Search Results (45)

Reconstruction in head and neck surgery requires restoration of complex functions, including speech, swallowing, and breathing, while preserving as much facial form and patient identity as possible. Over the past decade, advances in preoperative digital planning, intraoperative technologies, and robotic platforms have reshaped reconstructive strategies, giving rise to the concept of hybrid reconstruction. Hybrid approaches integrate free tissue transfer with computer-aided design and manufacturing (CAD/CAM), virtual surgical planning, intraoperative navigation, and robot-assisted microsurgery to enhance precision, reproducibility, and functional outcomes. This narrative review examines the principles and applications of hybrid reconstruction in head and neck surgery with particular emphasis on osseous reconstruction of the mandible, maxilla, and midface. The roles of intraoperative navigation and robotic assistance as enabling tools are discussed, along with their potential benefits and current limitations. Functional and morphologic outcomes, patient-reported quality of life, and challenges related to cost, access, training, and evidence heterogeneity are critically reviewed. Hybrid reconstruction represents an advancement toward outcomes-driven, patient-centered care; however, thoughtful integration of emerging technologies and continued emphasis on rigorous outcome assessment are essential to guide responsible adoption in contemporary head and neck reconstructive surgery. Full article

Background: Reconstruction of the maxilla and midface remains one of the most demanding challenges in craniofacial surgery, requiring precise planning and a clear understanding of defect geometry to achieve functional and esthetic restoration. Advances in computer-assisted surgery (CAS) and virtual surgical planning (VSP), based on 3D segmentation of radiologic imaging, have significantly improved the management of maxillary deformities, allowing for further knowledge of patient-specific information, including anatomy, pathology, surgical planning, and reconstructive issues. The integration of computer-aided design and manufacturing (CAD/CAM) and 3D printing has further transformed reconstruction through customized titanium meshes, implants, and surgical guides. Methods:This systematic review, conducted following PRISMA 2020 guidelines, synthesizes evidence from clinical studies on CAD/CAM-assisted reconstruction of maxillary and midfacial defects of congenital, acquired, or post-resection origin. It highlights the advantages and drawbacks of maxillary reconstruction with patient-specific implants (PSISs). Primary outcomes are represented by accuracy in VSP reproduction, while secondary outcomes included esthetic results, functions, and assessment of complications. Results: Of the 44 identified articles, 10 met inclusion criteria with a time frame from April 2013 to July 2022. The outcomes of 24 treated patients are reported. CAD/CAM-guided techniques seemed to improve osteotomy accuracy, flap contouring, and implant adaptation. Conclusions: Although current data support the efficacy and safety of CAD/CAM-based approaches, limitations persist, including high costs, technological dependency, and variable long-term outcome data. This article critically evaluates the role of PSISs in maxillofacial reconstruction and outlines future directions for its standardization and broader adoption in clinical practice. Full article

Background/Objectives: This study retrospectively evaluated maxillary sinus volume changes and linear changes in the craniofacial region after Le Fort I distraction osteogenesis using a rigid external distraction system. Methods: Ten patients who underwent LeFort 1 distraction osteogenesis between 2012 and 2025 were included in the study. Computed tomography scans and lateral cephalograms were obtained before and 12.3 ± 6.98 months after the surgery. The associated volumes of the maxillary left and right sinuses were subsequently measured using the semiautomatic segmentation method in the ITK-SNAP software. Linear measurements of the sinuses and cephalometric analysis were performed before and after the distraction. Results: The Wits appraisal (distance between perpendicular lines drawn from point A (on the maxilla) and point B (on the mandible) to the occlusal plane) presented an increase of 9.33 mm ± 7.93 mm, corresponding to an increase in the ANB angle by 9.88° ± 5.35°. There were statistically significant increases in the total sinus volume, by 3965 mm³ ± 5456 mm³ (n = 10, p = 0.047), and in the single maxillary sinus volume, by 1983 ± 2889 mm³ (n = 20, p = 0.003). A significant increase in height was also observed, with a mean value of 4.46 ± 2.94 mm (n = 20). Conclusions: Extraoral bone-anchored midface distraction osteogenesis led to increases in single sinus volume, total sinus volume and sinus height in the cleft cohort, resulting in improved maxillary retrusion and profile. However, the study group was small and non-uniform with different follow-up periods, indicating a need for further studies with larger, more homogenous cohorts. Full article

