Search Results (265)

Sports-related oral and maxillofacial trauma exhibits distinct injury mechanisms depending on the type of sport; however, comprehensive analyses integrating these characteristics remain limited. This study aimed to elucidate the clinical features of sports-related oral and maxillofacial trauma. This single-center retrospective study included 1615 patients (mean age 41.04 years; 64.8% male) treated between 2012 and 2025 in Shimane University Hospital, Department of Oral and Maxillofacial Surgery/Maxillofacial Trauma Center, Shimane, Japan. Among them, 239 (14.8%) had sports-related injuries and were significantly younger and more frequently male (p < 0.001). Multivariable analysis showed that nasal bone (odds ratio [OR] 5.900, 95% confidence interval [CI] 3.309–10.521), orbital wall (OR: 8.044, 95% CI: 4.664–13.874), zygomatic and zygomatic arch (OR: 3.239, 95% CI: 1.455–7.213), and naso-orbito-ethmoidal fractures (OR: 6.507, 95% CI: 1.971–21.483), as well as contusions (OR: 2.601, 95% CI: 1.385–4.885), were positively associated, whereas mucosal lacerations (OR: 0.485, 95% CI: 0.290–0.811) and referral from dental/medical clinics (OR: 0.312, 95% CI: 0.178–0.546) were negatively associated (all p < 0.01). However, panfacial fractures occurred less frequently. Sports-related trauma was primarily associated with nasal, orbital wall, zygoma and zygomatic arch, and naso-orbito-ethmoidal fractures. These findings indicate that sports-related oral and maxillofacial trauma is characterized by distinct and predominantly midfacial fracture patterns. 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

Background and Objectives: The surgical management of three-wall orbital fractures remains a significant challenge due to complex anatomy, limited exposure, and the absence of clear landmarks. These extensive reconstructions are rare and traditionally burdened by high complication rates and inconsistent outcomes. This study presents a standardized surgical protocol for complex three-wall orbital reconstruction, highlighting the role of digital planning and a novel two-piece interlocking patient-specific implant (PSI). Materials and Methods: Between 2018 and 2024, 17 patients with unilateral three-wall orbital fractures underwent reconstruction using digitally planned, patient-specific two-piece titanium implants designed to restore the orbital floor, medial, and lateral walls. Implant positioning was assessed through qualitative evaluation of postoperative CT scans and quantitative comparison between planned and actual implant positions, as well as orbital volume analysis between reconstructed and unaffected orbits. Clinical outcomes were evaluated pre- and postoperatively. Results: Reconstruction was classified as ideal in 16 cases (94.1%) and satisfactory in one case (5.9%). Quantitative analysis demonstrated a high level of concordance between the planned and postoperative implant positions, with a mean deviation of 0.982 ± 0.107 mm (95% CI: 0.927–1.037 mm). All implants were positioned within 1.5 mm of the planned location. Postoperative orbital volumes closely approximated those of the contralateral side, with a mean volume difference of 1.371 ± 0.176 cm³ (95% CI: 1.280–1.461 cm³). Diplopia resolved in all patients, and enophthalmos was fully corrected in 15 cases (88.2%). No major complications or revision surgeries were observed. Conclusions: The proposed two-piece interlocking PSI enabled precise and reproducible reconstruction of complex three-wall orbital fractures. This approach demonstrates that even technically demanding orbital reconstructions can be performed with greater reliability, leading to favorable functional and aesthetic outcomes. Full article

This study examines the microstructural characteristics and tensile properties of autogenous orbital gas tungsten arc (GTA) circumferential butt welds produced on commercially rolled 304 stainless steel seam pipes (outer diameter 38.1 mm, wall thickness 2.0 mm) for high-purity fluid distribution systems. A three-segment current profile was employed using an AMI 8-4000 orbital system, with peak currents of 70, 67, and 65 A for the penetration, remelting, and downslope (crater-fill) segments, respectively, under high-purity Ar (99.999%) shielding with back purging. Electron backscatter diffraction (EBSD) analysis, including image quality (IQ), inverse pole figure (IPF), and kernel average misorientation (KAM) mapping, showed that the weld metal consists of epitaxially grown columnar austenite grains strongly oriented along the solidification direction, whereas the heat-affected zone (HAZ) exhibits finer equiaxed grains with an increased Σ3 twin boundary fraction and elevated low-angle boundary fraction, indicative of partial recrystallization. Only sparse, discontinuous δ-ferrite stringers were detected in the fusion zone, and no non-metallic inclusions were observed on fracture surfaces, supporting the weld metal’s suitability for semiconductor-grade cleanliness. Vickers microhardness profiles revealed modest hardness differences (typically within 10–20 HV) between the weld metal, HAZ, and base metal, with no pronounced HAZ softening. Cross-weld tensile tests conducted in accordance with ASTM E8/E8M-22 yielded yield strengths above 200 MPa, ultimate tensile strengths of 650–680 MPa, and total elongations approaching 40%, comparable to the as-received pipe. Scanning electron fractography confirmed fully ductile failure via microvoid coalescence without evidence of cleavage, intergranular decohesion, or weld-defect-induced embrittlement. Collectively, these results demonstrate that the three-segment autogenous orbital GTAW procedure produces structurally sound, particle-clean joints suitable for 304 stainless steel seam pipes used in high-purity industrial piping. 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: 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

