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Prostheses for extended total temporomandibular joint replacement (eTJR) include modifications to the traditional alloplastic fossa-condyle joint that extend to adjacent bone defects. The aim of this retrospective study was to assess the feasibility, postoperative complications, and functional and aesthetic outcomes after eTJR. Patients aged ≥18 years undergoing eTJR between 2013 and 2022 were included. Data recorded were age, sex, comorbidities, indication for eTJR, prosthesis brand, classification, concomitant surgical procedures, postoperative complications, maximum inter-incisal opening (MIO), pain, quality of life (QoL), and aesthetic outcome. Twenty-five patients (mean age 40 years), with a total of 30 joint prostheses, were included. Over a median follow-up of 42 months, there was a significant improvement in MIO in patients with reduced mouth opening at baseline (P = 0.003), as well as in pain (P = 0.007) and QoL (P = 0.004). Both patients and surgeons judged facial appearance as improved or unchanged in 88% of cases. Postoperative complications included permanent trigeminal nerve hypoesthesia (44%), permanent facial nerve dysfunction (35%), infection (8%), salivary leak (4%), and lingual nerve impairment (4%). The findings suggest that eTJR is a safe and effective treatment for temporomandibular joint deficits extending to adjacent structures, yielding satisfactory functional and aesthetic outcomes., Competing Interests: Competing interests Maurice Y. Mommaerts is co-owner and innovation manager at CADskills BV., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The orbital cavity is a subject of interest for various specialists, and achieving optimal outcomes requires comprehensive, multidisciplinary management. This study aims to report 10 years of experience in the preoperative, surgical, and postoperative care of patients with orbital lesions, examining their clinical, radiological, and anatomopathological features and outcomes. A retrospective review of 125 patients who underwent surgical treatment for intraorbital masses between January 2012 and December 2021 was performed. Outcome measures included postoperative diplopia, exophthalmos, decimal visual acuity, eyeball position, ocular motility, operative time, complications, and aesthetic results. A total of 107 patients were included. All cases were discussed with a neuroradiologist to determine the best therapeutic approach based on preoperative imaging. Preoperative diplopia was linked to extraconal (p = 0.03) and anterior (p = 0.001) lesions, and exophthalmos and visual acuity deterioration were associated with intraconal (p = 0.02; p = 0.03) and retrobulbar (p = 0.001; p = 0.02) lesions. Complications (11.2%) included diplopia, worsened visual acuity, postoperative blepharoptosis, and postoperative ectropion. Of the patients, 80.4% reported an "excellent" aesthetic outcome. This study underscores the importance of a multidisciplinary approach based on a thorough analysis of preoperative imaging. Periorbital approaches tailored to the lesion's three-dimensional location enables safe access to most intraorbital lesions, resulting in minimal complications and good aesthetic results., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Reconstructing cranio-maxillo-facial defects presents significant challenges. This study evaluates the results of polyetheretherketone patient-specific implants (PEEK PSIs) in primary and secondary cranio-maxillo-facial reconstructions, with a focus on aesthetic and functional outcomes and long-term complications., Methods: From October 2009 to February 2023, 45 patients underwent cranio-maxillo-facial reconstructions with PSIs. Patients aged 18 years or older, with a minimum follow-up period of 12 months, were included. The morpho-functional outcome was evaluated through a modified Katsuragy Scale, the Visual Analogue Scale (VAS) for pain, and four FACE-Q|Aesthetics© scales., Results: In total, 44 PSIs were placed in 37 patients (51.3% males; mean age 45.1 years). The main cause of the defect was the resection of a tumor (55.4%). Mean follow-up was 78.6 months. Clinical evaluations showed an improvement in the postoperative period both in patient's and surgeon's scores ( p : 0.01 and p : 0.002, respectively). Subgroup analysis confirmed a significant improvement in patients undergoing cranioplasty ( p = 0.02) and mandible reconstruction ( p = 0.03). No cases of prosthesis dislocation, rupture, or long-term infection were recorded., Conclusions: PEEK PSIs offer significant advantages in craniofacial reconstructions. Despite challenges in predicting soft tissue adaptation, overall patient satisfaction was high with no long-term complications. Future improvements should focus on predicting and enhancing soft tissue adaptations.

Background/aim: Mandibular fractures are the most frequent type of pediatric facial traumatic injury, but their treatment remains controversial. The aim of this retrospective study was to analyze the surgical treatment and long-term outcomes of dentate mandibular fractures in children and adolescents., Material and Methods: Patients with mandibular fractures in the dentate area who were surgically treated in the period from January 1, 2001, to December 31, 2020, were included. The following data were collected: age, gender, cause and mechanism of injury, fracture site and type, associated maxillofacial fractures, the timing of surgical treatment, Facial Injury Severity Scale (FISS) score, surgical approach, number and thickness of plates, hospitalization stay and outcome. Patients were divided into three groups: deciduous (≤6 years, group A), mixed (7-12 years, group B), and permanent (13-18 years, group C) dentitions. Statistical analyses were performed using SPSS software., Results: During the study 91 patients (male: female ratio, 3.8:1), 4 in group A, 12 in group B, and 75 in group C, with 65 single and 52 double fractures were included. An intraoral approach was used in 87% of patients. In group C, 90% of patients were treated with fixation schemes consistent with those suggested in the literature for adults, versus 75% in groups A and B. Median follow-up time was 20 months. No tooth germ injury or facial asymmetry was observed and only six group C patients had post-operative malocclusions. Hardware removal occurred in 22% of the patients., Conclusions: This 20-year retrospective study shows that open reduction and internal fixation of pediatric dentate mandibular fractures caused no tooth germ damage or disturbances of mandibular growth in any dentition stage. Internal fixation schemes were similar to those used for adults, although it was necessary to adapt hardware size and position according to tooth and patient age., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Silent sinus syndrome is a rare disorder characterized by ipsilateral enophthalmos and hypoglobus following a collapse of the orbital floor, in the presence of asymptomatic long-term maxillary sinusitis. It results in enophthalmos, hypoglobus and deepening of the superior palpebral sulcus. A standardized treatment protocol for this infrequent syndrome has not yet been established. The management includes restoration of maxillary sinus ventilation with functional endoscopic sinus surgery and orbital reconstruction, either concurrently or separately. In this paper, the authors presented two patients successfully treated with patient-specific implants, and intraoperative navigation. These cases highlight the benefit of computer-assisted planning and titanium patient-specific implants in the management of silent sinus syndrome. To the best of our knowledge, this is the first report that described the use of PSI with titanium spacers performed with the aid of intraoperative navigation for SSS treatment. Advantages, drawbacks of this technique and treatment alternatives currently available in the literature were also discussed.