The zygomaticus major and minor (ZMa/ZMi) are key determinants of smile dynamics and midface contour, yet they exhibit substantial morphological variability—including bifid or multibellied bellies, accessory slips, and atypical insertions. Such variants can alter force vectors, fat-compartment boundaries, and SMAS planes, increasing the risk of asymmetry, contour irregularities, or “joker smile” following facelifts, fillers, thread lifts, and smile reconstruction. To our knowledge, this is the first review to integrate the Landfald classification of ZMa/ZMi variants with a standardized dynamic imaging-based workflow for aesthetic and reconstructive midface procedures. We conducted a narrative literature synthesis of anatomical and imaging studies. Bifid or multibellied variants have been reported in up to 35% of cadaveric specimens. We synthesize anatomical, biomechanical, and imaging evidence (MRI, dynamic US, 3D analysis) to propose a practical protocol: (1) focused history and dynamic examination, (2) US/EMG mapping of contraction vectors, (3) optional high-resolution MRI for complex cases, and (4) individualized adjustment of surgical vectors, injection planes, and dosing. Procedure-specific adaptations are outlined for deep-plane releases, thread-lift trajectories, filler depth selection, and muscle-transfer orientation. We emphasize that standardizing preoperative dynamic mapping and adopting a “patient-specific mimetic profile” can enhance safety, predictability, and preservation of authentic expression, ultimately improving patient satisfaction across diverse midface interventions. Full article

Background: Midfacial trauma involving the zygomatic-maxillary-orbital (ZMO) complex poses significant reconstructive challenges due to anatomical complexity and the necessity for high-precision alignment. Traditional manual reduction techniques often result in inconsistent outcomes, necessitating revisions. Methods: This feasibility study presents two clinical cases treated using a novel, fully digital workflow incorporating computer-aided design and manufacturing (CAD/CAM) of patient-specific osteosynthesis plates and surgical drill guides. Following virtual fracture reduction and implant design, drill guides and implants were fabricated using selective laser melting. Surgical procedures included intraoral and transconjunctival approaches with intraoperative 3D imaging (mobile C-arm CT) to verify implant positioning. Postoperative results were compared to the virtual plan through image fusion. Results: Both cases demonstrated precise fit and anatomical restoration. The “one-position-fits-only” orbital implant design enabled highly accurate orbital wall reconstruction. Key procedural refinements between cases included enhanced interdisciplinary collaboration and improved guide designs, resulting in decreased planning-to-surgery intervals (<7 days) and seamless intraoperative application. Image fusion confirmed near-identical congruence between planned and achieved outcomes. Conclusions: The presented method demonstrates that fully digital, CAD/CAM-based midface reconstruction is feasible in the primary trauma setting. The technique offers reproducible precision, reduced intraoperative time, and improved functional and aesthetic outcomes. It may represent a paradigm shift in trauma care, particularly for complex ZMO fractures. Broader clinical adoption appears viable as production speed and workflow integration continue to improve. Full article

Background: Bicycles constitute a primary means of transportation, particularly within the scope of urban micromobility. However, the use of this mode of transport is associated with the risk of traffic accidents and subsequent maxillofacial trauma. Cyclists are classified as vulnerable road users, among whom the assessment of injury patterns is a significant issue. This study aimed to identify the most common maxillofacial fractures resulting from bicycle-related traffic accidents. Methods: A retrospective analysis was conducted on the medical records of patients treated at the Clinic of Maxillofacial Surgery at the University Clinical Hospital in Poznan, who sustained maxillofacial injuries as a result of bicycle-related accidents between 2019 and 2023. Results: A total of 99 patients met the inclusion criteria. Most of the study population was males (70.7%), with a median age of 38. Accidents most frequently occurred during the summer months and on Fridays and weekends. The most common fracture site was the mandible (40.4%), with double fractures being the predominant type. Additionally, zygomatic-orbital fractures were frequently observed (30.3%). In terms of treatment, surgical intervention was predominant, and the mean duration of hospitalisation was 6 days. Only 5.1% of patients were under the influence of alcohol at the time of the incident. Furthermore, it was found that isolated mandibular fractures occurred more frequently in younger patients, whereas midface fractures of the Le Fort II and III types were more commonly observed in individuals under the influence of alcohol at the time of the event. Moreover, accidents involving alcohol consumption were associated with a higher incidence of concomitant cranio-cerebral injuries. Conclusions: Defining the profile of maxillofacial fractures resulting from bicycle accidents constitutes a clinically relevant issue. Additionally, identifying the main risk factors and developing preventive measures is of critical importance. Full article

