Craniomaxillofacial Trauma & Reconstruction

13 pages, 7695 KiB

Open AccessArticle

Hybrid Technique in Temporomandibular Joint Ankylosis Arthroplasty Using Surgical Cement and Screw Fixation with Three-Dimensional Printing Planning

by Guilherme Pivatto Louzada, Bianca de Fatima Borim Pulino, Camila Cerantula, Gustavo Câmara, Ana Beatriz Goettnauer de Cerqueira, Gines Alves, Guilherme Zanovelli Silva, Thiago Nunes Palhares, Wendell Fernando Uguetto and Raphael Capelli Guerra

Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 26; https://doi.org/10.3390/cmtr18020026 - 24 Apr 2025

Abstract

Temporomandibular joint (TMJ) ankylosis compromises essential functions such as chewing, phonation, and breathing. Surgical treatment aims to restore mandibular mobility and prevent the recurrence of joint fusion. This article describes a technical variation based on Puricelli biconvex arthroplasty, using surgical cement, screw fixation, [...] Read more.

Temporomandibular joint (TMJ) ankylosis compromises essential functions such as chewing, phonation, and breathing. Surgical treatment aims to restore mandibular mobility and prevent the recurrence of joint fusion. This article describes a technical variation based on Puricelli biconvex arthroplasty, using surgical cement, screw fixation, and 3D-printed cutting guides based on virtual planning, allowing for greater precision in joint reconstruction. In this work, we present the step-by-step process used in the customization of cutting guides, virtual planning, and the production of the interposition material with PMMA associated with fixation with titanium screws as a hybrid method for the treatment of recurrent TMJ ankylosis. This reported technique is demonstrated to be reproducible, low-cost, and effective. Full article

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28 pages, 1545 KiB

Open AccessSystematic Review

Redefining and Identifying Evidence-Based Indications for Open Reduction and Internal Fixation in Mandibular Condylar Fractures: A Comprehensive Systematic Review and Evidence Analysis

by Stephen A. L. Y. Youssef, Iva I. Raghoebar, Renee Helmers, Jan de Lange and Leander Dubois

Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 25; https://doi.org/10.3390/cmtr18020025 - 22 Apr 2025

Abstract

A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding [...] Read more.

A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding precise indications for ORIF remain unclear and non-uniform. We aimed to refocus the debate regarding the optimal treatment for CFs by identifying the recent indications for ORIF in the literature and assessing the quality of the existing evidence for each indication. This systematic review searched Medline, Embase and the Cochrane Central Register of Controlled Trials for eligible studies. The included studies consisted of articles from the past 15 years involving patients with any type of CF who underwent ORIF based on specified indications. From 4711 papers, 100 studies were included. In these, 121 indications were identified. The most cited indications for ORIF were those proposed by Zide and Kent, namely displacement/angulation ≥10° and ramus height shortening of ≥2 mm. Evidence supporting these indications is weak, relying mainly on expert opinion rather than robust data, with a focus on treatment comparisons. Clear, evidence-based cutoffs regarding when ORIF is the only viable treatment option are needed for a consensus. Full article

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17 pages, 837 KiB

Open AccessSystematic Review

Bioabsorbable Magnesium-Based Materials Potential and Safety in Bone Surgery: A Systematic Review

by Chun Ho Hung, Yui Chit Kwok, Jason Yip, Ho Hin Wong and Yiu Yan Leung

Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 24; https://doi.org/10.3390/cmtr18020024 - 7 Apr 2025

Abstract

The goal of this study was to evaluate the clinical outcomes, safety, and clinical applications of bioabsorbable magnesium-based materials for fixation in bone surgeries. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial [...] Read more.