In this retrospective case series, patients undergoing surgery to treat isolated orbital floor fractures were morphometrically analyzed. Cloud Compare was used to compare mesh positioning with a virtual plan, using the distance-to-nearest-neighbor method. To assess the accuracy of mesh positioning, a mesh area percentage (MAP) parameter was introduced and three distance ranges were defined as the outcome measures: the 'high-accuracy range' included MAPs at a distance of 0-1 mm from the preoperative plan; the 'intermediate-accuracy range' included MAPs at a distance of 1.1-2 mm from the preoperative plan; the 'low-accuracy range' included MAPs at a distance of >2 mm from the preoperative plan. To complete the study, morphometric analysis of the results was combined with clinical judgment ('excellent', 'good', or 'poor') of mesh positioning by two independent blind observers. In total, 73 of 137 orbital fractures met the inclusion criteria. In the 'high-accuracy range' the mean, minimum, and maximum MAP values were 64%, 22%, and 90%, respectively. In the 'intermediate-accuracy range', the mean, minimum, and maximum values were 24%, 10%, and 42%, respectively. In the 'low-accuracy range', the values were 12%, 1%, and 48%, respectively. Both observers classified 24 cases of mesh positioning as 'excellent', 34 as 'good', and 12 as 'poor'. Within the limitations of the study, it seems that virtual surgical planning and intraoperative navigation has the potential to add quality to the repair of the orbital floor and, therefore, should be taken into consideration whenever appropriate., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest, either direct or indirect. The study was conducted in compliance with the principles of the Declaration of Helsinki and the institutional review board. The manuscript is not under consideration by another journal; nor has it been previously published., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Proliferative glomerulonephritis with monoclonal immunoglobulin (mIg) deposits (PGNMID) is a rare glomerular disease characterized by glomerular deposits of mIg. The pathogenesis of PGNMID without circulating mIg is poorly understood but a role for aberrant immune response to infection or another exogenous stimulus has been proposed. We describe a unique case of PGNMID that presented with multiple episodes of acute kidney injury, nephritic syndrome, and hypocomplementemia, associated with self-limited febrile illnesses or COVID-19 vaccination. Monoclonal IgG lambda was detected in the serum and urine, consistent with monoclonal gammopathy of renal significance (MGRS). Consecutive kidney biopsies demonstrated evolving morphologic and immunohistologic features, with monotypic IgG lambda deposits identified only in the third biopsy. Despite the need for dialysis, renal dysfunction and hypocomplementemia resolved after each episode with corticosteroid therapy. This case illustrates infections or COVID vaccination maybe "second hits" that promote mIg deposition in PGNMID, possibly due to cytokine release by innate immune cells that promote endothelial cell injury., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Vanjarapu et al.)

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the evidence-based German guideline (register # 007-063) the ESTMJS members voted on 30 draft recommendations regarding terminology, diagnostics, and treatment initially via a blinded modified Delphi procedure. After unblinding, a discussion and voting followed, using a structured consensus process in 2019. An independent moderator documented and evaluated voting results and alterations from the original draft. Although the results of the preliminary voting were very heterogenous and differed significantly from the German S3 guideline ( p < 0.0005), a strong consensus was achieved in the final voting on terminology, diagnostics, and treatment. In this voting, multiple alterations, including adding and discarding recommendations, led to 24 final recommendations on assessment and management of TMJ dislocation. To our knowledge, the ESTMJS condylar dislocation recommendations are the first both evidence and consensus-based international recommendations in the field of TMJ surgery. We recommend they form the basis for clinical practice guidelines for the management of dislocations of the mandibular condyle.

The aim of this prospective study was to report the experience with a specific guided distraction protocol for the treatment of CLP patients with severe midface hypoplasia. From January 2016 to April 2019, six consecutive, non-growing, CLP patients with maxillary hypoplasia underwent a specific distraction protocol based on the use of VSP, CAD/CAM-generated surgical splints, cutting guides, prebent internal maxillary distractors, early removal of distractors, and acute callus manipulation and fixation. STL files for VSP, using multislice CT scans taken preoperatively (T0) and 3 months after distractor removal (T1) were superimposed using the free software 3D Slicer and Geomagic Wrap to evaluate the accuracy of maxillary repositioning and assess 3D bone changes. Clinical outcome was evaluated at the 1-year follow-up (T2). The patients and surgeon were satisfied with the occlusal and aesthetic outcomes. A maximum difference of 2 mm between the VSP and the actual surgical outcome was chosen as the success criterion for accuracy. The average linear difference for selected points was <2 mm in four patients and >2 mm in two patients. The average distance of the postoperative maxilla from the VSP model was 2.28 mm (median 1.85), while the average forward movement of the maxilla was 10.18 mm The protocol used is effective and accurate in the correction of severe maxillary hypoplasia in CLP patients. Early removal of the distractor and stabilization with plates reduces patient discomfort and does not jeopardize stability. This protocol should be reserved for complex cases due to the costs of the procedure, which are not negligible., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate and discuss the long-term outcomes of patients with condylar osteochondroma managed through 3 different surgical techniques. Seven patients with condylar osteochondroma treated in the author's department from May 2012 to January 2019 were included in this retrospective study. Clinical evaluations (visual analogue scale for TMJ pain, jaw function, symmetry, and quality of life), maximum interincisal opening (MIO) and radiological findings were collected pre- and postoperatively. Other parameters assessed included tumour size and location; complications and follow-up. Radical condylectomy with immediate total joint alloplastic reconstruction was performed in 4 patients, local excision in 2 patients and low condylectomy with concomitant orthognathic surgery in 1 patient. During an average follow-up period of 40,8 months no clinical or radiographic signs of recurrence were found. Average MIO increased from 25,5mm to 39,5mm at the longest follow up, and all clinical evaluations were greatly improved. In conclusion, the described surgical techniques appear valuable in the treatment of condylar osteochondroma. Local excision is indicated in tumor involving less than half the surface of the condylar head; radical condylectomy with immediate alloplastic total joint reconstruction is indicated in gigantic lesion compromising the anatomical components and function of the joint. Orthognathic surgery procedures should be combined with tumor resection when correction of associated dentofacial deformities is indicated., Competing Interests: Declaration of competing interest None., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Patients with severe facial deformities present serious dysfunctionalities along with an unsatisfactory aesthetic facial appearance. Several methods have been proposed to specifically plan the interventions on the patient's needs, but none of these seem to achieve a sufficient level of accuracy in predicting the resulting facial appearance. In this context, a deep knowledge of what occurs in the face after bony movements in specific surgeries would give the possibility to develop more reliable systems. This study aims to propose a novel 3D approach for the evaluation of soft tissue zygomatic modifications after zygomatic osteotomy; geometrical descriptors usually involved in face analysis tasks, i.e., face recognition and facial expression recognition, are here applied to soft tissue malar region to detect changes in surface shape. As ground truth for zygomatic changes, a zygomatic openness angular measure is adopted. The results show a high sensibility of geometrical descriptors in detecting shape modification of the facial surface, outperforming the results obtained from the angular evaluation.

