Search Results (184)

Background: Mandibular fractures constitute a significant proportion of maxillofacial trauma resulting from traffic accidents and present valuable information about the severity of the trauma mechanism. The aim of this study was to evaluate the demographic characteristics, fracture patterns, and accompanying injuries of mandibular fractures resulting from traffic accidents. Methods: A retrospective examination was made of 94 patients who presented for forensic medicine evaluation following a traffic accident between 1 January 2019 and 31 December 2024 and were determined with mandibular fracture. The demographic data, accident characteristics, localization of the mandibular fracture, number of fractures, displacement status, and accompanying injuries were analyzed. Results: The analyzed cases comprised 68.1% males and 31.9% females, with a mean age of 29.27 ± 14.34 years. The mandibular fractures were displaced in 52.1% of cases, and closed in 98.9%. The fracture regions were determined to most often be the ramus (32.9%) and the condyle (32.9%). A single fracture was present in 54.9% of cases and multiple fractures in 45.1%. A significant correlation was seen between ramus fractures and male gender, driver status, and concomitant systemic injuries, whereas no significant relationship was found between some fracture types and the demographic and accident-related variables. Conclusions: Mandibular fractures resulting from traffic accidents may represent relatively high-energy trauma mechanisms, and certain fracture patterns may occur together with multiple and systemic injuries. The localization and characteristics of mandibular fractures present important clues about the biomechanics of the trauma and a holistic approach is required in the forensic medicine evaluation. Full article

The mandible, due to its anatomical position, mobility, and functional role, is one of the bones most frequently involved in maxillofacial trauma, with fracture patterns influenced by impact mechanisms and anatomical characteristics. This study aimed to analyse the relationship between trauma mechanisms and affected anatomical subsites in patients with isolated mandibular fractures treated at a regional public hospital in Buenos Aires Province. A retrospective cross-sectional observational study was conducted using medical records, surgical reports, and diagnostic imaging of patients treated between 2011 and 2024. Isolated mandibular fractures were included, while pathological fractures, dentoalveolar injuries, and cases with incomplete data were excluded. Trauma mechanisms were classified as interpersonal aggression, vehicular accidents, falls from height, contact sports, and blows with blunt objects. Interpersonal aggression was the most frequent trauma mechanism, followed by falls from height and vehicular accidents. The mandibular angle, parasymphysis, and condyle were the most commonly affected anatomical sites. Multivariable analysis showed a higher probability of condylar fractures in falls from height (OR = 4.75; 95% CI: 2.24–10.3; p < 0.001) and vehicular accidents (OR = 3.02; 95% CI: 1.28–7.13; p = 0.01). Falls were also associated with a lower probability of mandibular angle fractures (OR = 0.16; 95% CI: 0.06–0.36; p < 0.001), while blunt object trauma showed a positive association with mandibular body fractures (OR = 3.12; 95% CI: 1.04–8.95; p = 0.04). These findings indicate that trauma mechanisms influence the anatomical distribution of mandibular fractures, providing relevant information for diagnostic assessment and surgical planning. Full article

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

Background/Objectives: Restoration of mandibular anatomy following complex trauma remains challenging when conventional anatomical and occlusal references, such as dental occlusion, contralateral morphology, condylar position, or mandibular continuity are lost. This technical note describes the clinical application of a mandibular statistical shape model as an alternative anatomical reference for diagnosis, virtual planning, and postoperative evaluation in patients with severe post-traumatic deformities. Methods: The MAGIC-SSM, an open-source, age-, and sex-specific three-dimensional model derived from a normative population dataset, enables reconstruction of plausible mandibular geometry in the absence of residual landmarks. Three clinical cases were analyzed using MAGIC-SSM-based reference alignment, with distance mapping applied when indicated. Results: The model provided an additional anatomical reference that supported decision-making in secondary correction, hybrid reconstruction with patient-specific implants, and quantitative evaluation of postoperative outcomes. Conclusions: By replacing lost spatial references with population-based geometry, the MAGIC-SSM offered support for restoring mandibular form and symmetry. These preliminary findings illustrate the feasibility of applying the MAGIC-SSM as an anatomical framework in complex trauma when conventional guides are absent. As its clinical application involved clinician-guided alignment and scaling, reproducibility and reliability remain to be established and require further validation. Full article