The goal of this study was to evaluate the clinical outcomes, safety, and clinical applications of bioabsorbable magnesium-based materials for fixation in bone surgeries. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases, followed by manual and reference searches. The articles selected were evaluated for patient characteristics, biocompatibility, the need for revision surgery, bone union rates, and the incidence of gas formation associated with implant degradation. Out of the 631 initially identified articles, 8 studies including a total of 386 patients were included in the final qualitative analysis. The magnesium (Mg) group carried a lower rate of revision surgery (1/275) when compared to the titanium (Ti) group (18/111). A high rate of bone union was found in the Mg group and a low infection rate (3/275) was found in the Mg group. The serum level of Mg and calcium (Ca) were not found to be affected. Mg implants are applied in various orthopedic surgeries but they are not applied in in oral or maxillofacial surgeries. Mg implants appear to be a safe alternative for bone fixation and are resorbable. Future research into the application of Mg implants in bone fixation in different anatomical sites is essential to fully harness their potential benefits for patients. Full article

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11 pages, 1051 KiB

Open AccessReview

Fracture Patterns in Craniofacial Gunshot Wounds: A Seven-Year Experience

by Gabriela G. Cruz, Sameer H. Siddiqui, David Z. Allen, Kunal R. Shetty, Sean P. McKee, Brady J. Anderson, Mark Knackstedt, W. Katherine Kao and Tang Ho

Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 23; https://doi.org/10.3390/cmtr18020023 - 1 Apr 2025

Abstract

Objective: To characterize facial fracture patterns and understand predictors of surgical repair and LOS with the objective of assisting providers in managing and understanding these complex injuries. Study Design: This is a retrospective cohort chart review study. Methods: A retrospective review was conducted [...] Read more.

Objective: To characterize facial fracture patterns and understand predictors of surgical repair and LOS with the objective of assisting providers in managing and understanding these complex injuries. Study Design: This is a retrospective cohort chart review study. Methods: A retrospective review was conducted for patients admitted with gunshot wounds (GSWs) to the head, neck, or face between January 2013 and March 2020 at a level one trauma tertiary care hospital. Univariate and multivariate analysis were performed to identify associations with surgical repair and LOS. Results: Of the 578 patients with head, neck, or facial GSWs, 204 survived and sustained facial fractures. The maxilla (n = 127, 62%), orbit (n = 114, 55%), and mandible (n = 104, 51%) were the most fractured. Operative rates differed by location (p < 0.001) with highest rates for fractures involving the mandible (76%). In univariate analysis, overall facial fracture surgery was associated with transfacial injuries; mandible, palate and nasal fractures; tracheostomy; gastrostomy tube placement; ICU admission; and a longer-than-24 h ICU stay (all p < 0.05). In multivariate analysis, predictors of surgical repair included a length of stay greater than 3 days (OR 2.9), transfascial injury (OR 3.7) and tracheostomy placement (OR 5.1; all p-values < 0.05), while nasal and mandible fractures were also associated with overall operative repair (OR 2.5 and 9.3, respectively; p-value < 0.05 for both). Univariate analysis showed that among patients with GSW injuries who underwent facial plastic reconstructive surgery (FPRS) with comorbid serious polytrauma, the inpatient LOS was predicted solely by the presence of subarachnoid, subdural and intracranial hemorrhage (p-value < 0.005). Subsequent multivariate analysis found that the only predictor for greater hospital LOS for patients who underwent surgical repair was earlier timing to FPRS of less than five days (OR 0.17) and placement of a gastrostomy tube (OR 7.85). Conclusions: Managing facial fractures in GSW patients requires complex medical decision making with a consideration of functional and esthetic outcomes in the context of concomitant injuries and overall prognosis. Certain characteristics such as ICU admission, longer hospital stay, trajectory of GSW, tracheostomy placement, and specific operative locations are associated with higher rates of operative repair. Inpatient hospitalization LOS for patients who underwent FPRS was predicted by timing from admission to surgical repair. Full article

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13 pages, 1940 KiB

Open AccessArticle

Quantitative and Qualitative Symmetry Analysis of Open Reduction and Fixation of Zygomatic Complex Fractures

by Frederic Van der Cruyssen, Mathilda Wylde, Anthony Campbell, Ali Reza Pourkarim, Zeeshan Ahmad, Nabeel Bhatti and Simon Holmes

Craniomaxillofac. Trauma Reconstr. 2025, 18(2), 22; https://doi.org/10.3390/cmtr18020022 - 27 Mar 2025

Abstract

Zygomatic complex (ZMC) fractures are among the most common craniofacial injuries, impacting both function and esthetics. This study evaluates the effectiveness of open reduction and internal fixation (ORIF) in restoring facial symmetry following ZMC fractures. Sixteen patients with unilateral ZMC fractures underwent a [...] Read more.

