury, and multisystem trauma. Management ranged from conservative treatment to operative fixation, orbital reconstruction, soft tissue repair, advanced airway management, and multidisciplinary care. Helmet use was often absent or poorly documented, particularly during unmounted activities. Conclusions: Horse kicks represent a distinct localized high-energy mechanism of maxillofacial trauma. Prevention should extend beyond riding and include facial protection, protective eyewear, and safety protocols for ground-based horse handling. Full article

Background/Objectives: The present investigation was designed and conducted with the aim to evaluate the statistical significance of the Comprehensive Facial Injury (CFI) score in relation to total surgical time (ST), length of hospital stay (LOS), and the presence of head injury in patients with fractures of the maxillofacial skeleton. Methods: The study includes 332 patients with maxillofacial fractures, a subset of whom also had associated head injuries. The CFI score was calculated for each patient. The Kolmogorov–Smirnov test was applied to assess the distribution of score values within the cohort. The Kruskal–Wallis H test was used to compare ST (minutes), LOS (days), and Glasgow Coma Scale (GCS) scores across different CFI score groups. Statistical significance was defined as p < 0.05. Results: The majority of the patients were male, at 77.1%, with 22.9% female. The mean age was 36.4 years, with a standard deviation of 19.3 years. Definitive surgical treatment was performed in 58.7% of patients, while the remaining 41.3% were managed conservatively (with closed reduction and external fixation) or received no surgical intervention. A statistically significant association was found between the CFI score and both ST and LOS (p < 0.001). Associated head injury was found in 33 patients or 9.9%. Furthermore, significant correlations were observed between CFI score values and Glasgow Coma Scale scores (p < 0.001) as well as the presence of head injury (p < 0.001). Conclusions: In conclusion, the CFI score provides a straightforward and comprehensive framework for assessing both operative duration and hospitalization length in patients with maxillofacial trauma. Moderate correlations between the CFI score and all investigated variables support its reliability in assessing trauma severity. The CFI score may therefore be useful in guiding treatment planning and developing standardized clinical protocols. However, its predictive capacity requires further validation in future studies. Full article

Background/Objectives: The aims of this study were to investigate maxillofacial trauma resulting from electric scooter accidents and to identify risk factors associated with the location of injuries. Methods: An 8-year retrospective cohort study was conducted involving all patients presenting with electric scooter-related maxillofacial fractures at a tertiary care center from 2017 to 2024. Data recorded for each patient included gender, age, date and cause of injury, contributing factors, type of facial fractures, other injuries, helmet use, and length of hospital stay. Results: Maxillofacial fractures were diagnosed in 138 patients (18.5% of e-scooter accident presentations). The study included 93 male and 45 female patients (ratio 2:1), with a mean age of 25.8 ± 7.75 years (range 14–45 years). Patients aged 20–29 years formed the largest group (51%). Most patients (89%) sustained a single facial fracture, and the most affected facial area was the lower third, with 80 cases (58%), followed by the middle third (36%). The remaining patients were represented by a combination of the various facial thirds, with thirds I-II being the most representative (12%). The most recurrent patterns were multifocal mandibular fractures (55%), followed by fractures of the orbito-malar-zygomatic complex (33%). Dental injuries were also frequent and were recorded in 40 patients (29% of all cases). Concomitant injuries outside the facial region were documented in 32 patients (23%), among which orthopedic limb injuries were most common (44% of patients with concomitant injuries). Contributing factors were identifiable in 102 patients (74%). Self-reported helmet use was low, with 63% of patients reporting never wearing a helmet, and 27% reporting inconsistent or occasional use. Conclusions: Accidents involving personal mobility vehicles have become a primary cause of emergency room admissions in recent years. Although electric-scooter-related maxillofacial fractures are a new phenomenon, an awareness of their frequency, contributing factors, and anatomical distribution is important for emergency and trauma teams who assess these patients first. Early recognition and timely management are crucial because missed diagnoses or delayed treatment can lead to permanent facial deformities and functional disability. These findings can inform targeted public health strategies and injury-prevention programs. In the future, helmet designs should be modified to improve maxillofacial protection in scooter-related injuries. Full article

