Craniomaxillofacial Trauma and Reconstruction

Study Design This study presents a review of the evolutionary development in reconstructive orbital surgery over the past 3 decades. Additionally, it proposes the Orbital Assessment Algorithm (OA 2 ) to enhance decision-making for intraorbital reconstruction of post-traumatic orbital deformities. Objective The objective of this paper is to provide insights into modern post-traumatic orbital reconstruction from a surgeon’s perspective, with a specific focus on adult patients. It aims to highlight the advancements in computer-aided design and manufacturing techniques, particularly in the field of reconstructive orbital surgery, and to introduce the OA 2 as a tool for improved decision-making in this context. Methods The study conducts a comprehensive review of the evolution of reconstructive orbital surgery, focusing on the integration of 3D technology into surgical practices. It also outlines the development and rationale behind the proposed OA2, emphasizing its potential to enhance the accuracy and efficacy of intraorbital reconstruction procedures for post-traumatic deformities. Results The review demonstrates the significant progress made in reconstructive orbital surgery, particularly in leveraging 3D technology for virtual modeling, navigation, and the design and manufacturing of patient-specific implants. The introduction of the OA 2 provides a structured approach to assessing and addressing post-traumatic orbital deformities, offering potential benefits in decision-making and surgical outcomes. Conclusions In conclusion, this paper underscores the pivotal role of computer-aided design and manufacturing in advancing reconstructive orbital surgery. It highlights the importance of integrating innovative design concepts into implant manufacturing processes and emphasizes the potential of the OA 2 to guide surgeons in the management of post-traumatic orbital deformities, ultimately contributing to improved patient outcomes.

Nils-Claudius Gellrich

Michael Grant

Damir Matic

Philippe Korn

Craniomaxillofacial Trauma & Reconstruction

Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA<sup>2</sup> (Orbital Assessment Algorithm)

眼眶缺损评估及患者个性化植入物设计指南：引入OA<sup>2</sup>（眼眶评估算法）

Study Design This study explores the workflow of in-house computer-aided design/manufacturing (CAD/CAM) in head and neck oncologic surgery, focusing on 3D printing of biomodels and cutting guides. Objective We aim to describe a validated workflow for an in-house 3D Printing Department within a level III University Hospital of the Spanish Public Health System using free software. Methods Our study outlines a cost-effective and time-efficient workflow utilizing free software for 3D printing. We assess the feasibility of establishing an in-house department compared to outsourcing to the biomedical industry. Results The study demonstrates that creating an in-house 3D Printing Department in a hospital setting is a viable option. We discuss the advantages, including cost savings and reduced lead times, as well as the limitations of this approach. Conclusions In conclusion, establishing an in-house 3D Printing Department has the potential to significantly streamline complex head and neck oncologic surgery procedures. This approach can enhance accessibility to advanced CAD/CAM, making them more efficient and cost-effective within the healthcare system.

Vicenç J. Gómez

Antonio Martín-González

Víctor Zafra-Vallejo

Ignacio Zubillaga-Rodríguez

Antonio Fernández-García

Gregorio Sánchez-Aniceto

In-House Virtual Surgery Planning and 3D Printing for Head and Neck Surgery With Free Software: Our Workflow

