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Purpose: Using network meta-analyses (NMA) has become increasingly valuable as it enables the comparison of interventions that have not been directly compared in a clinical trial. To date, there has not been a NMA of randomized clinical trials (RCT) that compares all types of treatments for mandibular condylar process fractures (MCPFs). The aim of this NMA was to compare and rank all the available methods used in the treatment of MCPFs., Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted in 3 major databases up to January 2023 to retrieve RCTs that compared various closed and open treatment methods for MCPFs. The predictor variable is treatment techniques: arch bars (ABs) + wire maxillomandibular fixation (MMF), rigid MMF with intermaxillary fixation screws, AB + functional therapy with elastic guidance (AB functional treatment), AB rigid MMF/functional treatment, single miniplate, double miniplate, lambda miniplate, rhomboid plate, and trapezoidal miniplate. Postoperative complications were the outcome variables and included occlusion, mobility, and pain, among other things. Risk ratio (RR) and standardized mean difference were calculated. Version 2 of the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluations system were used to determine the certainty of the results., Results: The NMA included a total of 10,259 patients from 29 RCTs. At ≤6 months, the NMA revealed that the use of 2-miniplates significantly reduced malocclusion compared to rigid MMF (RR = 2.93; confidence interval [CI]: 1.79 to 4.81; very low quality) and functional treatment (RR = 2.36; CI: 1.07 to 5.23; low quality).Further, at ≥6 months, 2-miniplates resulted in significantly lower malocclusion compared to rigid MMF with functional treatment (RR = 3.67; CI: 1.93 to 6.99; very low quality).Trapezoidal plate and AB functional treatment were ranked as the best options in 3-dimensional (3D) plates and closed groups, respectively.3D-miniplates (very low-quality evidence) were ranked as the most effective treatment for reducing postoperative malocclusion and improving mandibular functions after MCPFs, followed closely by double miniplates (moderate quality evidence)., Conclusions: This NMA found no substantial difference in functional outcomes between using 2-miniplates versus 3D-miniplates to treat MCPFs (low evidence).However, 2-miniplates led to better outcomes than closed treatment (moderate evidence).Additionally, 3D-miniplates produced better outcomes for lateral excursions, protrusive movements, and occlusion than closed treatment at ≤6 months (very low evidence)., (Copyright © 2023 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Literature describing the number of patients that had a facial fracture that required surgical intervention in the United States is very limited. The purpose of this study was to evaluate the percentage of patients who required surgical intervention after presenting to a Level 1 Trauma Center with 1 or more facial fractures., Materials and Methods: This was a retrospective cross-sectional study of all patients who presented with facial fracture(s) to University Hospital, a Level 1 Trauma Center (San Antonio, Texas), over a 5-year period from July 2015 to July 2020. Patients' charts that had 1 or more International Classification of Diseases 10 codes pertaining to facial fractures were collected. Cases were subdivided by fracture location: mandible, midface, upper face, or a combination of any of the aforementioned locations (predictor variables). After subdividing based on location, each chart was then reviewed and separated based on whether or not surgical intervention was provided (primary outcome variable). Data were tabulated and analyzed with descriptive and inferential statistics., Results: Over the 5-year period, 3,416 patients presented with facial fractures. Of the 3,126 patients who survived their injuries and were not lost to follow-up, the vast majority (80.9%) did not require surgical intervention for their facial fractures. Mandible fractures required surgical intervention, whether isolated or in combination, much more frequently than in patients who did not have any type of mandible fracture (RR 8.01, 95% CI 6.92-9.27, P < .05 and RR 4.60, 95% CI 3.42-6.18, P < .05, respectively). Patients aged 50 years or less were also more likely to receive surgical intervention than those aged 51 years and more (RR 1.98 95% CI 1.63-2.41, P < .05)., Conclusions: The vast majority of facial fractures that present to a Level 1 Trauma Center do not require surgical intervention. Patients who present with any type of mandible fracture and are aged 50 years or less are more likely to need surgical intervention., (Copyright © 2022 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: An extension of digital technology is to provide patient-specific hardware to reposition the first jaw in a bimaxillary case without the use of an intermediate splint. The purpose of our