Background and Clinical Significance: Fibrolipoma is an uncommon histological variant of lipoma characterized by mature adipose tissue with a significant fibrous component. Intraoral lipomas are rare (only about 1–4% of all lipomas) and lipomas arising in the buccal fat pad (buccal space) are particularly uncommon. Case Presentation: A 47-year-old male presented with a painless, slowly enlarging swelling in the left cheek region. Physical examination revealed a soft, non-tender mass in the buccal space, causing mild bulging of the cheek. Contrast-enhanced computed tomography and magnetic resonance imaging demonstrated a well-circumscribed lesion within the left buccal fat pad suggestive of a lipoma. The tumor was excised entirely via an intraoral approach under general anesthesia. Histopathological examination showed lobules of mature adipocytes interspersed with dense fibrous connective septa consistent with a diagnosis of a fibrolipoma. The postoperative course was uneventful. Conclusions: This case highlights that fibrolipoma, while rare in the maxillofacial region, should be included in the differential diagnosis of buccal space tumors. Imaging studies can aid in identifying the fatty nature and extent of such lesions, but definitive diagnosis relies on histopathology. The buccal fat pad’s anatomy allows an intraoral surgical approach in appropriate cases, providing direct access and excellent cosmetic outcomes. Complete excision is curative in benign fibrolipomas, and careful surgical technique prevents injury to adjacent structures. Full article

Background/objective: Maxillofacial fractures continue to represent a significant public health issue, with incidence patterns shaped by regional and demographic variables. This study aimed to deliver a comprehensive 15-year epidemiological analysis of maxillofacial trauma cases in southern Hungary. Methods: The study included patients who received treatment for maxillofacial trauma at the University of Pécs from 2009 to 2023. Data collected encompassed demographic characteristics, injury etiology, fracture location and complexity, date of injury, presence of alcohol involvement, therapeutic interventions, postoperative complications and reasons, and number of fixation plates removed. Descriptive statistics and odds ratios were calculated, with statistical significance defined as p < 0.05. Results: Among 1948 patients (69.9% male), a total of 2826 fractures were reported, averaging 1.45 fractures per patient. The most frequently affected age group was 21–30 years; however, a notable increase in cases among the elderly was observed for recent years. Falls accounted for the highest proportion of injuries (44.4%), followed by assaults (28.3%) and traffic accidents (16.8%). Injuries predominantly occurred on weekends, with Saturdays being particularly common. Alcohol consumption was documented in 14.7% of cases. The condyle (27.9%), body (25.7%), and angle (25.0%) were the most common sites of mandibular fracture. The maxillary sinus and zygomatic body were the leading sites of maxillofacial fractures. Conservative treatment was implemented in 54.6% of all cases, whereas surgical intervention was more frequently required for mandibular injuries (76.7%). Plate removal was performed in 15.3% of patients. Conclusions: During the study period, the incidence of maxillofacial trauma demonstrated a consistent increase, accompanied by demographic changes indicative of an aging population and a reduction in assault-related cases. Falls—especially among older adults—became the leading cause of injury. These results emphasize the necessity for targeted prevention efforts, geriatric-specific trauma management, and the implementation of health policies tailored to regional needs. Full article

Background: Pediatric craniofacial fractures represent a distinct clinical entity characterized by unique anatomical and developmental factors that differentiate them from adult facial trauma. Despite their relative rarity, these injuries pose diagnostic and therapeutic challenges due to the presence of active growth centers and the potential for long-term functional and esthetic sequelae. Methods: A retrospective observational study was conducted among pediatric patients aged 0–17 years treated for craniofacial fractures between 2020 and 2024 at the Department of Cranio-Maxillofacial Surgery, University Hospital in Kraków, Poland. Demographic data, injury mechanisms, fracture distribution, treatment modality, and associated injuries were analyzed. Multivariate logistic regression was applied to identify predictors of surgical intervention. Results: Ninety-eight patients met the inclusion criteria. The mean age was 12 years, with a male predominance. Midfacial fractures were most common, with orbital floor fractures representing the single most frequent injury. Surgical management was performed in 72 cases, predominantly using the transconjunctival approach and autologous bone grafting. Orbital floor fractures were identified as the only independent predictor of operative treatment (p < 0.05). Central nervous system trauma was the most frequent concomitant injury. No significant changes in etiology or fracture distribution were observed during the COVID-19 pandemic. Conclusions: Pediatric craniofacial trauma follows a reproducible, age- and mechanism-dependent pattern. Effective management requires individualized, growth-preserving, and function-oriented treatment strategies. Standardization of care protocols and multicenter prospective studies are essential to optimize outcomes and develop evidence-based, age-specific guidelines for the management and prevention of pediatric facial fractures. Full article

