Search Results (5)

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

Background: Zygomatico-maxillary complex (ZMC) fractures are prevalent facial injuries with significant functional and aesthetic implications. Computer-assisted surgery (CAS) offers precise surgical planning and outcome evaluation. The study aimed to evaluate the application of CAS in the analysis of ZMC fracture outcomes and to propose a reproducible workflow for surgical outcome assessment using cephalometric landmarks. Methods: A retrospective cohort study was conducted on 16 patients treated for unilateral ZMC fractures at the Maxillofacial Surgery Unit of Siena University Hospital (2017–2024). Inclusion criteria included ZMC fractures classified as Zingg B or C, treated via open reduction and internal fixation (ORIF). Pre- and post-operative CT scans were processed for two- and three-dimensional analyses. Discrepancies between CAS-optimized reduction and achieved surgical outcomes were quantified using cephalometric landmarks and volumetric assessments. Results: Out of the 16 patients (69% male, mean age 48.1 years), fractures were predominantly on the right side (81%). CAS comparison between the post-operative and the contralateral side revealed significant asymmetries along the X and Y axes, particularly in the fronto-zygomatic suture (FZS), zygo-maxillary point (MP), and zygo-temporal point (ZT). Computer-assisted comparison between the post-operative and the CAS-simulated reductions showed statistical differences along all three orthonormal axes, highlighting the challenges in achieving ideal symmetry despite advanced surgical techniques. CAS-optimized reductions demonstrated measurable improvements compared to traditional methods, underscoring their utility in outcome evaluation. Conclusions: CAS technology enhances the precision of ZMC fracture outcome evaluation, allowing for detailed comparison between surgical outcomes and virtual simulations. Its application underscores the potential for improved surgical planning and execution, especially in complex cases. Future studies should focus on expanding sample size, refining workflows, and integrating artificial intelligence to automate processes for broader clinical applicability. Full article

Study Design: Observational. Objective: To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods: Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations—neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. Results: In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4–C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1–2) joints. Conclusions: Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries. Full article

Study Design: Retrospective study. Objective: Zygomaticomaxillary complex (ZMC) fractures are common facial injuries with heterogeneity regarding aetiologies, fracture types, infraorbital nerve (ION) involvement, and treatment methods. The aim of this study was to identify associations between aetiologies, fracture types, and neurological complications. Additionally, treatment methods and recovery time were investigated. Methods: Medical files of 272 patients with unilateral and bilateral ZMC fractures were reviewed, whose cases were managed from January 2014 to January 2019 at the Department of Oral and Maxillofacial Surgery, University hospitals Leuven, Belgium. History of ION sensory dysfunction and facial nerve motoric dysfunction were noted during follow-up. Results: ION hypoaesthesia incidence was 37.3%, with the main causes being fall accidents, road traffic accidents, and interpersonal violence. Significant predictors of ION hypoaesthesia were Zingg type B fractures (p = 0.003), fracture line course through the infraorbital canal (p < 0.001), orbital floor fracture (p < 0.001), and ZMC dislocation or mobility (p = 0.001). Conclusion: Of all ZMC fractures, 37.3% exhibited ION hypoaesthesia. Only ZMC Zingg type B fractures (74.0%) were significantly more associated with ION hypoaesthesia. ION hypoesthesia was more likely (OR = 2.707) when the fracture line course ran through the infraorbital canal, and was less dependent on the degree of displacement. Neuropathic pain symptoms developed after ZMC fractures in 2.2% patients, posing a treatment challenge. Neuropathic pain symptoms were slightly more common among women, and were associated only with type B or C fractures. No other parameters were found to predict the outcome of this post-traumatic neuropathic pain condition. Full article

Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and reflects a more distinct aspect of inflammation than C-reactive protein (CRP) does. The study concerns a clinically silent state of the immune system expressed by the level of suPAR, which could affect the occurrence of complications (non-life threatening) after scheduled procedures. The purpose was the evaluation of suPAR predictive value in minor maxillofacial surgery complication incidents. Eighty patients were tested for suPAR, CRP and a series of basic laboratory serum tests on 1 day before surgery. Complications of orthognathic and minor injuries treatments were reported. The suPAR level, expressed as a measure independent of the patient’s age (Index of Body Inflammation, IBI), was analyzed. The protein level was also assessed on postoperative day 3. Basic statistical analysis did not reveal any relevant dependence between suPAR (or IBI) and occurrence of minor complications. The application of factor analysis, artificial neural network and inclusion of chlorides, glycaemia, alanine transaminase (ALT), albumin and hemoglobin levels allowed to indicate the suPAR/IBI ranges associated with an increased risk of minor postoperative complications. Concluding, it seems that, in the current state of the knowledge, the monitoring of pre-operational suPAR level solely does not include sufficient predictive information for the occurrence of minor complications after maxillofacial surgery. The suPAR/IBI level should be combined with other patient characteristics to predict healing complications. Full article