study was to determine if there were significant differences in maxillary repositioning using interim splints versus patient-specific guides and implants (PSIs) in executing a bimaxillary virtual surgical plan (VSP)., Materials and Methods: This is a retrospective cohort study of patients who underwent bimaxillary orthognathic surgery with interim splints or PSIs planned with VSP at our institution. The difference in maxillary positions from the VSP to the postoperative cone-beam computed tomography (CBCT) was evaluated in both groups. The primary predictor variable was the method by which the maxilla was repositioned (interim splint vs PSI). The primary outcome variable was the postoperative 3D position of the maxillary incisors and right and left first molars in the anteroposterior, transverse, and vertical dimensions. Differences in the planned and postoperative positions of the above landmarks in all three planes of space between the two groups were statistically analyzed., Results: A total of 82 patients were included. 13 patients had their maxillae repositioned with an interim splint between the unoperated mandible and the mobile maxilla, and 69 patients had their maxilla repositioned using custom drill/cutting guides and a PSI. The mean difference between the planned and actual position of the maxilla in the PSI group was smaller than in the splint group. In the PSI group alone, vertical changes were accurate whether the maxilla was being superiorly or inferiorly repositioned., Conclusion: The use of a PSI provides more accurate maxillary repositioning during bimaxillary surgery than the use of an interim splint., (Copyright © 2022 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: There is still no consensus about the best treatment for frontal sinus fractures (FSFs). Thus, the aims of this study were to answer the following questions: 1) what treatment of FSFs has the lowest rate of postoperative complications? 2) does sinus preservation using observation produce a lower complication rate? 3) are FSFs with nasofrontal outflow tract (NFOT) injury associated with greater complication rates following different treatment options when compared to those patients without NFOT involvement?, Methods: A systematic review and meta-analysis were performed based on PRISMA that included several databases with specific keywords, a reference search, and a manual search for suitable articles. Randomized clinical trials, controlled clinical studies, retrospective studies and case series that estimated complications rate after different treatments options for FSFs were included. The predictor variable was treatment groups, including observation, ORIF, cranialization and obliteration. The outcome variable was complication rate and correlation between complication rate and presence/absence of NFOT. A weighted complication rate/proportion using a random effect model, or risk ratio (RR) with a 95% confidence interval (CI), was performed to construct forest plots. Data analysis was done using a comprehensive meta-analysis., Results: A total of 2,911 patients with FSFs enrolled in 23 studies were included in this study. The weighted complication rate for different treatment was as follows: observation (7%), ORIF (9.4%), obliteration (10.6%), and cranialization (11%). Nonsurgical treatment decreased the complication rate by 2.1 times (low quality evidence, RR = 2.1, CI: 1.13 to 3.9, P = .000) when compared to surgical treatments for FSFs. CR for fractures with NFOT was 8 % (55/619) compared to a complication rate of 5% (18/353) for fractures without NFOT with insignificant difference (very low quality evidence, RR = 1.7, CI: 0.75 to 4.1, P = .158)., Conclusions: FSFs vary in their severity and treatments. The more severe fractures, the higher the complication rate, no matter how they were treated., (Copyright © 2021 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: We aimed to compare complication rates and functional outcomes in patients with bilateral mandibular fractures treated with different degrees of internal fixation rigidity., Patients and Methods: This international, multicenter randomized controlled trial included adults with bilateral mandibular fractures located at either the angle and body, angle and symphysis, or body and symphysis. Patients were treated with either a combination of rigid fixation for the anterior fracture and nonrigid fixation for the posterior fracture (mixed fixation) or nonrigid fixation for both fractures. The primary outcome was complications within 6 weeks after surgery. Secondary outcomes were complications within 3 months, Helkimo dysfunction index, and mandibular mobility at 6 weeks and 3 months after surgery., Results: Of the 315 patients enrolled, 158 were randomized to the mixed fixation group and 157 to the nonrigid fixation group. The overall complication rate at 6 weeks in the intention-to-treat population was 9.6% (95% confidence interval [CI], 5.3% to 15.6%) in the mixed fixation group