Zygomatic complex (ZMC) fractures are among the most common craniofacial injuries, impacting both function and esthetics. This study evaluates the effectiveness of open reduction and internal fixation (ORIF) in restoring facial symmetry following ZMC fractures. Sixteen patients with unilateral ZMC fractures underwent a retrospective analysis comparing preoperative and postoperative computed tomography (CT) scans to a control group of ten individuals without facial fractures. Quantitative metrics, including root mean square distance (RMSD) and heatmap analysis, were used alongside a qualitative zygoma fracture scale to assess outcomes. Postoperative results showed significant improvements in facial symmetry, with RMSD values approaching those of the control group. Heatmap analysis revealed that 50% of patients achieved deviations within 2–4 mm and 31% within 2 mm, highlighting the effectiveness of ORIF. More complex fractures exhibited higher residual asymmetry, emphasizing the influence of fracture severity on surgical outcomes. The zygoma fracture scale correlated with heatmap results, supporting its value as a complementary assessment tool. These findings demonstrate ORIF’s capability to restore symmetry while identifying areas for improvement in managing complex fractures. The study underscores the need for enhanced imaging and standardized evaluation methods to optimize surgical precision and outcomes in craniofacial trauma care. Full article

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12 pages, 413 KiB

Open AccessArticle

Airway Management in Complex Maxillofacial Trauma: Evaluating the Role of Submental Intubation as a Viable Alternative to Tracheostomy

by Giulio Cirignaco, Gabriele Monarchi, Lisa Catarzi, Mariagrazia Paglianiti, Enrico Betti, Umberto Committeri, Alberto Bianchi, Paolo Balercia and Giuseppe Consorti

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 21; https://doi.org/10.3390/cmtr18010021 - 17 Mar 2025

Abstract

Airway management in maxillofacial trauma is a critical and complex challenge, requiring both secure ventilation and optimal surgical access while minimizing risks to vital structures. This study evaluated the efficacy of submental intubation (SMI) as a minimally invasive alternative to tracheostomy in patients [...] Read more.

Airway management in maxillofacial trauma is a critical and complex challenge, requiring both secure ventilation and optimal surgical access while minimizing risks to vital structures. This study evaluated the efficacy of submental intubation (SMI) as a minimally invasive alternative to tracheostomy in patients with complex maxillofacial fractures. A retrospective analysis of 52 patients treated between 2015 and 2023 was conducted by comparing clinical outcomes between those who underwent SMI (n = 26) and those who underwent tracheostomy (n = 26). The duration of hospitalization, infection rates, and perioperative complications were assessed using t-tests, chi-square tests, and multivariate regression. Results indicated that SMI was associated with significantly shorter hospital stays (11.15 ± 3.29 vs. 23.96 ± 6.47 days, p < 0.001) and lower infection rates (3.8% vs. 30.8%, p = 0.028). Additionally, the SMI group demonstrated fewer intraoperative (p = 0.049) and postoperative complications (p = 0.037). Multivariate analysis identified tracheostomy as an independent predictor of prolonged hospitalization and increased complications. These findings support SMI as a safe and effective alternative to tracheostomy for short-term airway management in maxillofacial trauma, providing a shorter recovery period and fewer complications. Therefore, prospective studies with larger cohorts are warranted to confirm these results and establish comprehensive guidelines. Full article

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11 pages, 234 KiB

Open AccessReview

Technique and Muscle Preferences for Dynamic Facial Reanimation in Irreversible Facial Paralysis—A Literature Review

by Hilde Schutte, Robbin Maat, Marvick S. M. Muradin and Antoine J. W. P. Rosenberg

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 20; https://doi.org/10.3390/cmtr18010020 - 5 Mar 2025

Abstract

Study design: literature review. Introduction: Irreversible facial paralysis is a chronic condition characterized by an absence of mimetic muscle tone and function. This disruption of facial expressions not only has functional, but also psychological and social consequences. In facial dynamic reanimation, techniques are [...] Read more.

