Search Results (319)

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

Background: Interpersonal violence is one of the most common causes of maxillofacial injuries. These injuries can range from minor soft-tissue injuries to serious, life-threatening conditions. This is particularly important when injuries occur in an exposed and vulnerable area of the body, such as the facial area. This study aimed to analyse the types of maxillofacial injuries, assess a profile of a typical victim of violence and determine the circumstances of the injury. Methods: A retrospective review was performed on the clinical data of patients managed for maxillofacial trauma resulting from interpersonal violence at the Department of Maxillofacial Surgery, University Clinical Hospital, Poznan, spanning the period from 2021 to 2025. Results: The study group included 510 patients, of which 95.41% were males, and the median age in the study group was 34 years. Furthermore, 14.71% of patients were under the influence of alcohol at the time of the violent incident. Most injuries occurred in 2022 (25.88%). Regarding months, June had the highest reported incidents (10.59%), while Saturday was the most injury-prone day (25.10%). The median days of hospitalisation in the study group was five. The mandible was the most frequently affected area. The most common types of fractures were single mandible fractures (30.59%) and double mandible fractures (27.25%). Most injuries were treated surgically (96.67%). In 10.20% of cases, the intervention of other specialists was needed. Conclusions: It is important to effectively prepare medical staff to receive patients with a history of interpersonal violence to diagnose and treat these types of injuries properly. Full article

Primary Objective: To characterize high-resolution computed tomography (HRCT) fracture patterns, namely orientation and otic capsule status, among Sudanese patients with acute temporal bone trauma. Secondary Objectives: (i) To quantify the prevalence and pattern of concomitant craniofacial fractures, (ii) to describe early audiologic outcomes, and (iii) to document facial nerve dysfunction. Methods: Prospective cross-sectional study of 45 consecutive patients (≥5 years) with HRCT-confirmed TBF sustained within 7 days of injury, managed at two tertiary otolaryngology centers in Khartoum (October 2022–March 2023). All imaging, clinical, and audiologic variables were recorded once at the index presentation (≤7 days after trauma); the study did not include longitudinal follow-up. Two blinded experts independently classified fracture orientation (longitudinal, transverse, mixed/oblique), otic capsule status (sparing [OCS] vs. otic capsule-violating [OCV]), and ancillary HRCT signs (ossicular chain disruption, tympanic plate fracture, pneumolabyrinth/CSF leak); inter-observer reliability was assessed with Cohen’s κ. Concomitant craniofacial fractures, pure-tone audiometry, and House–Brackmann facial nerve grades were recorded. Predictor–outcome associations were examined with χ² statistics (p < 0.05). Results: Mean age 35.9 ± 17.4 years; 78% male. Road traffic accidents were associated with 58% of injuries. HRCT showed 60% longitudinal, 20% transverse, and 20% mixed/oblique fractures; 27% were OCV. Ossicular chain disruption, tympanic plate fracture, and ppneumolabyrinthCSF leak were present in 17.8%, 13.3%, and 8.9%, respectively. Concomitant craniofacial fractures occurred at 27%, chiefly Lefort III (15.6%) and Lefort II (8.9%). Transverse/mixed fractures were strongly associated with Lefort II–III injuries (χ² = 16.2, p = 0.001); age (p = 0.21) and sex (p = 0.08) were non-significant. Conductive, sensorineural, and mixed hearing loss affected 69%, 13%, and 18%; facial nerve palsy occurred in 58%. Inter-observer agreement was substantial to almost perfect for all imaging variables (κ = 0.77–0.92). Conclusions: Although longitudinal fractures predominated, over one-quarter breached the otic capsule and one-fifth followed transverse/mixed planes, configurations associated with higher odds of conductive deafness, facial nerve palsy, and complex mid-facial fractures. HRCT provides reliable characterization and should underpin comprehensive head-and-mid-face trauma protocols. Enhanced road safety policies and multidisciplinary trauma care are vital for reducing neuro-otologic morbidity in resource-limited settings. Full article

Background/Objectives: Cochlear implants (CIs) constitute a viable method for auditory rehabilitation in patients with profound sensorineural hearing loss after temporal bone fractures (TBFs). These patients comprise a challenging population due to the anatomical deformity and neural injury. Methods: By performing this systematic review, we attempted to evaluate the viability of CIs in the context of TBF. The literature search, across Pubmed/MEDLINE, Scopus and Google Scholar, was performed under the PRISMA guidelines. The selected time period was from December 1995 to September 2025. The final analysis included 11 manuscripts. The majority of the studies were retrospective case series with a moderate risk of bias. Results: The primary outcome was postoperative auditory function, evaluated with speech perception tasks and aided sound-field pure-tone audiometry. The secondary outcomes were the report of radiological and electrophysiologic prognosticators of implants’ viability, timing of surgery, procedural feasibility and complications. Across the studies, CIs conferred meaningful auditory benefit when the cochlear nerve was intact. High-Resolution Computed Tomography (CT) was utilized for TBF classification and cochlear patency, whereas Magnetic Resonance Imaging (MRI) and a promontory test were crucial for the assessment of neural integrity. Prompt placement, optimally within 12 months after trauma, was related to improved outcomes by limiting cochlear fibrosis and ossification. Despite patients’ impedance fluctuation, restricted speech perception in noise and frequent abnormal facial nerve excitation, the overall audiologic and speech discrimination results are comparable to non-trauma recipients. Conclusions: A CI appears to be the choice of treatment over auditory brainstem implants, as long as the cochlear nerve remains intact. Rapid implantation in well-selected patients coupled with ordinal mapping and follow-up can restore dysfunctional hearing and improve patients’ quality of life. Full article

