Search Results (56)

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

Background: Midfacial fractures are common outcomes of facial trauma. While younger individuals typically sustain these injuries through high-energy events like assaults and traffic or sports accidents, elderly patients increasingly present with fractures from low-energy mechanisms, primarily falls. Purpose: The aim of this study was to analyze age- and gender-specific patterns in midfacial fractures over a 10-year period, with emphasis on elderly individuals and low-energy trauma. Methods: A retrospective review was performed of proven midfacial fractures between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery (University of Pécs, Hungary). The patients were stratified by age (<65 vs. ≥65 years) and gender. The variables included the injury mechanism, fracture localization, the dental status, hospitalization, and the presence of associated injuries. Bivariate analyses were performed, and the significance level was set to p < 0.05. Results: A total of 957 radiologically confirmed midfacial fracture cases were evaluated, of whom 344 (35.9%) were ≥65 years old. In the elderly group, females had a 19-fold higher risk for midfacial trauma than younger females (OR: 19.1, 95%CI: 9.30–39.21). In the older group, a fall was significantly the most frequent injury mechanism (OR: 14.5; 95%CI: 9.9–21.3), responsible for 89.5% of the cases, while hospitalization (OR: 0.36; 95%CI: 0.23–0.56) was less characteristic. Most of the fractures occurred in the zygomatic bone, in the zygomaticomaxillary complex, or in the anterior wall of the maxilla. Associated injuries in the elderly group included mostly lower limb injuries—particularly pertrochanteric femoral fractures in females—and upper limb injuries, with a slight male dominance. Conclusions: Low-energy falls are the primary cause of midfacial fractures in elderly patients, particularly in women. Tailored prevention and management strategies are essential for improving the outcomes in this growing demographic group. Full article

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

Background/Objectives: Miniscrew-assisted rapid palatal expansion (MARPE) has been increasingly used as a nonsurgical alternative for maxillary expansion in adults. However, reports of complications remain limited. This case describes a rare instance of maxillary bone fracture following MARPE and its clinical implications. Methods: A 32-year-old patient underwent MARPE as part of presurgical orthodontic treatment for maxillary constriction. Five days after activation, severe pain developed, followed by sensory disturbances in the infraorbital region. CT imaging revealed a maxillary fracture extending from the infraorbital foramen to the alveolar process. Symptoms gradually improved over two years, but psychological distress led to the abandonment of orthognathic surgery. Results: This case suggests that MARPE-induced maxillary fractures may be associated with stress concentration at the zygomatico-maxillary suture, particularly in individuals with increased midpalatal suture interdigitation and thin cortical bone. Finite element analysis and stress distribution studies indicate that the zygomatic buttress serves as a major resistance point, which may have contributed to the fracture. Conclusions: These findings highlight the importance of careful patient selection, preoperative CT assessments of bone thickness, and individualized expansion protocols. In high-risk cases, alternative approaches, such as surgically assisted expansion, may be considered. Further research on MARPE’s risk assessment and treatment protocols is needed to improve safety. Full article

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

Background/Objectives: Zygomaticomaxillary complex (ZMC) fractures are the second most common of all facial bone fractures, and conventional treatment represents a challenge even for experienced surgeons. The aim of this systematic review and meta-analysis was to compare Intraoperative Surgical Navigation (ISN) with conventional surgery in the treatment of ZMC fractures. Methods: We reported our systematic review and meta-analysis based on the recommendation of the PRISMA 2020 guideline. The electronic search was conducted on 9 February 2025 in two search engines (PubMed and Web of Science) and two databases (Embase and the Cochrane Library). Randomized controlled trials and observational studies were included. The outcome variables were accuracy, operative time, maximum mouth opening, postoperative stay, amount of bleeding, and cheek numbness. The random-effects model was used for the analysis, and the results were given as mean differences and odds ratios with 95% confidence intervals (CI). After duplicate removal, 1961 articles were found. After the selection procedure, five studies were found to be eligible for qualitative and quantitative analysis. Results: There were no statistically significant differences between ISN and conventional surgery regarding the outcomes investigated, except in postoperative average deviation of the zygomatic bone. Our results showed an improvement of 0.64 mm [CI: 0.32, 0.92] zygomatic bone deviation when ISN was used. Conclusions: The results suggest that ISN is as effective as the conventional technique in the treatment of ZMC fractures. However, because of the low number of eligible studies, further randomized controlled trials are necessary to strengthen the level of evidence on this matter. Full article