Study design: literature review. Introduction: Irreversible facial paralysis is a chronic condition characterized by an absence of mimetic muscle tone and function. This disruption of facial expressions not only has functional, but also psychological and social consequences. In facial dynamic reanimation, techniques are proposed partly recovering facial reanimation and function. To date, a vast amount of literature is available on dynamic reanimation techniques. However, no review has yet been published that delineates in detail the musculature and techniques used for dynamic reanimation in irreversible facial paralysis. Objective: the aim of the present paper is to offer a complete overview of possible techniques. Methods: A chapter division is made between the lower, mid-, and upper face. Each chapter is subdivided between local transposition, free muscle flaps, and for the upper face, implantable devices. Results: The literature discussing reanimation of the lower face is limited. In midfacial reanimation, temporalis transposition and gracilis free flap transfer are popular. In upper facial reanimation, no consensus on muscle choice is available, and information is limited too. Suggested techniques include orbicularis oculi transpositioning, temporalis transpositioning, and platysma free muscle transfer. Conclusions: This paper discusses the current techniques for dynamic facial reanimation. Yet, studies comparing different techniques are lacking, setting ground for future research. This paper highlights the importance of a personalized approach in selecting a fitting reconstruction method. Full article

13 pages, 3573 KiB

Open AccessArticle

Need for Redo Surgery of Maxillofacial Fractures

by Hanna Thorén, Sami Suojanen, Anna Liisa Suominen, Tero Puolakkainen, Miika Toivari and Johanna Snäll

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 19; https://doi.org/10.3390/cmtr18010019 - 3 Mar 2025

Abstract

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 [...] Read more.

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

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14 pages, 4305 KiB

Open AccessArticle

Virtual Surgical Planning for Management of Acute Maxillofacial Trauma

by Kyle W. Singerman, Megan V. Morisada, J. David Kriet, John P. Flynn and Clinton D. Humphrey

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 18; https://doi.org/10.3390/cmtr18010018 - 21 Feb 2025

Abstract

Study design: A retrospective case series. Objective: The management of acute complex maxillofacial trauma is challenging. The intricate maxillofacial anatomy coupled with the significant functional and aesthetic repercussions of traumatic facial injuries necessitate meticulous preoperative preparation and operative precision to minimize patient morbidity. [...] Read more.

Study design: A retrospective case series. Objective: The management of acute complex maxillofacial trauma is challenging. The intricate maxillofacial anatomy coupled with the significant functional and aesthetic repercussions of traumatic facial injuries necessitate meticulous preoperative preparation and operative precision to minimize patient morbidity. The severe displacement of bone fragments, abnormal occlusion, comminution, and the involvement of multiple skeletal subsites further complicate the restoration of premorbid function and appearance. While previously recognized as a valuable tool for managing oncologic defects, orthognathic surgery, and for the correction of secondary deformities following maxillofacial trauma, virtual surgical planning (VSP) has now emerged as a viable tool for treating select patients following acute complex maxillofacial trauma. Methods: A retrospective chart review of all the complex facial trauma patients treated using VSP services over a 21-month period. Results: Multiple VSP services were used in the primary repair of complex facial trauma, with occlusal splints, pre-contoured plates, and 3D printed models being utilized most frequently. Conclusions: Our experience with VSP for primary maxillofacial trauma repair has helped us to identify specific indications for the use of VSP in this setting. Full article

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9 pages, 200 KiB

Open AccessArticle

Functional and Aesthetic Outcomes of Post-Mohs Nasal Reconstruction

by Nora A. Alexander, Kwasi Enin, Jenny Ji and Emily Spataro

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 17; https://doi.org/10.3390/cmtr18010017 - 20 Feb 2025

Abstract

Background: Similar to patients undergoing rhinoplasty, patients undergoing post-Mohs micrographic surgery (MMS) nasal reconstruction are concerned with both nasal form and function. Objectives: The objectives were to identify patient, defect, and surgical characteristics associated with post-MMS nasal reconstruction outcomes. Methods & Materials: A [...] Read more.