Patients with heavily calcified coronary arteries represent a challenge in percutaneous coronary intervention (PCI), as severe calcification impairs device delivery and limits optimal stent expansion, leading to higher risks of stent thrombosis, restenosis, and adverse clinical outcomes. Approximately 20% of patients undergoing PCI exhibit severe coronary calcification, which independently predicts incomplete revascularization, increased mortality, and higher rates of major adverse cardiovascular events over mid-term follow-up. Recent advances have focused on improving the assessment and management of calcified lesions. Intracoronary imaging modalities, including intravascular ultrasound and optical coherence tomography, allow precise detection and characterization of calcium burden, overcoming the limitations of angiography. These tools play a pivotal role in guiding procedural strategy, enabling tailored selection of calcium-modifying techniques based on lesion morphology, and optimizing stent deployment. Technological innovations have significantly expanded therapeutic options. While non-compliant balloon angioplasty alone is often insufficient, adjunctive devices such as cutting and scoring balloons improve plaque modification in focal disease. Atherectomy techniques, including rotational and orbital systems, are effective for more complex lesions but require technical expertise and carry procedural risks. Intravascular lithotripsy has emerged as a promising, less aggressive modality capable of fracturing deep calcium, while excimer laser atherectomy offers an alternative for resistant lesions. Despite these advances, current evidence supporting calcium-modifying strategies is largely based on procedural outcomes rather than definitive improvements in long-term clinical endpoints. Meta-analyses and randomized trials have not demonstrated clear superiority of any single technique, and most studies remain underpowered. Intriguingly, recent data suggest that outcomes in treated calcified lesions may approximate those of non-calcified disease, raising the hypothesis that these technologies could mitigate the adverse impact of calcification. However, this remains unproven, highlighting the urgent need for adequately powered randomized trials to determine their true clinical benefit. Full article

Background/Objectives: Reconstruction of orbital floor fractures remains surgically challenging due to limited intraoperative visibility and complex anatomy. Inaccurate implant placement often leads to persistent complications and the need for a revision surgery. This study evaluated the clinical accuracy and re-operation rates of a preoperative 3D-printed model-assisted technique compared to the conventional intraoperative free-hand mesh bending method. Methods: A comparative ambispective study was conducted on 74 patients with isolated orbital floor fractures. The control group (n = 34, retrospective) underwent reconstruction using intraoperatively formed titanium meshes. In the study group (n = 40, prospective), patient-specific 3D-printed models, created by mirroring the healthy contralateral orbit, were used for preoperative mesh adaptation. Primary outcomes included the rate of revision surgery due to implant malposition, changes in orbital volume, and postoperative diplopia. Results: The 3D model group demonstrated a significantly lower rate of revision surgery compared to the control group. In the retrospective group, 5 patients (15%) required reoperation due to implant malposition, whereas no patients (0%) in the prospective 3D group required secondary intervention (p = 0.017). While both techniques effectively restored orbital volume, the 3D group showed greater volumetric precision with less variance. The mean volume difference in the affected orbit was 3078 ± 2204 mm³ in the control group, compared to 2390 ± 1893 mm³ in the study 3D group. At the 6-month follow-up, persistent diplopia was observed in 12% of the control group compared to only 3% in the study group. Conclusions: The use of in-house 3D-printed models for preoperative mesh forming significantly enhances surgical precision and eliminates the need for revision surgery due to implant malposition. This workflow offers a cost-effective, predictable, and accessible alternative to expensive patient-specific implants (PSIs) or intraoperative navigation systems, improving patient safety and long-term clinical outcomes. Full article