Craniomaxillofacial trauma (CMFt) poses a significant burden, yet in many countries the evidence base is fragmented across single-center hospital series without specialized registry. Using Chile as a case study, we demonstrate a dual-synthesis approach to construct a national CMFt profile. Six databases were searched through February 2026 (PROSPERO: CRD420261290860). Two reviewers independently screened studies. Risk of bias was assessed with the JBI critical appraisal tool. Fracture-site proportions were pooled via random-effects meta-analysis and synthesized using GRADE. DEIS trauma discharges (2001–2024) were analyzed with negative binomial interrupted time-series. Nineteen studies were included. CMFt represented 2.6–6.1% of emergency consultations. CMFt admissions were 54.2/1000 trauma discharges; this rate dropped during 2020–2021 and rebounded post-2022. Pooled fracture-site distributions were highest for mandibular (45.3%) and zygomatic (24.2%) fractures. CMFt disproportionately affected males across both hospital series and national discharge data. According to DEIS, low-energy accidental injuries were the predominant etiology, followed by transport-related high-energy injuries and interpersonal violence, contrasting with hospital series where interpersonal violence predominated among adult surgical cohorts. Fracture admissions had longer length of stay (LOS) than soft-tissue CMFt (+0.94 days), with mean LOS ranging from 2.08 (nasal) to 8.35 days (multiple skull/facial fractures). These findings support prioritizing surgical preparedness and training in common fracture patterns, while strengthening trauma surveillance, referral pathways, and service planning in health systems without dedicated CMFt registries. Full article

The progressive development of microscopic fractures within rock masses is a primary mechanism of macroscopic failure, threatening the structural integrity of rock engineering systems. In this paper, a novel deep learning model, Principal Component Analysis (PCA)-Visual Geometry Group 16 (VGG16), is developed to accurately identify spectrogram features associated with limestone fractures. In this architecture, a PCA-based convolution encoder is seamlessly integrated as a foundational preprocessing layer before feedforwarding into the deep neural network to execute linear feature purification. The model is first validated on standard image datasets comprising handwritten digits and facial images to evaluate classification performance. Subsequently, acoustic emission signals are acquired during triaxial compression tests on limestone specimens pretreated with cyclic acid–alkali exposure. The PCA-VGG16 framework is then employed to classify the corresponding acoustic spectrograms, and its performance is quantitatively compared with a conventional convolutional neural network (CNN) and the standard VGG16 model. The results indicate that the PCA-VGG16 model achieves classification accuracies that are 19.19% and 10.77% higher than the conventional CNN and standard VGG16 models, respectively. In terms of computational efficiency, the training time is reduced by 35.00% and 23.53% compared to CNN and VGG16. The superior classification performance of the proposed PCA-VGG16 model enables accurate identification of internal microscopic fracture characteristics in limestone. Furthermore, the integration of acoustic emission signals with deep learning models offers an effective approach for quantifying internal fracture levels and predicting the progressive failure of rocks. Full article