Background: Similar to patients undergoing rhinoplasty, patients undergoing post-Mohs micrographic surgery (MMS) nasal reconstruction are concerned with both nasal form and function. Objectives: The objectives were to identify patient, defect, and surgical characteristics associated with post-MMS nasal reconstruction outcomes. Methods & Materials: A retrospective single-institution cohort study was conducted of post-MMS nasal reconstruction surgeries occurring between 2015 and 2020. Patient, defect, and surgical details were collected along with nasal aesthetic and functional outcomes. Multivariable logistic regressions were used to analyze data. Results: A total of 167 nasal MMS defects among 160 patients met the inclusion criteria. The median age was 66 years, and 70% were female. A poor aesthetic outcome (n = 20, 12.0%) was associated with diabetes (aOR 6.277, 95% CI 2.193–17.965). Post-operative nasal obstruction (n = 17, 10.2%) was associated with obesity (aOR 20.976, 95% CI 2.406–182.845) and major revision surgery (aOR 12.192, 95% CI 2.838–52.382). Conclusion: Post-MMS nasal reconstruction aesthetic and functional outcomes are associated with obesity, diabetes, and revision surgery. Improved standardization of functional and cosmetic outcomes is important to better understand these results in the future. Full article

11 pages, 1273 KiB

Open AccessArticle

General and Treatment-Specific Outcomes with Osseointegrated Implants in Auricular, Nasal, and Orbital Prosthetic Reconstruction

by Morgan M. Sandelski, Deema Martini, Todd M. Kubon, Greg G. Gion and Amy L. Pittman

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 16; https://doi.org/10.3390/cmtr18010016 - 18 Feb 2025

Abstract

Background: Osseointegrated implants outside of dental restoration remain an integral area of facial reconstruction in which more outcomes data is needed. We aimed to describe our 13-year experience using osseointegrated implants for orbital, nasal, and auricular reconstruction, looking at general outcomes, including radiated [...] Read more.

Background: Osseointegrated implants outside of dental restoration remain an integral area of facial reconstruction in which more outcomes data is needed. We aimed to describe our 13-year experience using osseointegrated implants for orbital, nasal, and auricular reconstruction, looking at general outcomes, including radiated and surgically manipulated bone. Methods: This retrospective chart review covered demographics and outcomes from January 2008 to August 2021 in patients who underwent an orbital exenteration, partial or total rhinectomy, and partial or total auriculectomy with subsequent osseointegrated implant placement. We hypothesized radiation would increase the failure rate of implants and prostheses. Results: There were 79 implants placed in 27 patients, with over half of the patients requiring implants for reconstruction because of malignancy. The success rate was 86%. Complications were uncommon. Only 2 (7.4%) patients were unable to use their prosthesis. Prior radiation and surgery to the bone were associated with an increased risk of loss of implant (p = 0.008 and p = 0.007, respectively) but not associated with other complications or prosthesis non-viability. Conclusions: Osseointegrated implants are a reliable, permanent option for a realistic prosthesis. Radiation and prior surgery are significantly associated with an increased risk of implant failure but not associated with the inability to use the prosthesis. Regardless of prior treatments, bone-retained implants should be considered in facial reconstruction, especially after failing autologous repair or with concerns for cosmetic outcomes. Full article

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27 pages, 2205 KiB

Open AccessArticle

Patient-Specific Solutions for Cranial, Midface, and Mandible Reconstruction Following Ablative Surgery: Expert Opinion and a Consensus on the Guidelines and Workflow

by Majeed Rana, Daniel Buchbinder, Gregorio Sánchez Aniceto and Gerson Mast

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 15; https://doi.org/10.3390/cmtr18010015 - 13 Feb 2025

Abstract

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 [...] Read more.