Orbital floor fractures may cause long-term functional and esthetic impairments. Diplopia due to impaired function of the inferior rectus muscle is frequently an indication for surgical repair, but some cases, such as those where the diagnosis has been delayed or a previous attempt at repair has been made, may not always be amenable to surgical correction. It is advantageous for the surgeon to know whether the proper function of the inferior rectus muscle can be restored for the purposes of surgical planning and prognostication. The authors hypothesized that real-time MRI could be used to characterize the appearance of the inferior rectus muscle in a way that would facilitate future analysis of inferior rectus function in patients with diplopia due to orbital floor fractures. Real-time MRI was performed on 10 volunteer participants with normal ophthalmic function and orbital anatomy to assess inferior rectus appearance during vertical duction testing. ImageJ software was used to measure and record characteristics of the inferior rectus muscle, viewed in a quasi-sagittal plane. The ratios evaluated included inferior rectus muscle length in upgaze versus downgaze (UDR, mean 1.58) as well as inferior rectus muscle length versus distance from inferior rectus origin to inferior rectus inflection point in upgaze (LIR, mean 1.30) and downgaze (mean 1.20). These values were found to be conserved between orbits and individuals. This data offers quantitative insight regarding inferior rectus muscle appearance across the full arc of vertical gaze in healthy individuals. We plan to use this normative baseline dataset as a comparison for future phases of this project, using real-time MRI to evaluate traumatized orbits with diplopia and derangement of the inferior rectus muscle. Full article

Aiming at satisfying the micro-dynamic lubrication requirements of moving parts in spacecraft on-orbit operation, this paper proposes a micro-oil supply scheme based on a piezoelectric drive. The working mode and transient sound pressure characteristics of the micro-oil supply device were analyzed by the numerical simulation method, and the influence of driving voltage and oil dynamic viscosity on droplet growth and desorption behavior was investigated. The research results show the following: (1) The driving voltage is a key external control parameter that affects the droplet ejection characteristics. The increase of its amplitude will promote the droplet morphology to change from a stable and concentrated overall state to a dispersed state with multi-satellite droplets and easy necking fracture. At the same time, the droplet size is significantly reduced, the distribution tends to be discretized and the droplet velocity and droplet mass are simultaneously improved. Under the 220 V voltage condition, the droplet ejection velocity can reach 17.8 m/s, and the single ejection mass can reach 6.98 mg, which can realize the rapid and large-scale delivery of droplets. (2) Dynamic viscosity is the core intrinsic parameter to determine the droplet ejection characteristics. When the value of dynamic viscosity increases, the droplet morphology will change from the wire-like fracture characteristics of ‘spherical head + satellite droplet developed’ to the droplet-like structure with overall concentration and stable mechanical state. The average droplet size increased and the distribution was more aggregated. The droplet velocity and droplet mass decreased significantly. When the viscosity increased to 0.16 Pa·s, the droplet ejection velocity decreased to 1.14 m/s, and the single ejection mass decreased to 0.35 mg. Full article

Orbital reconstruction following trauma remains challenging due to complex three-dimensional (3D) anatomy and limited surgical access. While pre-fabricated titanium mesh is standard, it requires extensive intraoperative manipulation and produces imaging artifacts. The 3D-printed polyetheretherketone (PEEK) patient-specific implants (PSIs) offer potential advantages; however, limited data exists for the acceptance of PEEK PSIs by surgeons compared to other established techniques. Fourteen surgeons performed simulated orbital reconstructions on nine cadaveric heads comparing titanium mesh and the 3D-printed PEEK PSIs. Titanium mesh was used for Class II orbital floor fractures, while the 3D-printed PEEK PSIs (native and radiopaque formulations) were used for Class IV defects. Surgeons were blinded to the PEEK formulation type. Outcomes included operative efficiency, handling characteristics, fit quality, and mechanical stability using validated 5-point Likert scales and objective timing. The 3D-printed PEEK PSIs demonstrated faster procedure times (9.5 ± 5.3 vs. 11.2 ± 5.1 min) and superior fit quality (2.00 ± 1.04 vs. 2.18 ± 0.60) and mechanical stability (1.67 ± 0.49 vs. 1.91 ± 0.54), with 100% rated stable versus 91% for the titanium mesh. Surgeons could not distinguish between the native and radiopaque PEEK formulations. Most surgeons (64.3%) preferred situation-dependent material selection. The 3D-printed PEEK PSIs demonstrated advantages in handling, fit quality, and mechanical stability for complex defects, while the titanium mesh showed a lower learning curve for simple reconstructions. Radiopaque enhancement expands PEEK’s clinical utility without compromising handling. Full article