免费软件在头颈外科手术中的虚拟手术规划与3D打印：我们的工作流程

Study Design This was a retrospective study at Noma Children Hospital, Sokoto, Nigeria, from January 2018 to December 2021. Objective The main objective of this appraisal was to present Braimah-Taiwo et al’s new classification system for mandibulo-maxillary synostosis secondary to noma and also to provide a guide to their treatment. Methods Noma with mandibulo-maxillary synostosis was the main inclusion criteria. Excluded were cases of acute noma and noma without mandibulo-maxillary synostosis. Data retrieved include demographics of patients and extent of bony ankylosis and mandibulo-maxillary synostosis. Results A total of 64 patients (30 (46.9%) males and 34 (53.1%) females) were managed. Ages ranged from 6 to 40 years with mean ± SD (18.2 ± 7.6) years. Regarding the new classification system of mandibulo-maxillary synostosis, 6 (9.4%) patients presented with Type 1 (Mild joint obliteration)±Soft tissue scarring, 24 (37.5%) presented with Type II (Total joint obliteration)±Soft tissue scarring, 21 (32.8%) presented with Type III (Coronoid, zygoma and maxilla) ±Soft tissue scarring, 4 (6.3%) presented with Type IV (Condyle, glenoid fossa, coronoid, sigmoid notch and zygoma) ±Soft tissue scarring, 7 (10.9%) presented with Type V (Condyle, glenoid fossa, coronoid, sigmoid notch, zygoma and pterygo-maxilla) ±Soft tissue scarring, while 2 (3.1%) patients presented with Type VI (condyle, glenoid fossa, coronoid, sigmoid notch, zygoma, pterygo-maxilla and the orbit) ±Soft tissue scarring. Conclusions Pattern of tissue destruction in noma patients is complex involving both soft and hard tissues. This new classification will guide surgeons in the effective management of these patients.

Ramat Oyebunmi Braimah

A. O. Taiwo

H. O. Olasoji

J. N. Legbo

M. Amundson

A. A. Ibikunle

I. K. Suleiman

M. Bala

B. O. Ile-Ogedengbe

Braimah-Taiwo et al New Classification System and Treatment Algorithm of Mandibulo-Maxillary Synostosis Related to Noma. Field Experience From Noma Children Hospital Sokoto, Nigeria

Braimah-Taiwo 等：关于Noma相关下颌-上颌联合的新的分类系统和治疗算法。来自尼日利亚索科托Noma儿童医院的实地经验

Study Design Qualitative Descriptive Study. Objective To evaluate the utility of post-operative instructions (POIs) for facial trauma provided by the language model ChatGPT as compared to those from electronic medical record (EMR) templates and Google search engine. Methods POIs for four common facial trauma procedures (mandibular fracture, maxillary fracture, nasal fracture, and facial laceration) were generated by ChatGPT, extracted from EMR templates, or obtained from Google search engine. The POIs were evaluated by a panel of surgeons using the Patient Education Materials Assessment Tool (PEMAT-P). Results Average PEMAT-P understandability scores across all 3 sources ranged from 55% to 94%. Actionability scores ranged from 33% to 94%, and procedure-specific scores ranged from 50% to 92%. ChatGPT-generated POIs ranged from 82% to 88% for understandability, 60% to 80% for actionability, and 50% to 75% for procedure-specific items. Conclusions ChatGPT has great potential to be a useful adjunct in providing post-operative instructions for patients undergoing facial trauma procedures. Detailed and patient-specific prompts are necessary to output tailored instructions that are accurate, understandable, and actionable.

Suresh Mohan

Spenser Souza

Shayan Fakurnejad

P. Daniel Knott

Utility of an Artificial Intelligence Language Model for Post-Operative Patient Instructions Following Facial Trauma

面部创伤术后患者指导中人工智能语言模型的应用价值

Study Design This institutional cross-sectional study using cadaveric mandibles aimed to measure and compare the strengths of three plating designs utilized in osteosynthesis of mandibular angle fractures. Objective There have been prior studies on angle fracture fixation though few biomechanical studies on human cadaveric specimen. This study aims to directly compare the biomechanical strength of different plating designs to the mandibular angle fracture using a human cadaveric specimen substrate. Methods After receiving an angle osteotomy and either single plate, two plate, or 3D plate fixation, the specimens underwent biomechanical testing using the Instron 5565 mechanical testing unit. The primary outcomes measured were peak load at which permanent deformation started, displacement value at peak load, and load necessary for a specific amount of displacement at 1, 3, 5, and 7 mm. Results There were 15 hemi-mandibles in each group. Based on data analysis of all the specimens, there were no significant differences in the mandibular height, ramus width, mandibular thickness, angle height, and gonial angle between the hemimandibles.. This study demonstrated a statistically significant increased strength performance of the 3D plate over the single plate fixation and the 2-plate over the single plate fixation. The results between 2-plate and 3D plate were in similar values. Conclusions In terms of biomechanical strength, the 3D plate and two plate designs outperform the single plate design to mandibular angle fractures. There are various anatomical and patient specific situations that can aid in selection between them. In the absence of the favorable angle fracture and patient, biomechanical strength to the method of fixation selection needs to be considered.