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

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9 pages, 225 KiB

Open AccessArticle

Patient-Reported Donor Site Quality of Life Outcomes Following Fibula Free Flap Reconstruction

by Edgar Ochoa, James Cevallos, Ramon Bustos, Nina Patel, Chase M. Heaton, Rahul Seth, P. Daniel Knott and Andrea M. Park

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 14; https://doi.org/10.3390/cmtr18010014 - 11 Feb 2025

Abstract

Study Design: Retrospective cohort study. Objective: To (1) assess post-operative quality of life (QOL) and functional outcomes of fibula free flap (FFF) donor sites, (2) examine the incidence of post-operative claw toe deformities (CTDs) following FFF harvest, and (3) assess the effect of [...] Read more.

Study Design: Retrospective cohort study. Objective: To (1) assess post-operative quality of life (QOL) and functional outcomes of fibula free flap (FFF) donor sites, (2) examine the incidence of post-operative claw toe deformities (CTDs) following FFF harvest, and (3) assess the effect of flexor hallicus longus (FHL) muscle preservation on the incidence of post-operative CTDs. Methods: Patients aged 18 years or older and at least 6 months from FFF reconstructive surgery completed the Manchester–Oxford Foot Questionnaire (MOXFQ)and the Short-form 36 (SF-36) Questionnaire. The incidence of post-operative CTDs reported by respondents was calculated. We assessed the associations between FHL preservation at time of surgery and QOL and functional outcomes, including the development of post-operative CTDs. Results: Sixty patients completed questionnaires at a mean of 38.3 months from surgery. The cohort consisted of 28 patients in whom the FHL muscle and nerve were preserved and 32 patients in whom they were not. Among respondents, 23.3% (14/60) reported post-operative CTDs. FHL status was not associated with post-operative CTDs or with worse scores in the domains of pain (p = 0.612), walking/standing (p = 0.431), or social functioning (p = 0.400). Overall, majority reported high post-operative QOL. Conclusions: While majority of patients who undergo FFF reconstruction can expect good long-term donor site QOL and functional outcomes, there are risks of functional impairment, including post-operative CTDs. Preservation of FHL muscle did not affect post-operative QOL outcomes or the incidence of CTDs. These data can inform patient QOL expectations following FFF harvest. Full article

10 pages, 420 KiB

Open AccessArticle

Sobering Overview of Traumatic Craniofacial Injuries Involving Drugs and Alcohol: A Comprehensive Analysis of the NEISS Database

by Sam Boroumand, Ismail Ajjawi, Tara Boroumand, Omar Allam, Lioba Huelsboemer, Viola A. Stögner, Martin Kauke-Navarro, Siba Haykal, Michael Alperovich and Bohdan Pomahac

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 13; https://doi.org/10.3390/cmtr18010013 - 7 Feb 2025

Abstract

The purpose of this study is to provide a comprehensive overview of the epidemiology of traumatic craniofacial injuries in the U.S. that occur in the context of drugs and/or alcohol. The National Electronic Injury and Surveillance System (NEISS) database was queried from 2019 [...] Read more.

The purpose of this study is to provide a comprehensive overview of the epidemiology of traumatic craniofacial injuries in the U.S. that occur in the context of drugs and/or alcohol. The National Electronic Injury and Surveillance System (NEISS) database was queried from 2019 to 2022 to identify all emergency department (ED) patients with reported traumatic injuries involving craniofacial anatomy. Clinical and demographic variables were assessed between cases that involved drugs/alcohol and those that did not, utilizing two-proportion z-tests. In total, 441,764 patients with traumatic craniofacial injuries were identified, with 20,285 cases involving drugs and/or alcohol. Cases involving drugs/alcohol had a significantly higher frequency of internal injuries (45.3% vs. 34.9%, p < 0.001), fractures (7.0% vs. 3.4%, p < 0.001), and hematomas (4.6% vs. 2.5%, p < 0.001) than those that did not. Craniofacial injuries involving drugs/alcohol also had a significantly higher frequency of falls to the floor (19.2% vs. 11.8%, p < 0.001) and down stairs/steps (18.3% vs. 6.6%, p < 0.001) and resulted in a significantly greater odds of hospital admission after ED presentation (OR 3.75, 95% CI: 3.63–3.88, p < 0.001). Ultimately, these epidemiological findings can be leveraged to provide clinicians invaluable qualitative context for the most frequent presentations of craniofacial injuries they can anticipate to treat among intoxicated patients. Full article

