Craniomaxillofacial Trauma & Reconstruction最新文献

Background: Genioplasty is a well-established surgical technique for reshaping the chin and enhancing facial harmony. However, conventional fixation methods may present biomechanical and aesthetic limitations.

Objective: This study introduces and evaluates a novel Anatomical Chin Plate (ACP), designed to enhance mechanical performance and facial aesthetics compared to the conventional chin plate (CP).

Methods: A three-dimensional finite element analysis (FEA) was conducted to compare stress distribution in ACP and CP models under a standardized oblique load of 60 N, simulating muscle forces from the mentalis and digastric muscles. Plates were modeled using Blender and analyzed using ANSYS software 2025 r2. Mechanical behavior was assessed based on von Mises stress, concentration sites, and potential for plastic deformation or fatigue failure.

Results: The ACP demonstrated a significantly lower maximum von Mises stress (77.19 MPa) compared to the CP (398.48 MPa). Stress distribution in the ACP was homogeneous, particularly around the lateral fixation holes, while the CP exhibited concentrated stress between central screw holes. These findings indicate that the anatomical geometry of the ACP enhances load dispersion, reduces critical stress concentrations, and minimizes fatigue risk.

Conclusions: The ACP design offers superior biomechanical behavior and improved aesthetic potential for genioplasty procedures. Its optimized shape allows for better integration with facial anatomy while providing stable fixation. Further studies are recommended to validate in vitro performance and explore clinical applicability in advanced genioplasty and complex osteotomies.

We present a deep learning-based approach for accurate bone segmentation directly from routine T1-weighted MRI scans, with the goal of enabling MRI-only virtual surgical planning in head and neck oncology. Current workflows rely on CT for bone modeling and MRI for tumor delineation, introducing challenges related to image registration, radiation exposure, and resource use. To address this, we trained a deep neural network using CT-based segmentations of the mandible, cranium, and inferior alveolar nerve as ground truth. A dataset of 100 patients with paired CT and MRI scans was collected. MRI scans were resampled to the voxel size of CT, and corresponding CT segmentations were rigidly aligned to MRI. The model was trained on 80 cases and evaluated on 20 cases using Dice similarity coefficient, Intersection over Union (IoU), precision, and recall. The network achieved a mean Dice of 0.86 (SD ± 0.03), IoU of 0.76 (SD ± 0.05), and both precision and recall of 0.86 (SD ± 0.05). Surface deviation analysis between CT- and MRI-derived bone models showed a median deviation of 0.21 mm (IQR 0.05) for the mandible and 0.30 mm (IQR 0.05) for the cranium. These results demonstrate that accurate CT-like bone models can be derived from standard MRI, supporting the feasibility of MRI-only surgical planning.

Introduction: Maxillary setback in orthognathic surgery has been extensively discussed regarding its effects on bone healing and facial soft tissue profile; however, its impact on upper airway volume remains unclear.

Objective: We evaluate the influence of maxillary setback combined with counterclockwise (CCW) rotation of the occlusal plane on upper airway dimensions.

Methods: A retrospective observational case series was conducted with eight patients diagnosed with Class II malocclusion who underwent orthognathic surgery involving maxillary setback and CCW mandibular rotation. All procedures were performed by the same surgeon. Preoperative (T1) and 6-month postoperative (T2) facial CT scans were analyzed using Dolphin Imaging software11.7 to measure airway volume (VOL), surface area (SA), and linear distances D1, D2 and D3. Statistical analysis was performed using the Wilcoxon test with a 5% significance level.

Results: Significant skeletal changes were observed, including 10.2 mm of mandibular advancement, 5.2 mm of hyoid advancement, and 4.1° of CCW rotation. Although increases in airway volume and surface area were noted, they did not reach statistical significance (p = 0.327 and p = 0.050, respectively), but suggesting a favorable trend toward airway adaptation.