Background: The aim of this prospective study is to objectively assess 3D soft tissue and bone changes of the malar region by using the malar valgization osteotomy in concomitant association with orthognatic surgery., Materials and Methods: From January 2015 to January 2018, 10 patients who underwent single stage bilateral malar valgization osteotomy in conjunction with maxillo-mandibular orthognatic procedures for aesthetic and functional correction were evaluated. Clinical and surgical reports were collected and patient satisfaction was evaluated with a VAS score. For each patient, maxillofacial CT-scans were collected 1 month preoperatively (T0) and 6 months after the operation (T1). DICOM data were imported and elaborated in the software MatLab, which creates a 3D soft tissue model of the face. 3D Bone changes were assessed importing DICOM data into iPlan (BrainLAB 3.0) software and the superimposition process was achieved using autofusion. Descriptive statistical analyses were obtained for soft tissue and bone changes., Results: Considering bone assessment the comparison by superimposition between T0 and T1 showed an increase of the distance between bilateral malar prominence (Pr - Pl) and a slight forward movement (87,65 ± 1,55 to 97,60 ± 5,91); p-value 0.007. All of the patients had improvement of α angle, ranging from 36,30 ± 1,70 to 38,45 ± 0,55, p-value 0,04 (αr) and 36,75 ± 1,58 to 38,45 ± 0,35; p-value 0,04 (αl). The distance S increased from 78,05 ± 2,48 to 84,2 ± 1,20; p-value 0,04 (Sr) and 78,65 ± 2,16 to 82,60 ± 0,90 (Sl); p-value 0,03. Considering the soft tissue, the comparison by superimposition between T0 and T1 showed an antero-lateral movement (p-value 0.008 NVL; p-value 0.001 NVR) of the malar bone projection together with an increase in width measurements (p-value 0,05 VL; p-value 0,01 VR). Angular measurement confirmed the pattern of the bony changes (p-value 0.034 αL; p-value 0,05 αR)., Conclusion: The malar valgization osteotomy in conjunction with orthognatic surgery is effective in improving zygomatic projection contributing to a balanced facial correction in midface hypoplasia.3D geometrical based volume and surface analysis demonstrate an increase in transversal and forward direction. The osteotomy can be safely performed in conjunction with orthognatic procedures., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives/hypothesis: The aim of this study was to explore whether the production of in-hospital, low-cost surgical cutting guides would be possible and to assess different cutting guide shapes to facilitate the surgery and the application with instruments., Study Design: Cohort study., Methods: Using free computer-aided design software, surgical cutting guides for the mandible and fibula were designed and used to perform virtual segmental osteotomies and fibula transplants in seven patients., Results: Fourteen virtual osteotomies were performed using the free software and the proposed workflow. Thirteen guides were then printed to transfer the virtual planning information to the operating room., Conclusions: Virtual planning and the three-dimensional (3D) printing of guides for mandibular reconstruction is reliable with the aid of an in-hospital 3D laboratory. We also demonstrated that different guides with different shapes could be produced with benefits during surgery., Level of Evidence: 4 Laryngoscope, 2020., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Orbital location of teratoma is extremely rare. The differential diagnosis can be difficult and they may be mistaken for other tumors as they may have both cystic and solid areas. The authors report a case of a 7-day-old neonate with a massive congenital orbital teratoma in which it was decided to apply a surgical technique that involves the aspiration of the cystic fluid, the subsequent infusion of fibrin glue, and the radical excision. The definitive histological examination reported a diagnosis of trifillic cystic teratoma. At fourth year of follow up the patient is free from disease.

Aim: To describe a multidisciplinary treatment to correct a severe II class malocclusion with reduced both maxillary and mandibular transverse dimensions and dental crowding. Case Report . A 17-year-old young woman presented with an increased overjet complaining chiefly of forwardly placed upper front teeth and unpleasant smile aesthetics. The patient facially exhibited a gently convex profile, severe mentalis strain on lip closure, and dark buccal corridors. The intraoral assessment indicates Class II molar relationship bilaterally, mandibular and maxillary anterior crowding, and narrow shape of upper and lower arches. The cephalometric evaluation of the lateral radiograph of the skull evidences a skeletal Class II with a reduction of lower face height. Based upon the diagnostic records and consultation with the patient, surgically assisted expansion of both arches using bone-borne distractors, comprehensive orthodontic treatment, and combined jaw surgery was planned., Results: This approach permitted achieving most of the desired objectives in approximately 30 months. The follow-up records 30 months after treatment conclusion showed a stable occlusion. No complications were clinically and radiographically noticeable during the follow-up., Competing Interests: The authors declare that they have no conflicts of interest concerning this article., (Copyright © 2020 G. Turatti et al.)