Background/Objectives: Subcondylar mandibular fractures represent a challenging subset of maxillofacial trauma due to their proximity to the temporomandibular joint and the facial nerve. The retromandibular approach can be performed through either an anteroparotid or a transparotid route, but comparative clinical data remain limited. This study aimed to evaluate clinical outcomes, complication profiles, and operative parameters associated with the retromandibular anteroparotid versus transparotid approach for open reduction and internal fixation (ORIF) of subcondylar fractures. Methods: A retrospective analysis was conducted on 80 consecutive patients treated for subcondylar mandibular fractures at the Department of Maxillofacial Surgery, Umberto I General Hospital, Sapienza University of Rome, between 2018 and 2025. All patients underwent ORIF via a retromandibular approach (anteroparotid or transparotid) with a minimum follow-up of 6 months. Demographic data, trauma etiology, fracture morphology (classified as simple or complex), associated fractures, surgical approach, fixation details, operative time, hospital stay, and postoperative complications were collected. Facial nerve function was clinically assessed and graded using the House–Brackmann scale. Associations between fracture type, surgical approach, number of plates, and complications were evaluated using Chi-square or Fisher’s exact tests, while operative time was compared using one-way ANOVA and Kruskal–Wallis tests (p < 0.05). Results: The cohort had a mean age of 41.9 years and was predominantly male (67.5%). The anteroparotid route was used in 54 patients (67.5%) and the transparotid route in 26 (32.5%). Overall, 10 patients (12.5%) developed postoperative complications, including transient facial nerve weakness, malocclusion, visible scarring, and sialocele. All cases of sialocele occurred in the transparotid subgroup, whereas no salivary complications were observed after the anteroparotid approach. No permanent facial nerve deficits, temporomandibular joint ankylosis, or long-term facial asymmetry were recorded at 6 months. No significant association was found between surgical approach and overall complication rate, but complex fracture patterns were significantly associated with increased operative time. Conclusions: The retromandibular approach is a safe and effective option for ORIF of subcondylar mandibular fractures. Both anteroparotid and transparotid routes provided reliable exposure and stable fixation with low complication rates. The anteroparotid route appears to minimize parotid-related complications, such as sialocele, while maintaining comparable functional outcomes. These findings support the retromandibular anteroparotid approach as a valuable alternative in the surgical management of subcondylar fractures. Full article

Background: Facial fractures are common in emergency and trauma care, with age and sex known to influence fracture patterns, injury mechanisms, and treatment approaches. However, detailed comparative data analyzing these demographic variables separately remain limited. Methods: In this retrospective single-center study, we analyzed 561 patients with radiologically confirmed facial fractures who were treated between January 2021 and December 2022. Patients were stratified by sex and age (<50 vs. ≥50 years). Fracture types, trauma causes, and treatment modalities were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Results: Male patients comprised 60.1% of the cohort. Interpersonal violence, alcohol-related trauma, and sports injuries were significantly more frequent in males, while females experienced more falls and syncopes (p < 0.001). Although most fracture types did not differ significantly by sex, female patients underwent surgical treatment significantly less often than males (OR = 0.45, 95% CI: 0.32–0.64, p < 0.001). Patients over 50 years were significantly less likely to suffer mandibular fractures (OR = 0.59, 95% CI: 0.40–0.88, p = 0.009), while frontal sinus fractures were more common in older individuals (OR = 4.77, 95% CI: 1.02–22.27, p = 0.029). Younger patients more often experienced interpersonal violence, alcohol-related incidents, and received operative care, whereas falls and conservative treatment were more frequent among older individuals. Conclusions: Age and sex significantly influence the epidemiology and management of facial fractures. Understanding these demographic differences can guide targeted prevention strategies and assist clinical decision-making in facial trauma care. 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