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

Low-level laser therapy (LLLT) is known for its biostimulant properties, which can reduce inflammation and promote tissue regeneration. The present study is randomized, blinded, and placebo-controlled and aims to investigate the role of LLLT in the postoperative recovery of facial fractures. Patients with fractures of the zygomatic bone are selected and divided into two groups: low-level laser and red placebo light. The patients are evaluated for bite force, pain, mouth opening, and paresthesia in the pre-operatory day, on days 1, 2, 7, and 14. The trismus data demonstrated better results in the laser with a significant difference in the periods 7 and 14 days, with p-values of 0.0442 and 0.026, respectively. Regarding the bite force analyzed, no statistically significant differences were observed. In the pain scale comparison, there was a difference between the PLACEBO group and the LASER group for day 1 (p = 0.011), day 2 (p = 0.001), 7 (p = 0.001), and 14 days (p = 0.010). In the evaluation of paresthesia, on days 7 and 14, there were better results in the LASER group with p = 0.012 and p = 0.001. The laser acted as a moderator of the healing process, having a considerable effect on the aspects of trismus, pain, postoperative paresthesia, and bite force. Full article

The zygomatic bone, a fundamental structure in facial anatomy, is exposed to fractures in impact situations, such as traffic accidents or contact sports. The installation of zygomatic implants can also alter the distribution of forces in this region, increasing the risk of fractures. To evaluate this situation, the first step is to develop a complex anatomical model from the stomatognathic point of view so that simulations in this sense can be validated. This study uses numerical simulation using a finite-element method (FEM) to analyze the behavior of the zygomatic bone under impacts of different velocities, offering a more realistic approach than previous studies by including the mandible, cervical spine, and masticatory muscles. Methods: An FEM model was developed based on 3D scans of actual bones, and simulations were performed using Abaqus Explicit 2023 software (Dassault Systemes, Vélizy-Villacoublay, France). The impact was evaluated using a steel cylinder (200 mm length, 40 mm diameter, 2 kg weight) impacted at speeds of 5, 10, 15, and 20 km/h. Zygomatic, maxillary, and mandibular bone properties were based on dynamic stiffness parameters, and bone damage was analyzed using ductile fracture and fracture energy criteria. Results: The results show that at impact velocities of 15 and 20 km/h, the zygomatic bone suffered crush fractures, with impact forces up to 400 kg. At 10 km/h, a combination of crushing and bending was observed, while at 5 km/h, only local damage without complete fracture was detected. The maximum stresses were concentrated at the zygoma–jaw junction, with values above 100 MPa at some critical points. Conclusion: The FEM model developed offers a detailed representation of the mechanical behavior, integrating the main structures of the stomatognathic apparatus of the zygomatic bone under impact, providing valuable information to, for example, advance injury prevention and zygomatic implant design. Higher impact velocities result in severe fractures, underscoring the need for protective measures in clinical and sports settings. Full article

Study Design: Retrospective with follow-up. Objective: To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods: Patients with unilateral ZMC fractures between 2007–2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018–2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results: The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions: Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery. Full article

Introduction: on-fatal strangulation (NFS) is a dangerous mechanism that can produce injuries with varying levels of severity. NFS-related injuries can range from low severity, such as simple contusions, to very severe, with convulsions and major forms of impairment. It is often difficult to gauge the severity of injuries from external and initial manifestations alone; it is therefore necessary to assess the possibility of misdiagnosed injuries or subsequent manifestations. Case report: In this study, we describe the case of a 71-year-old man with several injuries, mainly in the craniofacial region, following an assault by his flatmate. Not only did the subject suffer a concussive head injury and a fracture of the zygomatic bone, but he was also subjected to NFS. The patient was examined three times, and the third examination was carried out directly by us 40 days after the assault. Discussion: We concluded that NFS-related injuries are not always clearly visible and recognized after some time. It would therefore be necessary to standardize the clinical investigation procedure in suspected or confirmed cases of NFS. Conclusion: Clinical investigation should be done from the first hours after the injury event, with the help of forensic experts, with the use of dedicated instrumentation and the acquisition of photographic images, all carried out in a systematic manner for use in court, and a search performed for after-effects that cannot be identified by other methods. Psychological evaluation should also be considered as part of the broader assessment process as victims of NFS often experience significant psychological trauma. Full article