Background: An alternative approach to surgery for treating class II adult borderline patients is the non-extraction and multiloop edgewise archwire (MEAW) technique. The aim of the present study is to compare dentoskeletal effects of the orthognathic surgery with the MEAW technique., Methods: Thirteen adults (ten women, three men; mean age, 27.8 years) were consecutively treated using the MEAW approach. The control group was made of 13 adults (nine women, four men; mean age, 26.2 years) treated by orthognathic surgery and the multibracket appliance before and after surgery. Lateral headfilms before and after all the treatments were traced for linear and angular measurements, and data were blindly analyzed. ANOVA was conducted to compare any difference over time between the two treatments. Differences over time for each variable, separately for surgery and MEAW, were assessed by Wilcoxon test., Results: No significant differences between the two groups were detected at baseline. Both treatments were effective in correcting dental discrepancies. A significant difference over time between the two treatments was found in several cephalometric measurements., Conclusions: Considering the limits of the present sample the following conclusion emerged: in the MEAW group, the malocclusion correction was predominantly dentoalveolar, and a significant profile change was observed. Significant skeletal and occlusal plane changes were obtained with the orthognathic surgery approach.

An osteoma is a benign, slow-growing, osteogenic neoplasm with a low recurrence rate that is typically characterized by the proliferation of a compact or cancellous bone. It can be peripheral, central, or extraskeletal. Usually asymptomatic, peripheral osteomas in the maxillofacial region commonly arise in the paranasal sinuses and mandible and rarely occur in the zygomatic arch, with only six previously documented cases in the literature. Here, we present the management of a solitary peripheral osteoma of the right zygomatic arch in a 72-year-old woman and a review of the literature.

Background: The purpose of this study was to prospectively test the accuracy of computer-aided orthognathic surgery comparing the virtual surgical planning with the three-dimensional (3D) outcome., Methods: Patients that underwent computer-assisted orthognathic surgery were retrospectively evaluated. The postoperative results were compared with the surgical plan, superimposing the postoperative computed tomography (CT) scan onto the virtual plan. Surface-based superimpositioning of the postoperative CT scan onto the 3D preoperative plan was carried out to visualize the discrepancy between preoperative virtual plan and postoperative 3D CT result., Results: A total of 17 consecutive patients that underwent two-jaw computer-assisted orthognathic surgery were enrolled in the study.The average linear differences for selected points were <1 mm in 12 patients out of 17. In 5 patients out of 17, the average differences for selected points were <2 mm., Conclusions: An overall high degree of accuracy between the virtual plan and the postoperative result was found.

Purpose: The aim of this multicentric study was to retrospectively evaluate the surgical outcome of atrophic mandible fractures treated with open reduction and rigid fixation (ORIF), using load-bearing plates., Materials and Methods: 55 patients from three trauma centers were retrieved for the study. Inclusion criteria were: edentulous patients with mandibular body fractures; mandibular body thickness <20 mm. Collected data included: cause of fracture; degree of atrophy (according to Luhr's classification); characteristics of the fracture; adequacy of reduction; postoperative complications. All patients were treated with ORIF, using 2.0 mm, large-profile, locking bone plates and 2.4 mm locking bone plates. No bone graft was used in any case., Results: 12 patients were classified as class I atrophy, 18 patients as class II, and 25 patients as class III. Mean mandibular height at the site of fracture was 12.8 mm (ranging from 5.4 mm to 20 mm). 22 were unilateral fractures and 23 were bilateral. Mild displacement was observed in 11 fractures, moderate in 34, severe in 16, and comminution was present in seven fractures. Adequacy of reduction was judged good in 62 fractures and poor in six fractures. Transient weakness of the marginal branch of the facial nerve was recorded in 11 patients and permanent weakness in two patients. All patients achieved a complete fracture healing., Conclusion: External open reduction and rigid fixation (ORIF) with locking, load-bearing plates is a reliable and predictable treatment for atrophic edentulous mandible fracture. Immediate bone grafting should not be considered mandatory unless there is consistent bone loss., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Temporomandibular joint (TMJ) reconstruction with alloplastic implants is a reliable, safe and effective treatment option for selected debilitating pathologies of the TMJ. This study retrospectively analyzes our 14-year experience in total alloplastic reconstruction of the TMJ using stock and custom Biomet prostheses. Indications, results and rationale for the choice of stock and custom-made devices are discussed., Material and Methods: Patients were enrolled in the study who underwent single-stage alloplastic total joint replacement from January 2000 to October 2014. The subjective and objective variables were as follows: TMJ pain, diet, jaw function, maximum interincisal opening (MIO), quality of life and occlusion. The minimum follow-up was 12 months., Results: A total of 38 patients (55 joints) met the inclusion criteria and were enrolled in the study. Of the patients, 25 underwent Biomet total joint reconstruction system with stock prosthesis, 12 patients underwent total joint reconstruction system with custom made (patient matched) prosthesis, and 1 patient underwent bilateral total joint reconstruction using stock system on one side and custom system on the other side. The following adverse events and complications were recorded: bleeding, 2 cases; malocclusion, 1 case; postoperative infection with prosthesis removal, 1 case; heterotopic bone formation, 1 case; and contralateral TMJ overload in unilateral cases, 1 case. The occlusion was habitual unchanged in 29 of 38 cases. In 1 patient occlusion worsened with less stable functional contact. The patient refused postoperative orthodontic treatment. In 8 patients, a concomitant orthognatic procedure was planned in order to improve the occlusion. In all these patients, the occlusion improved. Quality of life and MIO relevantly improved in all cases., Conclusions: This study supports the use of total joint reconstruction for end-stage TMJ disease. Both stock and custom implants allow consistent results, but there are precise indications for the use of custom implants., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: In severe orbital fractures, restoration of orbital shape and volume is required to avoid diplopia and posttraumatic enophthalmos. The purpose of this study was to compare outcomes between navigation-aided and conventional techniques for complex unilateral orbital fractures using titanium mesh., Methods: The outcomes and the computed tomography-measured orbital volume of two groups of orbital complex unilateral reconstruction cases were compared. The study group consisted of a consecutive cohort of unilateral severe orbital fracture that underwent surgery with the aid of a Brainlab navigation system. A historical control group was composed of consecutive operations performed immediately before the beginning of navigation system use. A total of 55 operations were then identified and studied for patient characteristics, diplopia and globe position, preoperative and postoperative orbital volumes, complications, need for revision surgery, and the surgeon's performance., Results: Postoperative diplopia severity was lower in the study group than in the control group. Orbital volume analysis showed that reconstructed orbital volume in the study group was closer to unaffected orbital volume compared with the control group. Significant orbital volume reduction in the reconstructed orbit could be achieved in the study group, and there was no significant reduction in the control group compared with the unaffected side. The globe projection was higher compared with the preoperative situation in the study group than in the control group. The navigational platform could also contribute to reduce the learning curve., Conclusion: This study demonstrated that computer-assisted techniques improve outcomes compared with conventional techniques., Clinical Question/level of Evidence: Therapeutic, III.