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14 pages, 3544 KiB

Open AccessArticle

Patient-Specific Orthognathic Solutions: Expert Opinion on Guidelines and Workflow

by Alf L. Nastri, Isaac Liau, Jaewon Heo and Alexander Schramm

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 12; https://doi.org/10.3390/cmtr18010012 - 6 Feb 2025

Abstract

This document outlines guidelines for the use of three-dimensional virtual surgical planning in orthognathic surgery, with relevance to data acquisition, clinical diagnosis, data workflow sequencing, and operative considerations. A detailed description regarding fundamental principles of orthognathic assessment and planning is beyond the scope [...] Read more.

This document outlines guidelines for the use of three-dimensional virtual surgical planning in orthognathic surgery, with relevance to data acquisition, clinical diagnosis, data workflow sequencing, and operative considerations. A detailed description regarding fundamental principles of orthognathic assessment and planning is beyond the scope of this paper. Full article

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6 pages, 1835 KiB

Open AccessOpinion

Overcoming Barriers: The AO Foundation’s Role in Latin American Scientific Growth

by Rodrigo dos Santos Pereira, Rafael Vago Cypriano, Carlos Gaete Garcia, Juan José Larrañaga and Nicolas Homsi

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 11; https://doi.org/10.3390/cmtr18010011 - 5 Feb 2025

Abstract

This manuscript presents an exploratory evaluation of the challenges and opportunities in scientific research among craniomaxillofacial surgeons in Latin America. It focuses on initiatives introduced by the AO Foundation’s Research and Development (R&D) Committee to assess the current state of research involvement among [...] Read more.

This manuscript presents an exploratory evaluation of the challenges and opportunities in scientific research among craniomaxillofacial surgeons in Latin America. It focuses on initiatives introduced by the AO Foundation’s Research and Development (R&D) Committee to assess the current state of research involvement among AO Foundation members in the region and identify barriers to research. A survey conducted in 2023 among Latin American members of the AO Foundation gathered data on their interest in research, obstacles faced, and awareness of available opportunities, such as grants, fellowships, and mentorship programs. The outcomes revealed a strong interest in research, with 96.5% of respondents expressing a desire to engage. However, key barriers included limited time (46.5%), difficulties in project structuring and scientific writing (32.6%), and challenges in publishing (30.2%). Notably, 54.7% of respondents were unaware of the AO PEER program, and 65.6% were unfamiliar with the foundation’s research grant opportunities. The AO Foundation aims to enhance scientific development in Latin America by promoting multicenter research studies, training opportunities, and developing research group leaders. These strategies seek to support and encourage surgeons in advancing their scientific activities. Full article

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12 pages, 1754 KiB

Open AccessArticle

Training of Oral and Maxillofacial Surgery Residents in Virtual Surgical Planning: A Feasibility Study Comparing Open-Source Freeware and Commercially Available Software for Mandibular Reconstruction with Fibula Free Flap

by Bert Rombaut, Matthias Ureel, Benjamin Van der Smissen, Nicolas Dhooghe and Renaat Coopman

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 10; https://doi.org/10.3390/cmtr18010010 - 3 Feb 2025

Abstract

Study Design: This is an experimental feasibility study. Objective: The objective was to analyze the potential of open-source freeware (OSF) to train residents in virtual surgical planning (VSP) and compare this workflow with commercially available software (CAS). Methods: A workflow for mandibular reconstruction [...] Read more.