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

Background/Objectives: Isolated orbital floor fractures are a common consequence of midfacial trauma and are frequently associated with functional and aesthetic complications such as diplopia, enophthalmos, infraorbital hypoesthesia, restricted ocular motility, and, in rare cases, blindness. Current therapeutic approaches vary significantly between different surgeons. This systematic review aimed to evaluate different treatment strategies for isolated orbital floor fractures to determine the most effective approaches. Methods: Electronic systematic searches were conducted using keywords to identify studies reporting isolated orbital floor fractures. Publications were screened for eligibility, and relevant data were extracted and evaluated. Results: This systematic review included 444 patients from 27 selected studies. 42 patients were treated conservatively, while 381 underwent various surgical interventions. Overall, the mentioned treatment modalities were successful in correcting enophthalmos (85.2%), diplopia (74.8%), ocular motility restriction (61.6%), and sensory disturbances (61.1%) in their respective patient cohorts. The complication and reoperation rates for the surgical interventions were low during the follow-up periods ranging from 6 weeks to 10 years. The timing, surgical approach, and reconstructive technique varied widely across the studies. Conclusions: Both conservative and surgical management of isolated orbital floor fractures can achieve satisfactory clinical outcomes. Clinical symptoms, defect size, and the surgeon’s preference define the ideal treatment modality. Full article

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

Background: Surgical management of trauma in the maxillofacial complex can result in iatrogenic nerve injuries, particularly involving the infraorbital, inferior alveolar, and mental nerves. Paresthesia is a common postoperative complication, often attributed to the anatomical positioning of these nerve structures, making them vulnerable to injury. Among current therapeutic options for nerve injuries, low-level laser therapy (LLLT) has shown promising results in published studies. Objectives: This prospective observational study evaluated the effects of LLLT on nerve recovery following maxillofacial trauma surgery. Methods: A total of 21 participants, with a median age of 35 years and no gender-based selection criteria, were enrolled. Cases included zygomaticomaxillary complex and mandibular osteosynthesis; analyses were within-subject across time. Postoperative laser therapy was administered to both groups using the DUO MMO device (MMOptics, São Carlos, Brazil), delivering infrared light along the pathways of the inferior alveolar, infraorbital, and mental nerves. Nerve function was assessed regularly using a Visual Analog Scale (VAS) and the Brush Stroke Direction (BSD) test to evaluate sensory recovery. Results: Compared with baseline (15 days post-op, pre-LLLT), VAS scores showed significant reductions at sessions 7 and 10, and BSD responses increased over time. Conclusion: After multiplicity control, only the session 10 comparison remained significant. These observational findings support the feasibility of multi-session LLLT after maxillofacial trauma; controlled trials are warranted to determine efficacy. Full article

This meta-review evaluated the possibility of more specified recommendations in antibiotic treatment through a narrowed focus on facial trauma. The aim was to analyze the effect of different regimens of antibiotic in treatment of skeletal trauma to the face. The knowledge mapping was based on existing systematic reviews (SRs) on trials specified in a PICO: Participants (P): Adults and children, diagnosed with fractures to the facial skeleton. Interventions (I): Antibiotic intervention. Comparator (C): Placebo, no antibiotics. Outcomes (O): Postoperative infection, pain, re-operation, other complications, healing deficiencies, (Oral) Health related Quality of Life, removal of osteosynthesis, adverse reactions. The literature search in PubMed, The Cochrane Library, and Web of Science according to PRISMA resulted in 1487 records. A COVIDENCE selection process resulted in 29 articles retrieved and read in full text revealing 10 articles eligible for evaluated according to ROBIS. Three SRs were considered to have low risk of bias and constituted the final evidence evaluation. The meta-review of these SRs did not provide sufficient support for prolonged antibiotic treatment after surgical intervention of midfacial fractures in comparison with antibiotics only the first day postoperatively. No support for antibiotic treatment for conservatively managed fractures alone was found. This review is limited by a relatively low number of included SRs. However, tendencies in outcomes suggests a restricted duration of antibiotics in treatment of facial fractures. Full article