Conclusions: Maxillary setback combined with CCW rotation appears to safely correct Class II skeletal deformities without compromising upper airway space. These preliminary findings highlight the technique's potential for both functional and aesthetic outcomes, warranting further long-term studies.

Jaw in a Day (JIAD) reconstruction provides immediate restoration of mandibular form and function through a single-stage procedure that integrates fibula free flap reconstruction, virtual surgical planning (VSP), immediate dental implant placement, and delivery of a prefabricated prosthesis. Although the technique provides significant benefits in reducing rehabilitation time and improving patient outcomes, its adoption has been limited due to perceived technical complexity and unfamiliarity with dental workflow. This manuscript provides a detailed, step-by-step protocol to guide surgeons through their first JIAD case, from patient selection and data acquisition to VSP execution, intraoperative coordination, and implant positioning. Emphasis is placed on accurate osteotomy design, implant placement using guided protocols, fabrication of patient-specific hardware, and precise prosthesis pickup techniques. This guide also addresses essential OR team preparation and sterile handling of non-sterile components. By breaking down the process into actionable stages and highlighting common pitfalls and technical tips, this resource aims to lower the barrier for early adopters and enhance the success of initial JIAD cases.

Alcohol Use Disorder (AUD) is common among patients with maxillofacial trauma. Conventional perioperative care recommends complete abstinence. However, abrupt cessation can lead to Alcohol Withdrawal Syndrome (AWS), negatively impacting psychological well-being and compliance. This randomized controlled pilot study evaluated the effectiveness of Monitored Therapeutic Alcohol Administration (MTAA) in reducing perioperative stress and enhancing quality of life without impairing fracture healing. Twenty-four adult male patients with AUD and isolated facial fractures requiring surgery were enrolled. They were assigned to either an intervention group (n = 12) receiving MTAA-oral alcohol at 0.5 g/kg/day for two weeks-or a control group (n = 12) undergoing complete abstinence. Outcomes were assessed over six weeks, including stress (Zung Self-Rating Depression Scale), quality of life (Oral Health Impact Profile-14), soft tissue healing (Landry's Index), and hard tissue healing (Moed's Scale, serum osteocalcin). The MTAA group showed significantly reduced stress and improved quality of life (p < 0.001). Healing outcomes were comparable between groups, with no significant differences in soft tissue indices, osteocalcin levels, or radiographic scores. MTAA appears to be a safe and effective strategy to manage AWS-related distress and improve postoperative recovery, offering a practical alternative to strict abstinence in the surgical management of patients with AUD.

Auricular avulsion injuries are rare, and microvascular reimplantation is considered the preferred treatment according to current literature. However, when a small skin pedicle is preserved, non-microvascular reattachment techniques may offer comparable outcomes. This systematic review aims to assess whether these techniques could represent a viable alternative. We analyzed 32 cases of pedicled auricular avulsion reported in 16 articles, focusing on patient demographics, injury mechanisms, pedicle characteristics, venous congestion, and postoperative management. Venous congestion occurred in 11 patients, with a significantly higher risk in narrower pedicles (mean width 9.82 mm; 95% CI: 4.75-14.89; p = 0.025). Prophylactic heparin significantly reduced this risk (p = 0.007). Other interventions-leech therapy and hyperbaric oxygen-lacked sufficient data for firm conclusions. Most cases achieved graft survival; necrosis occurred in some, and only two patients required additional surgery. Non-microvascular techniques appear to be a viable alternative to microvascular reimplantation, with similar results and potentially fewer complications. Venous congestion remains the main challenge, requiring active management and hospitalization for monitoring. Limited case series and publication bias still hinder the development of standardized guidelines.