Background/Objectives: High-dose-rate (HDR) interventional radiotherapy (IRT) represents a valuable treatment alternative for basal cell carcinoma (BCC) of the midface, especially in the presence of esthetic or functional issues related to surgery. This retrospective study examines the clinical outcomes of patients who underwent HDR-IRT at our institution. Methods: Patients (pts) with histologically confirmed midface BCC were treated with HDR-IRT using superficial, interstitial, or endocavitary implants depending on tumor characteristics. Fractionation regimens were tailored to tumor location: 45 Gy in 9 fractions twice a day (the cheeks/lips) and 44 Gy in 14 fractions (the nose, with the first and last fractions delivering 4 Gy each, administered once daily, and the remaining 12 fractions delivering 3 Gy each, administered twice daily (BID) with an inter-fraction interval of at least 6 h). Treatment efficacy was assessed based on local control rates, toxicity (CTCAE criteria), and cosmetic outcomes. Results: Eight patients were considered. The most common tumor site was the nose (seven patients, 87.5%), followed by the upper lip. Tumors were either primary (three patients, 37.5%) or residual/recurrent after previous surgery with involved margins (five patients, 62.5%). The median follow-up was 6 months (range: 1–19 months). Clinical local control was achieved in all cases, with persistent alteration at dermoscopy in one patient six months after the completion of treatment. Acute toxicities were minimal, with two patients developing grade 3 skin toxicity, which resolved within 1–3 months with topical management. Cosmetic outcomes were favorable across all patients. Conclusions: HDR-IRT is a well-tolerated, effective, and cosmetically favorable treatment for midface BCC. Our institutional experience supports its use as an alternative to surgery in cosmetically sensitive areas and in selected patients/lesions unfit for surgery. Endocavitary implants appear to be an effective option to cover the full thickness nasal wall without resorting to interstitial implants. Full article

The purpose of the present study was to describe the demographic and clinical features of patients having undergone redo surgery for mandibular and/or midfacial fractures and to identify factors that increase the odds of redo surgery. Included were the files of all patients who had undergone open reduction and fixation of one or more mandibular and/or midfacial fracture or orbital reconstructions at the Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland, between 1 January 2013–31 October 2020. Patients having undergone redo surgery were identified, and descriptive characteristics were calculated. In the data analysis, the association between redo surgery and explanatory variables was analyzed. Altogether, 1176 patients were identified for the analysis. Of these, 25 (2.1%) underwent redo surgery for 28 fracture sites. The most common reasons for redo surgery were inadequate fracture reductions of the zygomatic process or the mandible (19 patients) and inadequate orbital reconstructions (four patients). Compared with surgery of only the mandible, combined surgery of the mandible and midface had almost four times greater odds of redo surgery (95% CI 3.8, 0.8–18.4), but the finding was not statistically significant. Although redo surgery was required fairly infrequently, the findings highlight the relevance of surgical competence to treatment success; suboptimal surgical procedure was the most common reason for redo surgery. The literature supports the use of intraoperative CT scanning as a useful tool in association with the treatment of complex midfacial fractures in general and orbital fractures in particular. The success of orbital reconstruction can be promoted by using patient-specific implants. Full article