Background: Facial trauma is frequently managed by multiple surgical specialties, but department-specific case distribution within a single institution has not been well characterized. This study aimed to describe the distribution of facial trauma cases managed by Oral and Maxillofacial Surgery (OMFS) and Plastic Surgery (PS) from 2016 to May 2025 and to evaluate department-specific patterns according to injury type, anatomical site, demographic characteristics, and temporal changes during the COVID-19 period. Methods: This single-center retrospective observational study included facial trauma cases managed by OMFS or PS after presentation to the emergency department at Chosun University Hospital between 1 January 2016 and 31 May 2025. Aggregated count data on demographic characteristics, fracture sites, laceration sites, injury mechanisms, dental trauma diagnoses, and annual case numbers were analyzed using cross-tabulation and chi-square tests. Results: A total of 6611 facial fracture patients and 17,133 facial laceration cases were analyzed. PS managed a larger number of facial fracture and laceration cases overall, whereas OMFS-managed cases were more concentrated in mandibular fractures and dental trauma. Sex distribution did not differ significantly between departments (p = 0.126), whereas age distribution differed significantly (p < 0.001). The annual distributions of facial fracture and laceration cases also differed between departments (p = 0.003 and p < 0.001, respectively). Zygomatic arch fractures represented the largest midfacial fracture-site category managed by PS, whereas condylar and angle fractures were the two most frequently recorded mandibular fracture-site categories managed by OMFS. Conclusions: This study describes department-specific distributions of facial trauma cases in a single tertiary institution. The findings should be interpreted as reflecting institutional case routing and documentation patterns rather than intrinsic differences between specialties. These data may support local audit of department-managed case distributions and generate hypotheses for future multicenter research. Full article

Background: Modern warfare has introduced novel mechanisms of injury, particularly drone-induced blast trauma, resulting in complex craniomaxillofacial injuries. These injuries differ substantially from typical ballistic wounds and require adapted surgical strategies. This study was conducted to evaluate the clinical characteristics, management approaches, and long-term outcomes of midfacial blast injuries. Methods: A retrospective analytical study was conducted on 41 patients with drone-induced midfacial blast injuries treated at a tertiary referral center in Armenia following the 2020 Nagorno-Karabakh War. All patients underwent surgical management after initial stabilization and were followed for 5 years. Clinical outcomes, complications, and reconstructive needs were assessed. Results: All patients presented with comminuted midfacial fractures, which were frequently associated with polytrauma (87.8%). Burns were observed in 82.9% of cases. Surgical management included radical debridement and early definitive osteosynthesis using titanium fixation systems. No cases of postoperative osteomyelitis, bone sequestration, or implant failure were observed during the 5-year follow-up period. Patients with extensive soft tissue defects, particularly nasal and lip amputations, required multiple reconstructive procedures. Long-term follow-up revealed progressive soft tissue thinning over titanium meshes, especially in the zygomatico-orbital region, necessitating secondary interventions such as lipofilling. Conclusions: Drone-induced midfacial blast injuries represent a distinct and severe form of trauma. Early definitive reconstruction following adequate debridement was associated with favorable outcomes. However, soft tissue reconstruction remains challenging and often requires staged procedures. Long-term follow-up is essential to manage delayed complications and optimize aesthetic outcomes. Full article

(1) Background: Mandibular condylar fractures continue to be a subject of debate, traditionally framed as a choice between open and conservative management. However, this binary approach fails to adequately account for fracture-level anatomy, Temporomandibular joint (TMJ) involvement, and functional outcomes. (2) Purpose: To present an imaging-guided, fracture-level-based algorithm that integrates radiologic evaluation, surgical approach selection, fixation biomechanics, and functional rehabilitation. (3) Review Strategy: This invited review combines current evidence with a 13-year institutional experience involving 495 joints. High-resolution Computed Tomography (CT) Imaging was used to assess fracture morphology, displacement, and ramal height, while Magnetic Resonance Imaging (MRI) was selectively employed in intracapsular fractures to evaluate disc–condyle relationships when intra-articular involvement was suspected. Management decisions, including surgical approach and fixation strategy, were guided by an institutional algorithm tailored to fracture characteristics. (4) Results: Implementation of this approach yielded consistent and predictable outcomes. Mouth opening improved from approximately 18.77 mm preoperatively to 40 mm at 6 months. Lateral excursions became symmetrical (~9.6 mm), occlusion was restored in all patients, and bite force returned to near-physiological levels. Pain scores showed near complete resolution within 1 month. Postoperative morbidity remained low, with predominantly transient facial nerve weakness. (5) Conclusions: This imaging-guided, algorithmic framework provides reproducible functional outcomes and signifies a shift toward structured, anatomically driven management of condylar fractures. Full article