Brendan R. Squier

Wichuda Kongsong

Stacey S. Cofield

Samuel Bignault

Somsak Sittitavornwong

Comparison of Strengths of Mandibular Angle Fractures Following Different Plate Designs: A Human Cadaver Study

不同板设计下下颌角骨折强度比较：一项人体尸体研究

Study Design Single-institution retrospective financial analysis. Objective Trauma care is consistently linked to inadequate reimbursement, posing a significant financial burden for large trauma centers. Data show that declining Medicare reimbursement rates have indirectly led to declining payment for all procedures covered by insurance. The goals of this study are to investigate the opportunity cost associated with contemporary surgical management of CMF trauma at our institution and to evaluate longitudinal financial trends. Methods Patients with operative facial fractures between 2015 and 2022 at Duke University Medical Center were included and compared to patients undergoing general otolaryngology, plastic surgery and oral surgery operations in the same period. Procedural codes, payor type, charges billed, collections, relative value units (RVUs) and other financial data were obtained and analyzed among the 2 patient populations. Comparative analysis was performed to assess the financial trends in data reported previously from 2007-2015. Results The collection rate at Duke University Medical Center for operatively managed CMF fractures remains significantly lower than non-CMF counterparts. Interestingly, the collection rate gap between CMF and non-CMF surgeries has narrowed when comparing to the data from 2007-2013. This is largely due to a decrease in collection rates for non-CMF procedures from 29.61% (2007-2013) to 26.57% (2015-2022) [ P = 0.0001] and an increase in collection rates for CMF procedures from 17.25% (2007-2013) to 18.05% (2015-2022) [ P = 0.0001]. Conclusions Despite a slight improvement of the gap in reimbursement rates for CMF and non-CMF surgeries over the last several years, trauma care continues to have a negative financial impact on health care institutions.

Khalil Issa

Nicholas A. Frisco

Kayla W. Kilpatrick

Maragatha Kuchibhatla

Dane M. Barrett

David B. Powers

Charles R. Woodard

Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma: A Longitudinal Study

颅颌面创伤手术管理的机会成本：一项纵向研究

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.

Samin Rahbin

Ola Sunnergren

Ellen McBride

Hatef Darabi

Babak Alinasab

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

更多侵入性手术是否导致更高的患者满意度？136例颧上颌复合体骨折的长期随访

Study Design Retrospective cohort study. Objective A major risk factor for oral squamous cell carcinoma (OSCC) is advanced age. Ablative surgery combined with microvascular reconstruction has become routine for OSCC. Nevertheless, there is an interdisciplinary debate about the appropriateness of surgery combined with prolonged general anesthesia in the elderly. In the present study, the ablative and microvascular strategies in OSCC were evaluated in terms of oncologic safety and surgical morbidity in relation to age. Methods A total of 345 patients with primary OSCC who underwent ablative tumor surgery and neck dissection according to the German national guideline for OSCC together with microvascular reconstruction from September 2010 to October 2017 were examined. General clinical data was analyzed descriptively with a special focus on perioperative morbidity of an elderly (≥70y) subgroup of 56 patients. Oncological outcome was estimated using Log Rank testing and Kaplan Meier plotting. Results Estimated 5 year overall survival (OS) and disease-free survival (DFS) was 69.6% (≥70y) vs. 76.7% (&lt;70y) and 62.9% (≥70y) vs. 78.2% (&lt;70y) respectively with no significant difference between the 2 age groups. In multivariate cox regression, only initial stage of disease revealed significant impact on OS. Analysis of perioperative death/complications, flap loss, operation time, dependence on tracheostomy and hospitalization revealed no significant differences between the 2 groups. Conclusions Tumor surgery including neck dissection in combination with primary microvascular reconstruction is a safe therapy in patients of advanced age. This results in excellent oncological outcome with no significant disadvantages in terms of perioperative morbidity, hospitalization or flap failure.

Anne Radermacher

Dominik Horn

Michael Fehrenz

Karl Semmelmayer

Oliver Ristow

Michael Engel

Jürgen Hoffmann

Kolja Freier

Julius Moratin

Microvascular Reconstructions in Elderly Patients With Oral Squamous Cell Carcinoma - Too Old for Surgical Treatment?