Objectives: This study aimed to determine the impact of standing electric scooters on maxillofacial on the Italian territory. Methods: The authors analyzed the epidemiology of the injuries to define electric mobility’s impact on maxillofacial surgery practice. For this retrospective cohort study, data were collected by unifying the standing e-scooter-related fractures database from 10 Italian maxillofacial surgery departments. The reference period considered was from January 2020 to December 2023. The main data considered included age, gender, type of access, time slot of admission, type of admission, alcohol level, helmet use, dynamics of the accident, and area of the fracture. Results: A total of 79 patients were enrolled. The average age of the participants was approximately 31 years. The blood alcohol level was found to be above the Italian norm in 15 cases (19%). Only one patient wore a helmet. The most affected facial third was the middle one with 36 cases (45.5%), followed by the lower one (31, 39.3%). The most recurrent patterns were fractures of the orbito-malar-zygomatic complex (15, 19%), followed by multifocal (bifocal, trifocal) fractures of the mandible (14, 17.5%). Conclusions: This study demonstrated how maxillofacial fractures related to the use of electric scooters are associated with complex patterns, associated with a high rate of post-surgical aftermaths. Full article

Background/Objectives: There is a need for alternative approaches to full-arch rehabilitation of atrophic maxillae. The aim of this short case series was to describe the technique and assess the short term-outcomes of atrophic maxillae rehabilitation using transnasal implants in conjunction with zygomatic implants. Methods: Three female patients (average age: 62 years) presenting comorbidities and atrophic maxillae preventing the insertion of standard maxillary anchored implants received a full-arch fixed prosthesis supported by transnasal implants together with zygomatic implants, using the ad modum all-on-4 concept. Patients were followed during the functional osseointegration period. Primary outcome measures were prosthetic and implant survival based on function. Secondary outcome measures were complication parameters (biological and mechanical), plaque and bleeding levels, and probing pocket depths > 4 mm. Results: No implant failures were registered, and all prostheses remained in function. The only complication was a fracture of a provisional crown that was resolved. Plaque and bleeding scores were mild during the follow-up period. Conclusions: The present manuscript describes the use of extra-long transnasal implants in combination with zygomatic implants in immediate function for full-arch fixed prosthetic rehabilitation of atrophic maxillae, with the objective of promoting more research into this relatively recent technique. More studies are needed to validate the technique. Full article

This contribution gives basic information about the mechanical behavior of the facial part of the human skull cranium, i.e., the splanchnocranium, associated with external loads and injuries caused mainly by brachial violence. The main areas suffering from such violence include the orbit, frontal, and zygomatic bones. In this paper, as a first approach, brachial violence was simulated via quasi-static compression laboratory tests, in which cadaveric skulls were subjected to a load in a testing machine, increasing till fractures occurred. The test skulls were also used for research into the dynamic behavior, in which experimental and numerical analyses were performed. A relatively high variability in forces inducing the fractures has been observed (143–1403 N). The results lay the basis for applications mainly in forensic science, surgery, and ophthalmology. Full article

Study Design: This is a retrospective observational study. Objective: To evaluate the clinical outcomes after an open reduction and internal fixation (ORIF) of condylar neck and base fractures (CNBFs) with a trapezoidal shape plate in patients using a less invasive transparotid approach. Methods: Fifteen patients with condylar fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial (AOCMF) classification system, treated by ORIF with a trapezoidal plate. All patients were evaluated by clinical examination (pain, occlusion, and mandibular dynamics) and imaging through computed axial tomography. Postoperative evaluations considered a favourable clinical outcome of fragment stability, stable occlusion, absence of pain, and regular mouth opening ranges. In addition, any signs of local infection, malocclusion, facial nerve damage, or failure of the fixation system were recorded. Results: According to the AOCMF classification for condylar fractures, eight fractures affected the condylar base and seven involved the condylar neck. No patients presented pain or joint sounds in the TMJ. All patients obtained a buccal opening greater than or equal to 35 mm. Two patients showed postoperative malocclusion which was corrected by intermaxillary elastics therapy. In addition, two patients had transient paresis during the postoperative period. One of them had paresis of the frontal and buccal branches of the facial nerve while the second patient had paresis of the zygomatic and buccal branches. Conclusions: Using trapezoidal miniplates provides functionally stable fixation for neck and base condylar fractures and allows for a less invasive surgical transparotid approach (2 cm extension). They also reduce the amount of osteosynthesis material and are easier to adapt and fix in the author’s opinion. Full article