The study aims to reconstruct the life history of an individual whose skeleton was recovered during the excavation of the late medieval Pauline monastery of the Blessed Virgin Mary on Moslavina Mountain, Croatia. The monastery was one of the most important ecclesiastical centres in continental Croatia during the 14th/15th centuries CE and was abandoned between 1520 and 1544 due to fear of imminent Ottoman attacks. The inscription and coat of arms on the tombstone of a tomb located in the chancel, next to the main altar, indicate that the skeleton belongs to Sofia Kaštelančić née di Prata (di Pordenone), a member of Croatian late medieval high-ranking nobility. We conducted a conventional bioarchaeological study, carbon and nitrogen stable isotopes analysis, paleoradiological imaging (CT/CBCT scanning), and three-dimensional facial reconstruction. The skeleton belongs to a middle-aged woman between 40 and 50 years old with an estimated stature of about 161 cm. Numerous pathological changes, such as ante mortem tooth loss, caries, abscess, linear enamel hypoplasia, dysodontiasis, and osteophytosis were observed, with the most notable pathology being the fracture of the right ankle, a fact also confirmed by CT scanning. Carbon and nitrogen isotopic values are consistent with a terrestrial diet based on C₃ plants with no marine input, and the consumption of large quantities of animal-based proteins. Three-dimensional facial reconstruction made it possible for the first time in over 500 years to obtain the approximate physical appearance of the individual. The presented results are consistent with the hypothesis that the skeleton probably belongs to Sofia Kaštelančić. Nevertheless, none of the observed osteological traits are individually or collectively diagnostic of Sofia, so, in the absence of individualising evidence, the identification remains hypothetical rather than demonstrative. Full article

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. Full article

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. Full article

Background: Maxillofacial trauma can impair crucial functions of the stomatognathic system. Mandibular condyle fractures, in particular, often lead to temporomandibular joint (TMJ) dysfunction. Methods: This study evaluated the effectiveness of open rigid internal fixation (ORIF) in restoring TMJ function, using the Helkimo Index to compare pre- and post-operative outcomes. Results: A total of 395 patients who underwent ORIF for condylar fractures were analyzed (302 males, 93 females). TMJ function improved significantly from baseline to 6-month follow-up (p < 0.001), with a mean reduction of 2.18 grades on the Helkimo Index. Higher post-operative Helkimo grades (2–3) occurred more frequently during warm months than during cold months (p < 0.05). Low body mass index (BMI) was associated with a greater risk of post-surgical TMJ dysfunction (p < 0.001). TMJ function correlated with facial nerve recovery: patients with poorer pre-operative TMJ function showed additionally slower facial nerve recovery during the first five months after surgery. Age, gender, place of residence, injury characteristics, comorbidities, delay of surgery, duration of surgery, surgical approach, fixing material and laboratory blood tests showed no significant association with post-operative TMJ function. Residual TMJ dysfunction was observed in 3% of treated patients (Di = 3). Conclusions: ORIF, combined with appropriate post-operative physiotherapy, effectively restores TMJ function after condylar fractures—including severe injuries. Simple clinical indices such as the Helkimo Index reliably capture functional improvement. Full article

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. Full article

Objectives: The aim of this study was to determine the epidemiological characteristics of bicycling-related maxillofacial fractures in a defined population and to identify factors contributing to these injuries. Methods: An 8-year cohort study was carried out, including all patients presenting with bicycling-related maxillofacial fractures at a tertiary care center from 2017 through 2024. Data recorded for each patient included age, gender, date and cause of injury, contributing factors, type of facial fractures, other injuries, hospital stay, and helmet use. Statistical analysis was performed. Continuous variables were assessed for normality (Shapiro–Wilk test) and compared using the Mann–Whitney test. Categorical variables were analyzed with chi-square tests. A p-value ≤ 0.05 was considered statistically significant. Results: Out of 899 cycling accident patients seeking medical treatment, 122 (13%) sustained facial fractures, accounting for 4% of all facial fracture cases in our department during the study period. In our cohort, the male–female ratio was 2.6:1, and the mean age was 29.5 years (SD 12.8, range 13–77). Collision with another object/vehicle was the most common cause (64%), followed by isolated falls (36%). A total of 135 facial fractures were recorded (some patients had multiple fractures). Mandibular fractures were most frequent (49% of patients), followed by zygomatic (32%), orbital (13%), nasal (7%), maxillary (2%) and frontal (2%) fractures. Among mandibular injuries, condylar fractures were the most common subtype (63%). Dental injuries were found in 27% of patients. The most common dental trauma was tooth fracture (43% of those with dental injuries), followed by tooth luxation (32%) and tooth avulsion (25%). In 80% of cases involving dental injuries, the upper anterior teeth were involved. Concomitant injuries were present in 20% of patients, most often orthopedic limb injuries. Only 27% of patients reported always wearing a helmet, whereas 43% reported never having worn one. Conclusions: Bicycling-related facial injuries are a noteworthy subset of facial trauma. Missed or delayed diagnosis can lead to lasting deformities and functional issues. Preventive strategies—especially promoting helmet use and improving helmet design—along with broader safety measures are important to reduce the incidence and severity of these injuries. Full article

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. Full article