Craniomaxillofacial Trauma & Reconstruction最新文献

[This corrects the article DOI: 10.1177/1943387520983634.].

Study design: Retrospective cohort study.

Objective: To determine patient, defect, and surgical factors associated with facial reconstructive outcomes.

Methods: Post-Mohs Micrographic Surgery (MMS) facial reconstructions performed at a single institution between 2015-2020 were reviewed. Patient demographics, comorbidities, defect characteristics, type and timing of reconstruction, and postoperative complications and revisions were collected. Data was analyzed with multivariable logistic regressions.

Results: 245 defects in 220 patients (median age 66 years, 143 (65%) female) were included. Most were located on the nose (68%), and median size was 3.0 cm² (IQR 1.32-7.5 cm²). Defect size over 10 cm² (OR 5.176, 95% CI 1.353-19.808) and two-staged melolabial flaps (OR 4.021, 95% CI 1.525-10.603) were associated with complications after univariate analysis. Nasal tip defects (OR 2.324, 95% CI 1.076-5.019) were associated with minor revisions. Major revisions were associated with nasal sidewall (OR 2.873, 95% CI 1.125-7.336) and tip (OR 2.780, 95% CI 1.145-6.749) defects, ear cartilage grafts (OR 3.373, 95% CI 1.382-8.231), two-staged paramedian forehead flaps (OR 19.273, 95% CI 6.864-54.112), and delayed reconstruction over 14 days (OR 5.727, 95% CI 1.298-25.281). On multivariable analysis, defect size over 10 cm² (aOR 4.972, 95% CI 1.286-19.073) and two-staged melolabial flaps (aOR 4.575, 95% CI 1.628-12.857) were independently associated with complications, while two-staged paramedian forehead flaps (aOR 14.421, 95% CI 3.976-52.310) were independently associated with major revisions.

Conclusions: More complex reconstructions with larger defects and interpolated flaps were associated with revision surgery and complications of facial reconstruction following MMS.

Study design: Randomized Clinical Trial.

Objective: Mandibular body fractures may result in inferior alveolar nerve damage. This study examined the effectiveness of platelet-rich fibrin (PRF) application to the inferior alveolar nerve during open reduction and internal fixation (ORIF) of mandibular fractures.

Methods: This was a double-blind, split-mouth randomized clinical trial. Patients with bilateral mandibular body fractures with minimal displacement (<5 mm) who underwent ORIF were assessed for enrollment. PRF was placed within the fracture site before reduction and fixation on the studied side. Fixation was performed on the contralateral side (control side) without PRF. The study and control groups were randomized using QuickCalcs software. Neurosensory disturbance (NSD) was assessed through two-point discrimination (TPD), self-reported NSD (SR-NSD), and brush directional stroke discrimination test (BDSD) at 6 and 12 months postoperatively.

Results: Twenty-five subjects were enrolled. BDSB recovery was greater in the study group during all time intervals (P < .001). There were no differences between TPD and SR-NSD at the follow-up periods (P > .05).

Conclusions: The results of this split-mouth randomized clinical trial indicate that PRF may enhance the recovery of a damaged inferior alveolar nerve in mandibular body fractures.

Study design: Case-control.

Objective: Although zygomaticomaxillary complex (ZMC) fractures are among the most common facial injuries, the optimal approach to management remains controversial. This study analyzes the relationship between displacement measures derived from pre-operative CT imaging and clinical symptomatology to enhance surgeon understanding of the need for operative intervention.

Methods: A retrospective analysis was conducted on 95 patients with ZMC fractures seen at a single institution between 2015 and 2020. Patient demographics, CT characteristics, and symptoms prompting surgery were recorded from the medical record. Statistical analysis was conducted to determine relationships between radiographic characteristics, symptomatology, and need for operative intervention.

Results: Malar flattening or facial asymmetry was significantly predicted by lateral maxillary wall impaction (OR = 1.36, P < .001) and anterior-posterior displacement (OR = 1.18, P = .01). Infraorbital rim step-off was significantly associated with lateral maxillary wall impaction (OR = 1.23, P < .01). Vertical displacement predicted complaint of malocclusion (OR = 1.47, P = .03). Moreover, fractures with posterior displacement greater than 2.5 mm (OR = 14.3, P < .001) or lateral maxillary wall impaction greater than 4.5 mm (OR = 12.0, P < .001) were significantly more likely to be considered operative. Fractures displaced less than 15 mm total in all directions (OR = 16.0, P < .001) were less likely to require surgery.

Conclusions: CT characteristics of ZMC fractures reliably predict a patient's likelihood of developing symptoms, indicating surgical intervention. We hope these findings will aid in surgical decision-making regarding the management of ZMC fractures.