Fibrous dysplasia is one of the most common skeletal lesions. The wide spectrum of clinical manifestations ranges from asymptomatic conditions (typical of monostotic forms) to severe skeletal diseases with deformity and fractures for polyostotic fibrous dysplasia. The classical radiological features include: an osteolytic geographic pattern, ground-glass bone matrix, cortical thinning/cortical scalloping, bone deformities and enlargement, concavity of margins (evaluated with MRI), and cystic areas (MRI). All the bones can be affected, and the proximal femur is the most common one (about 30% of cases). Nonetheless, the disease can also affect cranio-facial bones, leading to compression of neural structures, as well as deformation and enlargement of facial bones, leading to the so-called “leontiasis ossea” or “facies leonine”. The polyostotic forms of fibrous dysplasia can be associated with multiple soft-tissue myomas (Mazabraud syndrome) or several endocrine diseases (McCune–Albright syndrome). In every diagnostic step of the disease, as well as in different fibrous dysplasia forms, imaging plays a key role. Indeed, radiology is fundamental to assess the suspicion of fibrous dysplasia in classical monostotic forms, representing the sole diagnostic tool needed in many cases. Imaging is also fundamental to staging and following up on more severe polyostotic forms, as well as for detecting complications. In this comprehensive updated review article, we examine every aspect of the disease, with a main focus on imaging presentation. The indications for biopsy are discussed as well. Most importantly, the article details the potential risk of malignant transformation (osteosarcoma, fibrosarcoma, chondrosarcoma, and other rarer sarcomas, all accounting for <1% of cases) underlying the radiological patterns of these conditions. The occurrence of aneurysmal bone cyst-like changes on fibrous dysplasia is also analyzed in the article. This review article aims to be a comprehensive guide for radiologists and clinicians involved in the care of patients affected by various forms of fibrous dysplasia, and a starting point for future research. Many classical and atypical cases are collected as an iconographic comprehensive representation. Full article

The use of intraoperative computerised tomography (CT) to aid surgical management of facial fractures obviates the need for postoperative surgical scans, decreases return to theatre rates, and subsequently decreases overall hospital stay. This allows for better appreciation of a complex operative landscape in almost real time, and may become the gold standard of treatment. As with radiological investigations, decreasing radiation exposure of patients is a key goal. The aim of this study was to examine the effective radiation doses in patients undergoing surgical management of their facial fractures with the aid of a fixed-arm CT. This retrospective study was conducted on patients who underwent surgical fixation of their facial fractures within a hybrid surgical suite equipped with a fixed-arm cone beam CT (CBCT) from July 2023 to November 2024. The CBCT was used to assess adequacy of bony fixation. Data from imaging was collected to assess total effective radiation dose. Data from 30 random patients who underwent standard CT facial bones (CTFB) were collected as control. Data from 24 patients was collected. The majority were male (17/24, 70.8%) with an age range of 20–94 years. The average dose of the effective doses calculated in the CTFB cohort was 0.64 mSv (SD 0.05). This is a more-than-twenty-five-fold reduction in the average effective dose in the CBCT cohort, which was 0.025 mSv (SD 0.01). There was a statistically significant difference between the two cohorts with p < 0.0001 (95% CI 0.60–0.64). This study demonstrates that intraoperative CBCT delivers a significantly lower effective dose to patients compared with postoperative CTFB. Where facilities exist, CBCT offers a safer and more efficient alternative, with future work needed to assess staff dose, wait times, and cost impacts. Full article