Conducting scientific research in craniomaxillofacial surgery presents distinct challenges, particularly in the Asia Pacific region. This study aimed to assess research interests, barriers, and support needs among surgeons in the region through an anonymous online survey conducted via Google Forms from 12 to 31 May 2025, with 169 responses collected. The survey included 13 structured questions and an open-ended comment section. Findings were compared with a similar survey done in Latin America in 2024, to identify regional differences. The results revealed a significant gap in research participation, with 18.3% of Asia Pacific respondents having no publications, unlike Latin America, where all had at least one. Familiarity and participation in the Arbeitsgemeinschaft für Osteosynthesefragen Program for Education and Excellence in Research (AO PEER) were lower in Asia Pacific (29% and 6.5%), and greater challenges were reported in establishing topics, research methodology, and data collection. Although interest was high, only 42% conducted research frequently, and 90.5% indicated a need for mentorship. Despite higher awareness of AO grant opportunities (58%), barriers, like inadequate support for scientific research, lack of training, and limited time, persist. These findings highlight the need for AO Craniomaxillofacial surgery (AOCMF) to implement targeted strategies, such as research training, mentorship, promotion of funding opportunities, and support for multi-center collaborations, to enhance research participation across the region.

Orbitozygomatic fractures represent a complex surgical challenge. Given the urgent need for validated educational tools that surpass traditional learning models, this multicenter study developed and validated a novel synthetic advanced simulation model for the reconstruction of these fractures. The model integrates platinum-cured silicones and 3D-printed bony structures with prefabricated fractures, accurately replicating the anatomy and tactile properties of soft and hard tissues, including simulated herniation of orbital contents. To our knowledge, it is the only available synthetic model combining both tissue types for this training. Ten participants (faculty and residents) completed simulated procedures. Technical performance was assessed using a hand motion tracking system, the global OSATS (Objective Structured Assessment of Technical Skills) scale, and a task-specific error measurement (Specific Fault Measurement, SFM) scale. Statistically significant differences (p = 0.021) were observed in operative time and error count between novices and experts, confirming the model's construct validity. Faculty completed the surgery in significantly less time (mean 18.16 min vs. 37.01 min for residents) and made fewer errors (mean 12.25 vs. 53.25). Face and content validity were strongly supported by participant surveys, with 100% stating they would use the simulator to practice before real surgery. A strong inverse correlation (r = -0.786, p = 0.021) between OSATS and SFM scores demonstrated concurrent validity. This model enables ethical, repeatable, and cost-effective training, supporting its implementation into surgical curricula to enhance competence and provide objective skill assessment in orbitozygomatic trauma surgery.

Objective: Trauma is a leading cause of enophthalmos, typically resulting from an increase in the volume of the bony orbit. The general consensus is that post-traumatic primary deformity repair should aim to restore the premorbid volume, shape, and cosmesis of the orbitozygomatic complex (OZC). This study aims to utilise novel three-dimensional (3D) printed patient-specific moulds to intraoperatively fabricate enophthalmos wedges and onlays using polymethylmethacrylate (PMMA) bone cement to reconstruct the OZC.

Methods: A total of seven patients underwent digital surgical planning using Freeform software to virtually correct orbitozygomatic complex deformities guided by a design algorithm. Three-dimensionally printed nylon patient-specific moulds were used intraoperatively to fabricate enophthalmos wedges and/or onlays using an industry-standard PMMA bone cement. Clinical examination and application of the proposed design algorithm determined that enophthalmos wedges were indicated for four patients, with one also requiring an onlay; and periorbital onlays were required for the three remaining patients.

Results: Hertel exophthalmometry at a mean follow-up of 19.1 months demonstrated good outcomes in the correction of post-traumatic enophthalmos and hypoglobus and with patients reporting good subjective cosmetic results. Patients 5 and 7 had follow-up three-dimensional computed tomography (3D-CT) to confirm correct placement.

Conclusion: The use of patient-specific PMMA wedges and onlays, fabricated intraoperatively with the aid of 3D-printed moulds, offers a reliable and effective approach for correcting post-traumatic enophthalmos and hypoglobus. This method allows for the restoration of orbital volume and anatomical contours, addressing both functional and aesthetic concerns. Our results demonstrate that this technique yields favourable outcomes.

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.