Study Design: This is an experimental feasibility study. Objective: The objective was to analyze the potential of open-source freeware (OSF) to train residents in virtual surgical planning (VSP) and compare this workflow with commercially available software (CAS). Methods: A workflow for mandibular reconstruction with a fibular free flap (FFF) was developed in 3D-Slicer^® and Blender^® and compared to our clinical workflow in Materialise Mimics Innovation Suite version 25 (Materialise InPrint^®, ProPlan CMF^® and 3-Matic^®). Five CMF residents, inexperienced in VSP, were trained to use both the OSF and CAS workflows and then performed four planning sessions on OSF and CAS. The duration (minutes) and the amount of mouse clicks (MCs) of every step in the workflow were recorded. Afterwards, the experience with VSP was investigated with the System Usability Scale (SUS) and a self-developed questionnaire. Results: The total VSP time with CAS took 91 ± 15 min and needed 2325 ± 86 MCs compared to 111 ± 26 min and 1876 ± 632 MCs for OSF, respectively. The questionnaire had an 80% response rate. The SUS for CAS was 67.5 compared to 50 for OSF. The participants believe it is extremely valuable to learn VSP during their training and to be able to perform VSP as a surgeon. Conclusion: We believe OSF can be a cost-effective alternative compared to CAS for the training of surgical residents to gain insight in complex surgeries and to better understand CAD limitations and possibilities. Full article

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9 pages, 445 KiB

Open AccessArticle

Comparative Analysis of Open and Closed Nasal Fractures in Trauma Settings: Mechanisms, Intent, Surgical Interventions, and Outcomes

by Ahmad K. Alnemare

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 9; https://doi.org/10.3390/cmtr18010009 - 22 Jan 2025

Abstract

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data [...] Read more.

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data Bank (NTDB) for the years 2013 to 2016. Main outcome measures: Trauma mechanism and mortality rates between closed and open fractures were conducted. Results: This study involved 122,574 closed and 9704 open nasal fractures to elucidate demographic, hospital, and clinical characteristics. Significant risk factors for open nasal fractures included a higher injury severity score, self-inflicted intent, unintentional causes, and firearm mechanism compared to assault injuries. Conclusions: Significant factors associated with open nasal fractures include injury severity, self-inflicted intent, trauma type, and firearm mechanisms, which notably increase the likelihood of open fractures. Findings highlight the need for targeted prevention, efficient resource allocation, and risk screening to enhance the management of complex facial traumas in the national trauma system. Full article

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12 pages, 849 KiB

Open AccessArticle

Oncological Outcomes Following Computer-Aided Reconstructive Jaw Surgery

by John M. Le, John Hofheins, Myra Rana, Jay Ponto, Anthony B. Morlandt and Yedeh P. Ying

Craniomaxillofac. Trauma Reconstr. 2025, 18(1), 8; https://doi.org/10.3390/cmtr18010008 - 5 Jan 2025

Abstract

The purpose of this study was to analyze computer-aided surgical planning (CAS) and margin status following oncological reconstructive surgery of the jaws. A retrospective study was conducted on patients who underwent microvascular reconstructive surgery from 2014 to 2021. The predictor variable was the [...] Read more.

The purpose of this study was to analyze computer-aided surgical planning (CAS) and margin status following oncological reconstructive surgery of the jaws. A retrospective study was conducted on patients who underwent microvascular reconstructive surgery from 2014 to 2021. The predictor variable was the use of CAS. The primary and secondary outcomes were histopathological bone margin status, local recurrence, and disease-free survival (DFS). Covariates included demographic, operative, pathological, and clinical outcomes. Thirty-five CAS and fifty-two non-CAS subjects were included for analysis. Demographic characteristics such as age, sex, and comorbidities were comparable between the study groups, with all p-values > 0.05. For operative variables, the osteocutaneous radial forearm flap was more commonly used in the non-CAS group (34.6%) compared to the CAS group (2.9%) (p < 0.01). The mean follow-up period was shorter in the CAS group (31.9 months) than in the non-CAS group (42.6 months) (p < 0.01). CAS was not associated with margin status (p = 0.65) or local recurrence (p = 0.08). DFS was comparable between the study groups (p = 0.74). Bone margin involvement was not associated with any covariates. The use of CAS in oncological reconstructive jaw surgery was not associated with increased bone margin involvement. Full article

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Craniomaxillofacial Trauma & Reconstruction

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