and 7.8% (95% CI, 4.0% to 13.5%) in the nonrigid fixation group. With an unadjusted odds ratio of 1.25 (95% CI, 0.51 to 3.17), there were no statistically significant differences in complication rates between the 2 groups (P = .591). A multivariable model for complication risk at 6 weeks found no significant differences between treatment groups, but patients with moderate or severe displacement had a higher complication rate than those with no or minimal displacement (adjusted odds ratio, 4.58; 95% CI, 1.16 to 18.06; P = .030). There were no significant between-group differences in complication rates at 3 months. Moreover, no significant differences in Helkimo dysfunction index and mandibular mobility index at 6 weeks and 3 months were found between groups according to treatment allocated and treatment received., Conclusions: A combination of rigid and nonrigid fixation in patients with bilateral mandibular fracture has similar complication rates and functional outcomes to nonrigid fixation for both fractures., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of the present study was to identify the perceived barriers to full-text journal publication (JP) from abstracts presented at the 2010-2013 American Association of Oral and Maxillofacial Surgeons (AAOMS) meetings., Methods and Materials: In the present cross-sectional study, all unpublished AAOMS abstracts (n = 473) from the temporal period were procured using a database from a previous publication. An online questionnaire was then distributed to the primary or secondary author for whom an e-mail address was available through the AAOMS Member Directory (n = 260) to assess 1) the current publication status of the abstract; and 2) the perceived barriers to JP. The responses were summarized with descriptive statistics., Results: Of the 260 authors surveyed, 51 responded, for a response rate of 19.6%. At the time of the survey, 66.7% of the authors stated that submission for JP had not been pursued, and 15.7% stated that the abstract had achieved JP. However, no citations were provided. Overall, a low perceived priority (52.9%), insufficient time (50%), methodologic limitations (23.5%), and inadequate institutional support (17.6%) were the 4 primary reasons cited by the authors for the failure to pursue or achieve JP., Conclusions: JP of abstracts presented at the annual AAOMS meeting is very low, with many barriers to JP of presented abstracts., (Copyright © 2020. Published by Elsevier Inc.)

Purpose: Although many oral and maxillofacial surgical (OMS) procedures might seem to be profitable, no current data have analyzed the costs versus benefits of performing office-based OMS procedures. The purpose of the present study was to analyze the costs of performing 6 common office-based OMS procedures compared with the reimbursement rates for those same procedures., Materials and Methods: The present study was a cross-sectional, microcosting survey analyzing the costs of materials used in the outpatient Oral-Maxillofacial Surgery clinic at the University of Texas Health Science Center at San Antonio. The costs incurred were based on dental procedure coding and national statistical databases and not on actual patient interactions. The primary predictor variable was the procedure costs for 6 commonly performed outpatient OMS procedures using 3 types of trays: a simple tray, a surgical tray, and an implant tray. The ancillary materials were listed for as-needed use for each tray. The primary outcome variable was the revenue after expenses per procedure. Descriptive statistics were computed. The net profit or net loss of performing 6 commonly performed outpatient OMS procedures was analyzed by subtracting the cost of performing the procedure from the insurance reimbursement for those procedures., Results: Without the addition of sedation to the procedures, routine extractions had a net loss of $230 to $261, surgical extractions had a net loss of $153 to $242, and incision and drainage procedures had a net loss of $212 to $311. Furthermore, preprosthetic procedures had a net loss to net profit of -$269 to +$140, and pathologic procedures had a net loss to net profit of -$269 to +$326. Only implant procedures yielded a net profit of $847., Conclusions: The results of the present study have demonstrated that not all routine OMS procedures are profitable when performed alone without the inclusion of additional procedures or sedation., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the stability of disc position and condylar status by magnetic resonance imaging (MRI) after temporomandibular joint (TMJ) disc repositioning surgery with a mini-screw anchor technique., Materials and Methods: Patients diagnosed with anterior disc displacement (ADD) and operated on for disc repositioning from 2010 through 2016 were included in the study. MRI scans within 1 week after operation (T1) and during at least 1-year follow-up were used to evaluate changes in disc position and condylar bone. During