Reconstruction of cranio-maxillofacial defects following ablative surgeries requires a comprehensive approach that balances functional restoration with aesthetic outcomes. Advances in computer-aided design and manufacturing (CAD/CAM) technology have revolutionized this field, enabling precise preoperative planning, including 3D modeling, segmentation, and virtual resection planning. These methods allow for the production of patient-specific implants and surgical templates while facilitating the evaluation of treatment outcomes. CAD/CAM technology offers numerous benefits, such as enhanced surgical accuracy, improved aesthetic results, reduced operative times, and the possibility of single-stage resection and reconstruction. However, limitations exist, including high costs, the need for specialized expertise, and dependency on accurate imaging data. This paper provides a surgeon-centric evaluation of the advantages and limitations of CAD/CAM in cranio-maxillofacial reconstruction. The discussion encompasses the technological workflow, clinical applications, and recommendations for optimizing outcomes. Future perspectives highlight ongoing developments, such as integrating non-ionizing imaging techniques and expanding the applicability of virtual and augmented reality. By synthesizing technical advancements and clinical expertise, this review aims to establish practical guidelines for implementing CAD/CAM technology in routine surgical practice. Full article

Background: Individually personalized reconstructive microsurgery is more and more universally recognized and applied as a one-time, part of a few, or even the only highly effective treatment of patients with locally advanced midface cancer. Among the increasing number of publications focused on this field, most present different reconstructive techniques used for a single patient (case reports), and fewer papers evaluate a group including more than 100 patients. Methods: A dataset of 119 locally advanced midface cancers in stage T₃ or T₄ was used to analyze whether there is any correlation between clinical factors, resection defect parameters, and the free flaps chosen for reconstruction. Results: In general, the 5-year OS was 95% and 77% for the DFS, which inversely correlated with the increasing Cordeiro’s type of resective defects. Local recurrence occurred in 23% of cases. Taxonomic dendrograms allow the selection of four (A–D) different case clusters. Cluster B, which characterizes a tumor size of 8–18 cm², Cordeiro type IIIA, and an uncertain radicalism of resection, has the worst prognosis with a very high (89%) risk of local recurrence. On the contrary, the most favorable was found in cluster C, characterized by Cordeiro type IIA, a tumor size of 8 cm², and negative resective margins, because it has a very low (6%) risk of local recurrence. Conclusions: The results of the present analysis have led to design algorithms for midface resection and reconstruction. However, these should not be considered obligatory but rather as a useful general guideline. Full article

Objective: This paper compares two popular techniques for tear trough correction—fat repositioning and hyaluronic acid (HA) fillers—highlighting their efficacy, safety profiles, patient satisfaction, and associated complications. Methods: A narrative review of 20 studies comparing fat repositioning and HA fillers was conducted, focusing on parameters such as duration of results, volume restoration, complication rates, and patient satisfaction. Results: Fat repositioning provides long-lasting results but carries higher surgical risks compared with HA fillers. The transconjunctival approach is suitable for patients with minimal skin excess. The supraperiosteal plane allows for a quicker procedure and, despite postoperative edema and temporary irregular contouring, shows no difference in final cosmetic outcomes compared with other planes. Internal fixation reduces the risk of fat relapse and skin scarring but carries the risk of suboptimal positioning. HA fillers offer immediate, minimally invasive results but require periodic maintenance. The use of a cannula reduces the risk of vascular occlusion. Combining a high G’ filler for the midface with a low G’ with low hydrophilicity for the tear trough reduces the amount of filler needed and prolongs the results. Both surgical and non-surgical methods are effective, depending on patient needs and anatomical considerations. Conclusions: Fat repositioning is ideal for patients seeking long-term correction and are willing to undergo surgery, while HA fillers suit those preferring non-invasive treatments with customizable, short-term effects. Both techniques have pros and cons that must be matched to patient goals and conditions. Full article