Introduction: Maxillomandibular transverse osteodistraction (MMTOD) is an alternative approach to the traditional treatment for transverse maxillary and mandibular deficiencies and crowding. The aim was to report soft and hard-tissues changes and airway volume variation., Methods: In this study, skeletally mature, non-syndromic patients with transverse maxillary and mandibular hypoplasia, who underwent a MMTOD between 2010 and 2012, were included. Surgical changes were analysed using clinical evaluation, three-dimensional facial surface data and computed tomography analysis before (T0) and after the completion of post-op orthodontic treatment (T1)., Results: Nineteen patients (eight males and eleven females; average age: 26.3 years) were enrolled. MMTOD produces facial changes in the cheek, paranasal areas, nasal base and chin. Facial changes are mostly explained by the underlying skeletal movements, which are essentially represented by the transverse enlargement of both the maxilla and the mandible. Following MMTOD, the airway volume and the lateral dimension of the cross-sectional airway increased significantly., Conclusions: MMTOD is a technique that allows an increase in airway volume and in both maxillary and mandibular arch perimeters simultaneously by increasing skeletal width. Facial appearance is improved and a stable occlusion is obtained., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction. The functional results of surgery in terms of facial mobility are key elements in the treatment of patients. Little is actually known about changes in facial mobility following surgical treatment with maxillomandibular advancement (MMA). Objectives. The three-dimensional (3D) methods study of basic facial movements in typical OSAS patients treated with MMA was the topic of the present research. Materials and Methods. Ten patients affected by severe obstructive sleep apnea syndrome (OSAS) were engaged for the study. Their facial surface data was acquired using a 3D laser scanner one week before (T1) and 12 months after (T2) orthognathic surgery. The facial movements were frowning, grimace, smiling, and lip purse. They were described in terms of surface and landmark displacements (mm). The mean landmark displacement was calculated for right and left sides of the face, at T1 and at T2. Results. One year after surgery, facial movements were similar to presurgical registrations. No modifications of symmetry were present. Conclusions. Despite the skeletal maxilla-mandible expansion, orthognathic surgical treatment (MMA) of OSAS patients does not seem to modify facial mobility. Only an enhancement of amplitude in smiling and knitting brows was observed. These results could have reliable medical and surgical applications.

A 26-year-old man presented with a 6-year history of severe obstructive sleep apnoea syndrome followed a bimaxillary osteotomy procedure for a class III skeletal pattern. The patient was born with a unilateral cleft lip and palate and underwent primary lip and palate repair and later a pharyngeal flap for severe velopharyngeal insufficiency. Surgical management of obstructive sleep apnoea syndrome with conventional osteotomy, in cleft lip and palate patients, is a difficult problem. Distraction osteogenesis may provide a safer alternative. The authors describe and discuss the indications and the technical challenge of a multistage treatment protocol with distraction osteogenesis.

Introduction: Temporomandibular joint ankylosis is a joint disorder due to bone or fibrous adhesion of the joint components that cause loss of function. There are many causes, such as trauma, infections and systemic diseases. To date, no uniform treatment protocol has been established., Materials and Methods: We enrolled in the study patients that underwent single stage alloplastic total joint replacement for complete bony ankylosis. The subjective and objective variables were as follow: TMJ pain, diet, jaw function, quality of life, maximum interincisal opening (MIO) and occlusion. The minimum follow-up was 12 months., Results: 12 patients met the inclusion criteria. Six patients underwent bilateral or monolateral total joint reconstruction with stock prosthesis, six patients underwent bilateral total joint reconstruction with custom made prosthesis. The mean preoperative MIO was 7.9 mm. The mean MIO reordered at 12-month follow-up was 26.5 mm (P < 0,0001). The occlusion was unchanged in 9 patients out of 12. In two patients the occlusion was changed by means of custom prosthesis design. In one patient occlusion worsened with less stable functional contact. Quality of life and diet relevantly improved in all cases., Conclusions: Single stage resection and reconstruction with total alloplastic TMJ reconstruction is an effective and reliable method to reestablish stable long-term mandibular function in ankylotic patients., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Surgical management of medial wall orbital fractures should be considered to avoid diplopia and posttraumatic enophthalmos. Treatment of these fractures remains a challenge for the maxillofacial surgeon because of complex anatomy and limited vision. This article aims to retrospectively evaluate the outcomes in the repair of medial orbital wall fractures using a retrocaruncular approach and titanium meshes, comparing the placement of the titanium mesh with three different techniques: (1) conventional free hand under direct vision, (2) with the assistance of an endoscope, and (c) with the assistance of a navigation system. Eighteen patients who underwent surgery for orbital medial wall fracture were enrolled in the study. On the basis of the implant placement technique, three groups were identified: group 1 (CONV), conventional free hand under direct vision; group 2 (ENDO), endoscopically assisted; group 3 (NAVI), a navigational system assisted (BrainLab, Feldkirchen, Germany). The postoperative quality of orbital reconstruction was assessed as satisfactory in 12 cases, good in 4 cases, and unsatisfactory in 2 cases. Particularly in group 1 (CONV) in four patients out of eight, the posterior ledge of the fracture was not reached by the implant and in one patient the mesh hinged toward the ethmoid. In group 3 (NAVI), in one patient out of five, the posterior ledge of the fracture was not reached. In conclusion, titanium orbital mesh plates and retrocaruncular approach are a reliable method to obtain an accurate orbital medial wall reconstruction. The use of endoscopic assistance through the surgical incisions improves accuracy of treatment allowing better visualization of the surgical field. Navigation aided surgery is a feasible technique especially for complex orbital reconstruction to improve predictability and outcomes in orbital repair.