The straddle packer fracturing technique represents a core technology for reservoir stimulation in horizontal wells targeting deep shale gas formations. However, the fracturing string constrained by dual packers is highly susceptible to severe vibrations induced by high-pressure pulsating fluid flow, which subsequently leads to collisions between the string and the casing. These collisions may compromise the sealing integrity of the packers or cause fatigue damage to the string. The existing design of packer spacing primarily relies on static mechanical experience and lacks the support of nonlinear dynamics theory. As a result, it is difficult to maximize operational efficiency while ensuring safety. Therefore, this paper establishes a fluid–solid coupling fracturing string model that takes into account fluid pulsation, geometric nonlinearity and gap collision constraints. Using the Galerkin discretization and the fourth-order Runge–Kutta algorithm, the influence laws of packer spacing and flow rate on the system stability are systematically studied. Studies have shown that the spacing of packers non-monotonically controls the system stability. Both too short or too long packer spacings will induce chaotic instability. However, there exists a highly robust, stable contact window near the ratio. Within this interval, the fracturing string is locked onto a stable period-doubling orbit. Based on this proposed optimization criterion, compared with the traditional conservative design, the spacing of the packers can be extended by approximately 90%. This not only avoids the risk of chaos but also significantly improves the efficiency of the fracturing operation. Full article

Background/Objectives: This network meta-analysis aimed to evaluate and compare the risks of lower eyelid complications—ectropion, entropion, scleral show, and postoperative scarring—associated with four surgical approaches (subciliary, subtarsal, infraorbital, and transconjunctival) for orbital and zygomaticomaxillary fracture repair. Methods: A systematic search of PubMed, Embase, and Cochrane databases identified relevant studies published between 1 January 1990 and 10 January 2026. Twenty-seven eligible studies involving 2790 patients were included. Direct pairwise meta-analyses and network meta-analyses were conducted to compare complication risks among the approaches. Sensitivity analyses were performed to assess the influence of individual studies, and inconsistency tests were applied to evaluate model robustness. Results: The subciliary approach was associated with the highest risk of ectropion and scleral show. The transconjunctival approach had the lowest risk of ectropion and scarring but the highest risk of entropion. The subtarsal approach had the lowest risk of scleral show, while the infraorbital approach had the highest risk of postoperative scarring. Sensitivity analyses confirmed consistent rankings, and no significant inconsistency was detected. Conclusions: This study provides updated, comprehensive evidence to guide the choice of surgical approach for orbital and zygomaticomaxillary fracture repair. Surgeons should balance operative exposure, cosmetic outcomes, and complication risk, and communicate these trade-offs clearly with patients to optimize decision-making. Full article

Background: Pediatric orbital floor fractures differ from adult injuries due to bone elasticity and a higher incidence of trapdoor-type defects with extraocular muscle entrapment, often presenting with limited external signs but carrying a high risk of functional impairment. Early recognition and prompt surgical release are essential to prevent irreversible neuromuscular damage and persistent binocular vision disturbances. Case Presentation: A 13-year-old patient sustained an orbital floor blow-out fracture with inferior rectus muscle incarceration following blunt trauma. The child presented with vertical diplopia, ocular motility restriction, and infraorbital hypoesthesia. Computed tomography demonstrated a posteriorly located linear orbital floor defect with soft-tissue entrapment, supporting the indication for urgent surgical intervention to avoid ischemic injury. Management and Outcome: Through a transconjunctival retroseptal approach, the entrapped muscle was promptly released, and orbital floor continuity was restored using an autologous bone graft harvested from the anterior maxillary wall with piezosurgery. This technique allowed controlled and precise bone harvesting while preserving adjacent anatomical and developing dental structures. Postoperative recovery was uneventful, with complete resolution of diplopia and full restoration of binocular ocular motility during follow-up. Conclusion: Early surgical intervention plays a pivotal role in achieving functional recovery in pediatric orbital floor fractures with muscle entrapment. Autologous reconstruction supported by piezosurgical bone harvesting represents a safe and effective approach in growing patients, providing reliable functional and anatomical outcomes. This case reinforces the clinical relevance of timely intervention and highlights practical considerations in pediatric orbital trauma management. Full article

Paediatric orbital fractures require careful reconstruction to prevent long-term functional and aesthetic sequelae. Material selection is critical due to the anatomical and developmental considerations unique to children. Comparative data to guide decision making remain sparse and inconclusive. A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase (through February 2025), following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Studies reporting outcomes and/or complications associated with implant materials used in the reconstruction of paediatric orbital fractures were included. Outcomes included postoperative diplopia, enophthalmos, restriction of eye movements, removal of material, and return to theatre (RTT). In total, 54 studies encompassing a total of 562 patients and 563 implants were included. Polymers (n = 169), alloplasts (n = 167) and autologous (n = 166) implants were the most commonly used reconstructive material. Late postoperative diplopia occurred in 7% of polymers (12/169), 6% of alloplasts (10/167), 29% of allografts (6/21), 24% of xenografts (6/25) and 33% of metals (2/6). Reported enophthalmos was highest in the autologous group (8%) but was only reported in 34 of the 54 studies. Infection, removal of implant material and RTT were low across all groups (1–4%). No donor site morbidity was reported. Robust studies with standardised outcomes and adequate follow-up are needed to inform evidence-based material selection in paediatric orbital reconstruction. Full article