Craniomaxillofacial Trauma & Reconstruction最新文献

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.

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.

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.

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.

Background: The purpose of the study was to describe proportional condylectomy in patients with condylar hyperplasia using a titanium 3D-printed ultrathin wire mesh cutting guide placed below the planned bone resection.

Methods: Eight patients with condylar hyperplasia underwent proportional condylectomy using an ultrathin titanium 3D-printed cutting guide placed below the planned bone resection. The placement of the guide was facilitated by the incorporation of anatomical landmarks. The accuracy of bone resections guided by such devices was evaluated on postoperative radiographs. The mean postoperative follow-up was 30 months.

Results: Surgery could be performed in all patients in the same manner as virtually planned. The fitting accuracy of the cutting guides was judged as good. Postoperative radiographs revealed that the virtually planned shape of the newly formed condylar head after condylectomy could be achieved.

Conclusions: In conclusion, the use of virtual computer-assisted planning and CAD/CAM-based cutting guides for proportional condylectomy in unilateral condylar hyperplasia of the mandible offers high accuracy and guarantees very predictable results.

Study design: Systematic review.

Objective: Obstructive sleep apnea (OSA) is a possible complication following secondary velopharyngeal insufficiency surgery in patients with repaired cleft palate. Various surgical techniques are used to treat secondary velopharyngeal insufficiency after cleft palate repair, but the optimal procedure remains debatable. This review provides an overview of the incidence of airway obstructive outcomes related to different surgical modalities.

Methods: A systematic search was performed on the 1st of February following the PRISMA guidelines and registered on PROSPERO (CRD42022299715). The following databases were reviewed: Medline, EMBASE, Web of Science, Google Scholar, and the Cochrane Library databases. Studies that included data on the occurrence of OSA following velopharyngeal surgery in children with a repaired non-syndromic cleft palate were included. Non-English articles and studies that included syndromic cleft palate patients were excluded.

Results: Twenty-eight articles met the inclusion criteria. The surgical procedures are classified into three groups: pharyngeal flap procedure (PF), sphincter pharyngoplasty (SP), and palatal muscle repositioning (PMR). Incidence of post-operative OSA and symptoms of OSA were lowest after PMR compared to SP and PF (3%; 34%; 29%, respectively). Pharyngeal flap procedures resulted in the best speech outcomes.

Conclusions: PMR results in fewer postoperative complications in terms of OSA and achieves a satisfactory reduction in hypernasal speech. PF procedure carries a higher risk of developing OSA postoperatively but seems to be superior in the reduction in hypernasality.

Study design: Qualitative analysis study.

Introduction: Social media has been pivotal in the dissemination of medical knowledge to the public. The aim was to identify the demographics of individuals posting about cleft lip and palate on YouTube Shorts and Instagram, to characterize the content of these posts, and to highlight factors that could aid surgeons in better educating patients with cleft lip and palate.

Methods: Instagram posts and YouTube Shorts with "#cleftlip", "#cleftawareness", "#cleftpalate", "#cleftplipandpalate", and "#cleftproud" were searched on 8 June 2024. Postings were subclassified and analyzed for content, including topics of posts, authors, media type, tone of the post, and year of post.

Results: A total of 3321 posts were analyzed, with 2698 coming from Instagram and 623 from YouTube Shorts. The majority of content creators were patients and their family members (n = 2054, 61.8%), cleft lip and palate foundations (n = 384, 11.6%), and companies (n = 381, 11.5%). Only 167 posts were authored by physicians (5.1%). Among the educational and informational posts, patients and family members accounted for the majority of the posts (409 posts, 57.7%). Physicians contributed to a small fraction of the educational content (37 posts, 5.2%).

Conclusions: Physician participation in the cleft lip and palate social media realm on Instagram and YouTube Shorts was found to be limited. Moreover, there was a scarcity of educational content on both platforms, indicating a significant opportunity for physicians to engage more actively in cleft lip and palate social media discussions.

Study design: A literature review of relevant publications regarding panfacial fracture sequencing.

Objective: To review the current landscape of sequencing of panfacial trauma and propose the utilization of the Major Fragment Theory when conventional sequencing techniques are inadequate.

Methods: We conducted a review of existing literature on panfacial fracture management, focusing on sequencing techniques. Additionally, we analyzed unique fracture patterns to identify instances where conventional sequencing may be insufficient.

Results: Existing literature emphasizes directional-based sequencing techniques for panfacial fracture reduction. However, unique fracture patterns often necessitate deviation from these sequences. The Major Fragment Theory suggests prioritizing the reduction of larger fragments over conventional sequencing, particularly when dealing with complex fractures.

Conclusions: While directional-based sequencing techniques provide a valuable framework for panfacial fracture management and almost any approach can be utilized successfully, the Major Fragment Theory offers a complementary approach for cases where conventional sequencing falls short. Incorporating this theory into practice may enhance outcomes in the treatment of panfacial fractures.

Study design: Systematic review.

Objective: This systematic review examines the existing literature concerning the objective and subjective evaluations of osseous genioplasty outcomes.

Methods: A comprehensive search was conducted in databases including PubMed, Embase, and Web of Science, yielding 2563 references, which were screened by two independent reviewers. We included 105 articles originating from 25 different countries. Data were systematically extracted, categorized, and documented.

Results: Genioplasty was performed in 5218 patients, either independently (3560 cases) or in combination with other orthognathic procedures (1696 cases), with a predominant focus on female patients (64%). Objective evaluation primarily focused on surgical accuracy, relapse, and neurosensory disturbance, while subjective assessments were largely related to aesthetics and patient satisfaction. Despite significant advancements in three-dimensional surgical planning and assessment, the review highlights a lack of standardized methods for evaluating isolated genioplasty outcomes.

Conclusions: The findings emphasize the need for improved and validated instruments that specifically assess the functional and aesthetic results of genioplastic surgery. Future research should prioritize patient-centered prospective studies and the development of assessment tools to ensure more comprehensive and reliable outcome evaluations.