Orbital fractures account for up to 16% of all facial fractures. Surgical intervention for these fractures depends on several factors, including globe displacement. This case-control study aimed to quantify the effects of orbital reconstruction on the three-dimensional globe position after orbital trauma. Pre- and post-operative radiological data of 29 cases (27 patients, with two patients requiring reintervention) with an orbital fracture were analyzed. The contralateral, unaffected orbits of the same patients served as the control group. This study used a recently validated method employing semi-automatic registration algorithms to measure globe displacement after trauma and its post-operative change. The statistical analysis, performed using the Mann–Whitney U test, showed significant globe position restoration in the anterior–posterior (2.15 mm, p ≤ 0.001) and medial–lateral (1.34 mm, p ≤ 0.001) directions, as well as in overall three-dimensional Euclidean distance (3.04 mm, p = 0.014) after surgery. The repositioning was clinically relevant in 62% of the cases, indicating that the three-dimensional globe repositioning was 2 mm or more with a positive clinical impact. Additionally, it was important to note that both the number of fractured walls and fractures of the inferomedial strut significantly affected globe repositioning after trauma. This finding highlights the importance of accurately considering the fracture pattern in surgical planning, as a better understanding of globe displacement following orbital trauma could enhance patient selection, surgical planning, and clinical outcomes. Full article

Background/Objectives: Bone fractures represent a growing public health concern worldwide, yet national epidemiological assessments remain limited in Brazil. Understanding temporal trends, demographic disparities, and geographic heterogeneity is essential to guide prevention, resource allocation, and trauma-care planning. To characterize the epidemiological profile of bone-fracture-related hospitalizations and mortality in Brazil between 2015 and 2024, analyzing trends by sex, age, fracture type, and geographic and ethnic distribution. Methods: An epidemiological, observational, descriptive, and population-based ecological study was conducted using Hospital Information System of the Unified Health System SIH/SUS and IBGE data. Hospitalization rates, case fatality rates (CFR), relative risks, odds ratios, and Years of Life Lost (YLL) were calculated. Temporal trends were evaluated using Annual Percent Change (APC). Results: Other limb fractures were the most frequent injuries, while femur fractures showed the highest lethality. Men had nearly twice the hospitalization rate of women, driven by high-energy trauma in adults aged 20–59 years, whereas women experienced a sharp increase in femur-fracture admissions at older ages. Skull, facial, and thorax/pelvis fractures contributed disproportionately to premature mortality. Marked geographic and ethnic disparities were observed, with higher burdens in the North/Northeast and predominance among Brown and Indigenous populations. Conclusions: Fracture-related hospitalizations in Brazil have increased consistently, with distinct epidemiological patterns across demographic and regional groups. These findings highlight the need for targeted prevention and improved trauma-care strategies. Full article

Background/Objectives: The subciliary approach offers excellent exposure for orbital and zygomaticomaxillary complex fracture repair but is associated with a relatively high risk of postoperative lower eyelid ectropion. This study evaluated the preventive efficacy of an acellular dermal matrix (ADM; WITHderm^®) spacer graft placed during subciliary incision repair. Methods: This prospective observational cohort study included 20 patients who underwent open reduction and internal fixation for orbital wall or zygomaticomaxillary complex fractures using a subciliary approach between June and December 2024. A human-derived ADM (WITHderm^®) spacer graft was interposed between the orbital septum and the orbicularis oculi muscle during incision closure. Postoperative outcomes were assessed at three time points: ectropion grading at 1 month and scar outcomes at 3 and 6 months using the Patient and Observer Scar Assessment Scale (POSAS). Results: No patients developed postoperative lower eyelid ectropion at 1-month follow-up (0% incidence). Both patient-reported and observer-reported scar outcomes improved significantly over time. The mean total PSAS score decreased from 21.0 ± 2.85 at 3 months to 11.3 ± 2.13 at 6 months (p < 0.001), while the mean total OSAS score decreased from 21.35 ± 2.25 to 11.4 ± 1.67 (p < 0.001). Overall patient satisfaction and objective scar ratings also showed significant improvement. Conclusions: ADM (WITHderm^®) spacer grafting during subciliary incision repair appears to be a safe and effective strategy for preventing early postoperative lower eyelid ectropion and achieving favorable scar outcomes. Further studies are warranted to confirm these findings. Full article

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. Full article