老年口腔鳞状细胞癌患者微血管重建——手术治疗是否已为时过晚？

Study Design Retrospective Cohort Study. Objective Reconstruction of maxillary bone defects can be completed with vascularized and non-vascularized autografts. Cellular bone matrix allografts (CBMs), which have lineage committed bone cells, has risen as an alternative. The purpose of this study was to describe our experience and to determine the success of CBM based maxillary reconstruction in a variety of clinical scenarios. Methods A retrospective cohort study was designed and implemented using data from subjects who presented to the University of Louisville and were treated with a CBM for maxillary reconstruction from 2019 to 2023. Subjects were excluded if they were not treated with a CBM, data were not complete, or postoperative follow-up time was less than 3 months. Descriptive statistics were calculated for each variable. To measure the associations between the risk factors and graft success, Fisher’s exact test was implemented. A P-value of &lt;0.05 was considered significant. Results The sample included 48 subjects. The mean age of all subjects was 43 ± 24 years. Overall, 42 (87.5%) cases were successful. The perioperative antibiotic administered ( P = 0.02), etiology ( P = 0.021), and the addition of platelet rich fibrin or autograft as an adjunct influenced CBM success ( P = 0.039). Conclusions CBMs are a viable option for reconstruction of maxillary bone defects. CBMs may be an alternative to autografts.

Abbreviation	Craniomaxillofac. Trauma. Reconstr.
Journal Impact	0.64
Quartiles(Global)	DENTISTRY, ORAL SURGERY & MEDICINE(Q4)

Publication Information	Publisher: SAGE Publications Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2014，Proportion of original research papers: 81.58%，Self Citation Rate:0.00%， Gold OA Rate: 5.56%

Craniomaxillofacial Trauma and Reconstruction

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Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA² (Orbital Assessment Algorithm)

In-House Virtual Surgery Planning and 3D Printing for Head and Neck Surgery With Free Software: Our Workflow

Braimah-Taiwo et al New Classification System and Treatment Algorithm of Mandibulo-Maxillary Synostosis Related to Noma. Field Experience From Noma Children Hospital Sokoto, Nigeria

Utility of an Artificial Intelligence Language Model for Post-Operative Patient Instructions Following Facial Trauma

Comparison of Strengths of Mandibular Angle Fractures Following Different Plate Designs: A Human Cadaver Study

Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA² (Orbital Assessment Algorithm)

Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma: A Longitudinal Study

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

Microvascular Reconstructions in Elderly Patients With Oral Squamous Cell Carcinoma - Too Old for Surgical Treatment?

Reconstruction of Maxillary Bone Defects With Cellular Bone Matrix Allografts

Craniomaxillofacial Trauma and Reconstruction

Journal Citation Format

A journal article with 1 author

A journal article with 2 authors

A journal article with 3 authors

A journal article with 5 or more authors

Books Citation Format

Thesis Citation Format

Web sites Citation Format

Patent Citation Format

Staying up late manually editing references? ivySCI automatically matches journals and helps you generate references with a single click.

Share Submission Experience

Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA2 (Orbital Assessment Algorithm)

In-House Virtual Surgery Planning and 3D Printing for Head and Neck Surgery With Free Software: Our Workflow

Braimah-Taiwo et al New Classification System and Treatment Algorithm of Mandibulo-Maxillary Synostosis Related to Noma. Field Experience From Noma Children Hospital Sokoto, Nigeria

Utility of an Artificial Intelligence Language Model for Post-Operative Patient Instructions Following Facial Trauma

Comparison of Strengths of Mandibular Angle Fractures Following Different Plate Designs: A Human Cadaver Study

Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA2 (Orbital Assessment Algorithm)

Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma: A Longitudinal Study

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

Microvascular Reconstructions in Elderly Patients With Oral Squamous Cell Carcinoma - Too Old for Surgical Treatment?

Reconstruction of Maxillary Bone Defects With Cellular Bone Matrix Allografts

Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA² (Orbital Assessment Algorithm)

Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA² (Orbital Assessment Algorithm)