Transorbital penetrating intracranial injuries are a rare but life-threatening subset of penetrating head traumas. While isolated cases caused by bicycle brake handles have been reported, often with fatal outcomes, this is the first documented case of such an injury caused by an electric scooter (e-scooter) brake handle. The objective is to present the unique management and clinical course of this unusual case. A case of a 76-year-old male is presented. The patient sustained a transorbital intracranial injury after a same-level fall onto a parked e-scooter, which resulted in the brake handle penetrating his left orbit and reaching the third ventricle. A combined maxillofacial and neurosurgical team performed a frontal craniotomy for foreign body removal, followed by duraplasty. No cerebrospinal fluid leakage was detected postoperatively. Imaging and clinical follow-up at six months and one year revealed significant post-traumatic encephalomalacia in the frontal lobes, ventricular enlargement, and persistent neurocognitive deficits, including memory impairment and executive dysfunction. Visual acuity in the affected eye was reduced, with associated orbital fat atrophy and mild ptosis. E-scooter brake handles pose a previously unrecognized risk for severe transorbital penetrating intracranial injuries. This case underscores the critical importance of a multidisciplinary surgical approach to manage complex craniofacial trauma. Despite successful acute management, patients can suffer substantial long-term neurological and functional sequelae, necessitating comprehensive follow-up care. Full article

Orbital floor fractures are primarily caused by blunt trauma to the area around the eyes. These injuries most commonly affect the orbital floor and medial wall due to the fragility of these structures. The mechanism typically involves transmission of force through the orbital rim or an acute increase in intraorbital pressure caused by globe displacement. Blowout fractures often occur alongside additional maxillofacial fractures and periorbital soft tissue injuries. The reported causes mirror those of general maxillofacial trauma and include motor vehicle collisions, interpersonal violence, falls, sports-related injuries, incidents involving firearms, and occupational accidents. Here, we present the case of a 56-year-old male patient who sustained an exceptionally rare injury pattern characterized by a complete orbital floor fracture with globe dislocation into the maxillary sinus. Such extensive fractures are associated with significant functional impairments, including diplopia, enophthalmos, and restricted extraocular muscle movement, as well as marked aesthetic deformity. Comprehensive diagnostic imaging, comprising coronal, sagittal, and three-dimensional CT reconstructions, was crucial for accurately assessing the extent of bony disruption and soft tissue involvement. Particular emphasis should be placed on imaging that clearly delineates the extraocular muscles and the optic nerve, as precise evaluation of these structures is essential for surgical planning and prognosis. Surgical management involved repositioning of the globe and the orbital contents, followed by reconstruction of the orbital floor using a titanium mesh anchored to the infraorbital rim. This case highlights the technical challenges of total orbital floor reconstruction, emphasizing the importance of meticulous anatomical restoration for achieving optimal functional and aesthetic outcomes. Full article

Introduction: Concussions are a growing concern in professional football due to their potential short- and long-term neurological consequences. Despite increasing global awareness, data on the epidemiology and clinical management of concussions in Portuguese football remain scarce. This preliminary exploratory study aimed to characterize the incidence, mechanisms, symptomatology, and medical response to concussions in Portugal’s Professional Football Leagues during the 2023/2024 season, based on reported cases. Methods: A retrospective observational analysis was conducted on head injuries reported by club medical teams during official matches in Liga Portugal First and Second Leagues. Collected variables included player position, time of injury, mechanism, symptoms, medical interventions and hospital referral. Results: Only six concussions were reported during official matches, with an overall incidence of 0.60 per 1000 player-hours. Most occurred in defenders, primarily due to head-to-head collisions, followed by ball impact, falls, and maxillofacial trauma. Injuries were more frequent during the final third of matches. Common symptoms included loss of consciousness, headache, and amnesia. Half of the players were referred to hospital care and underwent cranial CT scans. Among all variables analyzed, a statistically significant association was found between mechanism of injury and occurrence of amnesia (p = 0.014), with non-head-to-head impacts more frequently associated with amnesia. However, given the extremely limited sample size, this finding should be interpreted with extreme caution and requires replication in larger cohorts. Conclusions: This preliminary study suggests that defenders face a higher risk of head injuries, particularly from head-to-head impacts occurring late in matches. The prevalence of severe symptoms and the potential association between non-head-to-head impacts and amnesia highlight the need for more robust injury surveillance systems and underscore the importance of improved sideline assessment and return-to-play protocols. The findings emphasize the urgent need for comprehensive, standardized reporting mechanisms for concussions. Further research should explore long-term neurological effects and the effectiveness of preventive measures such as rule modifications, protective measures, and enhanced concussion management protocols, supported by more extensive and systematically collected data. Full article