Background and Objectives: Surgeons have long been aware of Murphy’s Law: “If anything can go wrong, it will”. When applied to surgery, Murphy’s Law suggests that if there is a way that an operation can be set up incorrectly then someday, somewhere, it will be set up incorrectly. This paper focuses on complications in medical doctor (MD) and VIPs during aesthetic surgery. Materials and Methods: We evaluated the clinical results of 368 MDs/VIPs (group 1) and 368 non-MDs/VIPs (group 2) who underwent aesthetic surgery (upper blepharoplasty, facelift, breast augmentation) between January 2010 and September 2021. The minimum follow-up after surgery was 2 years. Results: There was no statistically significant difference in the rate of complications between the two groups. Among the treated patients, the percentage of complications was similar to what has been reported in the literature. Interestingly, the time spent in surgery was longer, and there was an increased number of admissions to outpatient clinics in group 1. Conclusions: We suggest changing the current perception of Murphy’s Law regarding complications in MD patients/VIPs undergoing aesthetic surgery. Full article

Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included “dynamic repair”, “late-stage facial paralysis”, “nerve and muscle transplantation”, “muscle flap”, and “tendon transposition”. Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies. Full article

Background: Maxillofacial trauma (MFT) caused by falls, interpersonal violence or traffic accidents leading to fractures of different facial regions, including the midface and the mandible, are common clinical conditions requiring open reduction and internal fixation. The aim of this study was to analyze the incidence and time trends in MFT-associated surgeries regarding different facial regions in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related group (DRG) inpatient billing system was received from the German Federal Statistical Office for the years 2005–2022. We estimated the age–gender standardized incidence of MFT-associated procedures classified by the Operation and Procedure Classification System (OPS) and evaluated age- and gender-adjusted time trends using Poisson regression analysis. Results: The total standardized incidence rate of MFT-associated procedures in the observational period 2005–2022 was 25.1 (♀13.3; ♂37.5) per 100,000 person-years within a slight significant annual decrease of 0.5%. A significant increase in the incidence of MFT-related procedures within the observational period was found in older adults from 60 to 79 years (+55.1%; ♀+54.8%; ♂+56.3%) and elderly patients over 80 years (+66.7%; ♀+59.1%; ♂+85.1%). Other significant trends are decreases in MFT-related procedures performed in children from 0–14 years (−28.1%; ♀−30.3%; ♂−27.3%) and young adults between 15 and 35 years (−20.4%; ♀−7.3%; ♂−22.5%). Conclusions: MFT-associated surgery is a persisting challenge in the German healthcare system. There is an ongoing transition in MFT-associated surgeries from younger to older patients beyond the scope of demographic change, highlighting the increasing importance of interdisciplinary treatment of patients with pre-existing conditions in maxillofacial surgery. Implementation of injury prevention measures might be beneficial in this population. Full article

Introduction: Ectopic foreign bodies in the maxillary sinus occur rarely. Ectopic tooth eruption rarely occurs in the orbit, nasal cavity, maxillary sinus, and elsewhere. Ectopic eruption of teeth in the maxillary sinus is most commonly associated with wisdom teeth and is rarely associated with supernumerary teeth. This rare phenomenon may be accompanied by chronic recurrent sinusitis with headaches and facial pain. However, fibro-osseous lesions in the paranasal sinuses are discovered incidentally on X-ray images and are often asymptomatic. Osteoma is the most common fibro-osseous lesion that develops in the paranasal and nasal sinuses. Osteomas rarely cause serious symptoms such as orbital lesions and intracranial invasion. Case Presentation: We report a rare case of exostosis containing supernumerary teeth within the maxillary sinus. A characteristic pedicled bone lesion with a clear border on computed tomography was the undefined orthopantomogram radiopacity in the maxillary sinus, and the lesion contained supernumerary teeth. As the patient had chronic nasal congestion, the tumor was surgically removed. Pathologically, the surgical specimen revealed an osteoma. The patient’s symptoms of chronic sinusitis disappeared. Because the patient had no history of midface trauma or surgery, the supernumerary teeth were speculated to have migrated during a reactive osteogenic process caused by chronic sinusitis. Conclusions: A foreign body in the maxillary sinus can be easily diagnosed by computed tomography. Surgical removal is recommended if the foreign body is symptomatic or occupies more than half of the maxillary sinus. This can help resolve chronic sinusitis symptoms and prevent serious complications in the future. Full article