Purpose: The aim of this study was to evaluate the surgical outcomes using polyetheretherketone (PEEK) patient-specific prostheses produced by computer-aided design and manufacturing for primary and secondary reconstruction in patients with craniofacial defects., Material and Methods: The study included 13 patients who underwent reconstruction for craniofacial defects using PEEK patient-specific implants (PSI). Eight patients underwent single-step primary reconstruction using individual custom-made surgical guides and custom-made prostheses during the same surgery; five patients underwent delayed reconstruction. The material used to manufacture the implants was PEEK in 13 cases. All patients underwent esthetic examination, ophthalmological examination, and radiological evaluation during the preoperative and follow-up periods. The operation duration and short- and long-term complications were recorded., Results: The shape and global position of the implants were satisfactory in each case. Fitting of the implant during surgery required extensive adaptation in 1 case and minor in 11 cases. Of 13 implants, 11 adequately restored a morphological complex area with satisfactory cosmetic results. No complications related to the implants were reported., Conclusion: Reconstruction for cranio-facial defects using PEEK computer-aided designed and manufactured implants is a promising new technique that allows for accurate restoration of the complex 3D anatomy of the craniofacial region., (Copyright © 2015. Published by Elsevier Ltd.)

We describe here a peculiar case of a 30-year-old woman presenting with an orbital trapdoor fracture. Preoperative and postoperative magnetic resonance images are provided to explain the mechanism of the injury.

A 31-year-old woman presented with a large oro-nasal communication (ONC), loss of vomer and significant nasal cartilage and nose deformity. Physical examination of the patient revealed a typical midline destructive lesion (MDL) with nasal septum and hard/soft palate perforation with a friable granular surface and a large amount of necrotic tissues. Medical history was unremarkable and the patient denied previous local trauma, including surgical procedures or drug assumption. Pathological examination revealed the presence of necrosis and chronic inflammation. MDLs have numerous etiologies. Signs and symptoms of MDLs can be similar and an accurate diagnosis may be elusive. We hereby present detailed clinicopathological findings., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: This study analyzed the outcomes of nongrowing patients with unilateral mandibular hypoplasia treated according to a specific protocol, which combines distraction osteogenesis, orthodontic treatment, and conventional osteotomies., Materials and Methods: The patients treated were objectively evaluated. Patient's satisfaction was assessed by questionnaire. Surgical changes were analyzed using cephalometry and three-dimensional facial surface data before surgery (T0) and at long-term (T1) follow-up., Results: Four patients were included in this study. The normalization of facial proportion and a high increase in symmetry were evident. Residual defects were documented in the postoperative symmetry of the chin. In the questionnaire, all patients gave favorable responses to their facial changes; for most of the objective parameters, all patients improved., Conclusions: A multistage treatment protocol for the correction of facial deformities in patients with unilateral mandibular hypoplasia is a valid procedure for skeletal and occlusal stability. An evident improvement of the facial appearance is also achieved.

The purpose of this prospective study was to evaluate the clinical and radiological features of a consecutive series of orbital lymphomas in two Institutions in the North West of Italy. A prospective study was performed of all cases of diagnosed orbital lymphomas. Data on patient demographics, symptoms and clinical findings, histological type of lymphoma, site of lesion, imaging, and systemic involvement were recorded in each case. The mean age of the enrolled 20 patients was 63.65 years. Most orbital lymphomas were located in the superior-lateral quadrant. Superior rectus muscle was the most frequently involved orbital structure. Most patients were affected by extranodal marginal-zone lymphomas. The diagnosis of orbital lymphomas may be challenging, because these neoplasms present few specific features. Although not typically performed by the maxillofacial surgeon, an understanding of the staging process is crucial for multidisciplinary management of orbital lymphomas., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Maxillo-mandibular advancement (MMA) is the most successful surgical treatment for OSAS. This study prospectively evaluated soft tissue changes in typical OSAS patient before and after MMA., Material and Methods: Ten patients with severe OSAS, who underwent MMA, were considered. Age, BMI, polysomnographic recordings and cephalometric data were examined. Facial surface data acquired using a 3D laser scanner before (T0) and 1 year (T1) after surgery were pooled by electronic surface averaging to obtain the mean T0 and T1 facial model. A virtual optimal face (V) was used as control group. Mean T0, T1 and V models were compared., Results: The mean AHI improved from 69.8 ± 35.2 to 17.3 ± 16.7. The mean maxillary advancement was 9.2 mm ± 1.2 and the mean mandibular advancement was 10.4 mm ± 2.2. The comparison between T0 and T1 showed an overall increase of the sagittal projection of the cheeks, lips and of the chin. The comparison between T1 and V showed a transversal increase of the cheeks at the cross section through ch (cheilon)., Conclusion: MMA is a highly effective treatment for OSAS. The evaluations of 3D laser scanning showed that surgery in OSAS patients didn't cause an impairment of the facial appearance., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to evaluate surgical outcomes using patient-specific prostheses produced by computer-aided design and manufacturing for primary reconstruction in patients with benign cranio-orbital tumors. Polyetheretherketone was used to manufacture the implants., Materials and Methods: The present study included 3 patients who underwent fronto-orbito-pterional craniotomy using individual custom-made surgical guides. Patient-specific polyetheretherketone prostheses were used for reconstruction during the same surgery. All patients underwent esthetic examination (facial and orbital symmetry, globe projection and position), ophthalmologic examination (diplopia with the Hess-Lancaster test, visual field and acuity), and radiologic evaluations (computed tomography and magnetic resonance imaging) during the preoperative and follow-up periods. Operating time and short- and long-term complications were recorded., Results: The immediate and long-term morphologic results were satisfactory; in particular, ocular globe position and projection were correct. After 25 to 31 months, none of the patients developed implant-related complications, such as infection, extrusion, or malposition. Two-year postoperative computed tomograms and magnetic resonance images showed no recurrences., Conclusion: Single-step resection and reconstruction with computer-aided designed and manufactured implants is a challenging new technique that decreases operative time and morbidity. The implants adequately restore an anatomically complex area with satisfactory cosmetic results., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