Study design: Retrospective cohort study.

Objective: Frontal sinus fractures (FSFs) can lead to a range of clinical challenges, including facial deformity, impaired facial sensation, cerebrospinal fluid (CSF) leakage, sinus drainage impairment, chronic sinus pain and mucocele formation. The optimal management approach, whether surgical or conservative, remains a topic of ongoing discussion. The aim of this study was to evaluate and compare the functional and esthetic outcomes of patients with surgically and conservatively treated FSFs.

Methods: In this retrospective study, patients treated for FSFs at the Karolinska university hospital 2004 to 2020 were identified in hospital records and invited to participate in a long-term follow-up. Sequelae and satisfaction with the esthetic result were assessed trough questionnaires and physical examinations.

Results: A total of 93 patients were included in the study, with 49 presenting isolated anterior wall fractures and 44 presenting combined anterior and posterior wall fractures. Surgical intervention was performed in 45 cases, while 48 were managed conservatively. Among patients with moderate anterior wall fractures (4-6 mm dislocation), 80% of surgically treated patients compared to 100% of conservatively treated patients expressed satisfaction with their cosmetic outcomes at follow-up (P = .03). In conservatively treated patients with a forehead impression, the anterior wall fracture dislocation ranged from 5.3 to 6.0 mm (P < .0001). Approximately 50% of surgically treated patients vs 15% of conservatively treated patients developed impaired forehead sensation at follow-up (P = .03). Thirty-six percent of surgically treated patients reported dissatisfaction with surgery-related scarring, particularly those who underwent surgery via laceration or bicoronal incision.

Conclusions: This study suggests that anterior FSFs with a dislocation of 5 mm or less can be effectively managed conservatively with high patient satisfaction, low risk of long-term forehead sensation impairment and without potential development of forehead impression. Bicoronal incision or incision via a laceration may be associated with esthetic dissatisfaction and late sequelae such as alopecia.

Study design: Retrospective review.

Objective: Auricular hematomas are generally associated with sports-related injuries, with studies predominantly in white populations and high neighborhood socioeconomic status (NSES) compared to our county. A previous population-based study of trauma patients in our county, Shelby County, Tennessee, shows that those who live in high vs low NSES experienced socioeconomic variation in injury. We aim to determine if differences exist in clinical management and outcomes in this population.

Methods: Patients from two hospital systems diagnosed with auricular hematomas from 2008-2023 were reviewed retrospectively. Inclusion criteria included adequate follow-up, clinical description of the hematoma, and comment on any complications or recurrence.

Results: 48 patients, with a median age of 28 (range: 0-83), with the most common etiology being assault/non-accidental trauma (NAT) at 41.7%, equally distributed across all NSES (P = .30), with one sports-related injury. Facial trauma consults were associated with lower recurrence rates, 25% vs 62.5% (P = .003) and were less likely to be placed for self-pay patients (P = .019). Bolster placement resulted in lower recurrence rates, 23.3% compared to 58.3% (P = .030).

Conclusions: Higher rates of assault/NAT etiologies existed in our population, independent of NSES. Our study reiterates the importance of facial trauma consultation and bolster usage to reduce recurrence.

Study design: Retrospective cohort study.

Objective: Calvarial osteoradionecrosis (ORN) is a rare but devastating complication of radiotherapy. The aim of this study was to describe the cumulative incidence of Calvarial ORN in patients in patients treated for cutaneous malignancy of the scalp.

Methods: Data was compiled from patient records of a large tertiary hospital Plastic Surgery department and radiotherapy records of an affiliated cancer Center. We included all patients that were treated for cutaneous malignancies of the scalp that received radiotherapy. Patient demographics, cancer stage, treatment modalities, intraoperative details, and patient outcome data were recorded. Patients with incomplete radiotherapy data were excluded.

Results: We analyzed 105 radiotherapy treatments to the scalp administered to 84 patients and recorded 7 cases of calvarial ORN resulting in a gross incidence of 6.67% per radiotherapy treatment. The parietal bone was the most frequently targeted site of radiotherapy and accordingly the most common site of ORN (85.7%). Median time from radiotherapy dose to the development of ORN was 846 days. Higher number of radiotherapy fractionation (P = .038), cumulative radiotherapy dose (P = .035), prolonged radiotherapy duration (P = .022) and skin grafting (P = .003) were associated with the development of ORN.

Conclusions: Our findings suggest radiotherapy variables, such as prolonged radiotherapy duration, increased cumulative dose and higher radiotherapy fractions were strongly associated with the development of ORN. In addition, skin grafting following surgical resection was associated with the development of ORN. Further studies with larger sample sizes are required to further explore this relationship.