This report describes a peculiar case of needle breakage during inferior alveolar nerve block to perform third molar extraction that was removed with the aid of a BrainLAB VectorVision neuronavigation system. This report adds to the currently limited scientific literature on the image-guided removal of foreign bodies from the oral cavity., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to assess the incidence and patterns of work-related maxillofacial injuries, identifying worker categories with a high risk of injury., Material and Methods: From a systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients with work-related injuries were considered. Occupation, mechanism of injury, and demographic and clinical data were analyzed., Results: Work-related facial injuries represented the fifth most common cause of injury, with a percentage of 6.3 %. Maxillofacial fractures were most often seen in construction workers (37.9 %). The middle third was involved in 67 % of the cases; the mandible was the most frequently injured site., Conclusions: Work-related maxillofacial trauma is rare, but it is often complex and challenging as Facial Injury Severity Scale values show. In agreement with the few published reports, construction workers, together with farm and forestry workers, are at the highest risk of injuries, mainly because of struck by a thrown, projected, or falling object.

The percentage of patients on dialysis who do not adhere to their dietary and therapeutic regimens ranges from 25% to 86%. These data are relevant because nonadherence to the prescribed diet affects the mortality and morbidity of these patients. The aim of this study was to evaluate some indicators of nonadherence to drug therapy and diet. Patients showing serum potassium levels >6 mEq/L, serum phosphate levels >5.5 mg/dL, or interdialysis weight gain >5.7% of their body weight were considered as nonadherent. Behaviors, habits and adherence to prescribed therapies were investigated by administering a drug and diet questionnaire to the patients. The percentages of values exceeding the nonadherence threshold were 16.4% for potassium, 30.2% for phosphate, and 7.5% for weight gain. The weight gain index was significantly related to both potassium (p<0.01) and phosphate (p<0.05) indexes. Age was inversely correlated with non -adherence indexes of both phosphate (p<0.05) and weight gain (p<0.05). Residual diuresis was associated with better adherence to potassium (p<0.01). Factor analysis of the questionnaire suggested a 4-factor solution. None of these subscales were correlated with nonadherence indexes. ''Continuity in the intake of drugs'' showed a correlation with the ''trust in the drugs'' factor (p<0.01). Measurements of nonadherence remain a crucial step for understanding the impact on patients' quality of life.

Background: Preservation of lip sensation is crucial in ablative surgery of mandibular tumors. When tumor control does not necessitate sacrifice of the inferior alveolar nerve (IAN), as in some cases of benign tumors of the lower jaw, attempts may be made to spare the nerve. The authors present and discuss their experience with an ultrasonic device in the treatment of benign tumors of the jaw in correspondence of the IAN., Materials and Methods: Five patients with tumoral lesions involving the IAN underwent surgery with an ultrasonic surgical device (Sonopet Omni Surgical System; Stryker, Kalamazoo, MI)., Results: Fine, delicate movements allowed the surgeon to remove bone without damage to surrounding tissue. Three of 5 patients did not present intraoperative or postoperative complications that could be attributed to the Sonopet. Two cases were partial failures. In 1 case, postoperative dysesthesia was encountered, and in the other case, intraoperative transection of the nerve occurred., Conclusion: The Sonopet ultrasonic bone curette proved to be highly useful in surgical procedures close to the IAN because it does not produce heat or cause mechanical injury to the neurovascular bundle. Application of this instrument may provide improved ability to preserve sensibility of the chin and lower lip in patients affected by lesions in proximity to the IAN., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: This study was designed to evaluate the incidence of severe ocular injuries associated to maxillofacial fractures and report their management in the Emergency Department., Patients and Methods: Among the 1779 patients admitted for maxillofacial fractures, those with partial or total loss of vision at the time of emergency consultation were included in the study. Data collected from the patients' medical records included age, gender, mechanism of injury, location and type of facial fractures, type of ocular injuries and cause of blindness, methods of treatment, and days of hospitalization., Results: Forty patients (2.2%), 32 men and 8 women, ranging from 17 to 85 years of age, presented with severely reduced vision or blindness associated to fractures of the facial middle third with involvement of one or more orbital walls, mainly caused by motor vehicle and work accidents. In 18 patients, severe ocular injuries were determined by direct lesion of the globe, in 14 by direct or indirect traumatic optic neuropathy and in 8 by a retrobulbar hematoma. Direct lesion of the eyeball was treated by prompt repair or enucleation of the globe, though no or little recovery of vision was obtained. Ophthalmologic and/or maxillofacial treatment of the anterior compartment lesions of the eye allowed a partial or total recovery of the vision. A partial or total recovery of the vision was observed in almost all the patients with indirect traumatic optic neuropathy after administration of steroids according to NASCIS II protocol. Likewise, an evident improvement of the vision was obtained by immediate drainage of retrobulbar hematoma., Conclusions: Early diagnosis of the nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory.

The purpose of this prospective study was to evaluate the temporomandibular joint (TMJ) morphology, the disk position, and the TMJ symptoms before and after surgical-orthodontic correction of skeletal class III malocclusion.Eleven adult patients were recruited to participate in this longitudinal study. Each patient received presurgical and postsurgical orthodontic treatment with fixed appliances. Six patients were corrected exclusively through mandibular setback, whereas 5 received combined mandibular setback and maxillary advancement. All patients were investigated before and 2 years after treatment through (1) clinical examination, (2) magnetic resonance imaging, and (3) Computerized axiography (CA).The incidence of clinical signs and symptoms was reduced 2 years after surgical-orthodontic treatment, the condyle-disk relationship and TMJ appearance at magnetic resonance imaging were unchanged, and CA showed a significant improvement of TMJ border movements.Mandibular setback surgery does not appear to alter the condyle-disk relationship, whereas correction of class III malocclusion seems to improve clinical and CA signs of TMJ function. Further controls and more long-term evaluation of these patients are necessary to assess the maintenance of these improvements in time.

Purpose: Orbital trapdoor fractures are pure orbital floor fractures with herniation and entrapment of the orbital contents, leading to restricted eye movement and diplopia. Trapdoor fractures in children have been discussed widely in published reports; however, the treatment policy and outcome remain controversial, although early treatment has been advocated. Our retrospective study analyzed the long-term results of pediatric patients undergoing surgery for trapdoor fractures to determine the outcome in relation to the type of fracture and the timing and technique of intervention., Patients and Methods: The present study included 24 patients (age range 6 to 16 years) who underwent surgery for trapdoor fractures from 1998 to 2007. The demographic, etiologic, radiologic, and surgical findings, interval between trauma and surgery, surgical techniques, and complications were recorded. Diplopia, ocular motility, dysesthesia, and scar quality were recorded at follow-up., Results: The follow-up duration averaged 36 months. At follow-up, 1 (8.3%) of 12 patients who underwent surgery within 24 hours (urgent treatment) had residual diplopia. In contrast, 3 (37.5%) of 8 patients who underwent surgery 24 to 96 hours (early treatment) and 4 (100%) of 4 who underwent surgery after 96 hours (late treatment) had diplopia. No sensory deficit of the skin or unesthetic eyelid scar was noted., Conclusions: We found a correlation between the outcome and the timing of surgery for trapdoor fractures in the pediatric population. The success rate was significantly better when the fractures were treated within 24 hours of the injury. The results of the present study have strengthened the assertion that trapdoor orbital fractures pose a true surgical emergency., (2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Achieving functional and anatomic restoration is remarkably difficult in patients with symphyseal mandibular fractures associated with bicondylar fractures. Our objective was to evaluate the functional and esthetic outcomes of a group of patients who underwent surgery using rigid fixation., Patients and Methods: In our study, 25 patients with symphyseal mandibular fractures associated with bicondylar fractures surgically treated from 1998 to 2008 at the Division of Maxillofacial Surgery of the University of Turin were retrospectively analyzed. The standardized evaluation consisted of an evaluation of occlusion, assessment of mandibular motion, and esthetic evaluation of facial width., Results: The patients showed good mandibular motion and good occlusion. After esthetic evaluation of the facial width of the 25 patients, 23 patients were rated as "excellent" or "good.", Conclusion: Successful treatment of multiple mandibular fractures may be achieved by different techniques. The key point is the re-establishment of the transversal bigonial dimension by a correct reconstruction of the mandibular arch.

Purpose: This retrospective study evaluated the long-term results and complications of open reduction and internal fixation of displaced and dislocated fractures of the condylar process., Patients and Methods: Two hundred four patients were treated via various surgical approaches between 1991 and 2005. Fifty patients with a total of 57 treated condylar fractures who underwent complete clinical and radiological documentation were included in this study. Follow-up clinical and radiological evaluations were carried out after an average period of 88 months., Results: We found that 12% of our patients reported temporary weakness of the facial nerve and 4% had mild permanent facial nerve palsy. Clinical and radiological assessment showed satisfactory recovery of facial symmetry. Excellent recovery of function was observed, and very few patients complained of temporomandibular joint-related symptoms. Severe condylar remodeling was observed in 8% of the patients, 47% showed slight or moderate remodeling, and 45% showed no remodeling. A statistically significant association was observed between the presence of condylar remodeling and poor mouth opening at the follow-up examination., Conclusions: Surgical treatment of condylar fractures, in association with postoperative functional therapy, promotes the recovery of function, occlusion, and facial symmetry with few complications. However, some difficulties remain related to the surgeon, the patient, and the objective complexity of this pathology.

Retrobulbar haematoma following blunt orbital trauma is a rare, but potentially serious, complication, since it can evolve rapidly from visual impairment to permanent loss of vision. This sight-threatening situation most commonly arises from orbital bleeding accompanying undisplaced fractures of the orbital walls, an event that increases the pressure inside the orbit and results in vascular damage to the optic nerve. The clinical presentation includes pain, exophthalmos with proptosis, and internal ophthalmoplegia, with impairment or loss of the pupillary reflex. A thin-layer orbital CT scan is an essential diagnostic aid. Any delay between the onset of symptoms and treatment can have a significant effect on functional recovery. Therapy is based on orbital decompression, via different surgical approaches, with the intention of reducing the pressure on the nerve and vascular structures inside the orbit. This paper presents eight cases of retrobulbar haematoma and their follow-up, in detail.

A retrospective analysis is presented of 158 patients who sustained frontal sinus fractures and were subsequently treated in the Division of Maxillofacial Surgery, University of Turin, from 1987 to 1998. The fractures were subdivided according to involvement of anterior and posterior walls, and of the nasofrontal duct. While treatment involving only the anterior wall is well standardized and without complications, management of anterior plus posterior wall fractures or involving the nasofrontal duct is still controversial. In dislocated posterior wall fractures, cranialization and obliteration of the remaining dead space and of the nasofrontal ducts using bone grafts, combined with the use of a pericranium flap, allow separation of the nasal cavity from the anterior cranial fossa, preventing ascending infections and thus reducing the rate of complications. When the fracture involves the nasofrontal duct with the posterior wall substantially intact, it is better to re-establish patency of the nasofrontal duct with a drainage tube and preserve the function of the sinus. A protocol used in the management of each group of fractures, clinical and radiological results, timing of operation, surgical procedures, outcomes, and long-term complications are all discussed., (Copyright 2000 European Association for Cranio-Maxillofacial Surgery.)

Maxillofacial fractures and associated lesions following airbag deployment were studied in six patients who suffered frontal or fronto-lateral car crashes. Installation of airbags in motor vehicles has reduced the morbidity and the mortality following motor vehicle accidents, but the appearance of new types of trauma directly related to airbag deployment raise questions about the potential danger of these devices when used improperly. The results of this limited study suggest that airbag injuries can be aggravated if: (1) seat belts are not worn; and (2) if the driver's chest is too close to the steering wheel as can easily happen with small people (in our study, two women). There needs to be a way of disconnecting the system.