follow-up, ADD without reduction was considered relapse and the bone status was classified as regeneration or degeneration., Results: One hundred seven patients with 149 joints were included in the study. Postoperative MRI scans (T1) showed that all discs were repositioned. During an average 23.40-month follow-up (range, 12 to 84 months), 95.3% of discs (142 of 149) were still in position, whereas 4.7% of discs (7 of 149) had relapsed anteriorly. New condylar bone formation was observed in 74.50% of joints (111 of 149), no bone change was observed in 23.49% of joints (35 of 149), and bone resorption was observed in 2.01% of joints (3 of 149)., Conclusions: TMJ disc repositioning by a mini-screw anchor provides stability for treatment of ADD. Disc repositioning also can stimulate condylar bone regeneration., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate the clinical and radiologic results of Zimmer Biomet stock prostheses (Jacksonville, FL) in temporomandibular joint replacement after surgical modifications during at least 1 year of follow-up., Patients and Methods: We recruited patients treated by Zimmer Biomet stock prostheses after technical modifications, including digital templates, autogenous ipsilateral bone grafting from the mandible to the fossa, salvaging of the disc remnant and suturing it to the medial aspect of the prosthesis, and fat grafts from a retromandibular incision, between 2010 and 2016. Clinical examination findings including maximal incisal opening; visual analog scale scores for pain, diet, and mandibular movement; and quality of life were compared before the operation and at least 1 year postoperatively. The status of the fossa bone graft was evaluated by computed tomography examination., Results: The study comprised 38 joints in 33 patients with diagnoses including osteoarthritis, ankylosis, and neoplasm. Compared with before the operation, maximal incisal opening and visual analog scale scores for diet, function, and pain level, as well as the quality-of-life survey score, were considerably improved during the last follow-up. Computed tomography scans showed all bone grafts were completely healed within the fossa 1 year after surgery. There was no ectopic bone formation, screw loosening, or component displacement or breakage., Conclusions: Our surgical modifications of Zimmer Biomet stock prostheses showed good results for at least 1 year of follow-up., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. All rights reserved.)

It is technically difficult to arthroscopically reposition and suture the temporomandibular joint disc to the auricular cartilage. This article introduces a straightforward method to reposition the disc and suture it to the auricular cartilage through a small incision., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: There are different total temporomandibular joint (TMJ) prostheses on the market but no comparison of their efficacy. The purpose of this meta-analysis was to evaluate the effectiveness of different TMJ replacement (TJR) systems., Materials and Methods: A systematic review and meta-analysis was performed using the PubMed, Embase, Medline, and Cochrane Library search engines in May 2017 to identify qualified studies. Outcome measurements were changes in maximal incisal opening (MIO), pain, dietary limitations, and functional deficiencies from before to after TJR. Analyses of heterogeneity, sensitivity, and publication bias were performed. A fixed-effects model was used for the meta-analysis of pooled weighted mean differences in pre- versus postoperative MIO, pain, diet, and function., Results: Twenty studies with 1,262 patients were included in the meta-analysis. Comparison of the TJR systems showed no real difference for pre- versus postoperative MIO, pain, diet, and function. MIO and functional efficiency decreased gradually over time, but effective pain relief and improvements in dietary limitations were stable with no relevant differences during follow-up. Comparison of the custom and stock devices showed similar results for pre- and postoperative MIO, pain, function, and diet., Conclusion: This analysis showed no relevant difference in treatment outcomes among the TJR systems., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: There is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs., Materials and Methods: A systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ)., Results: A total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) (P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) (P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy (P = .001), but no significant difference after BSSO (P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) (P = .728)., Conclusions: Orthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients' TMDs would improve, remain the same, or worsen after surgery., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Numerous studies have shown that tooth size is an important key to ideal occlusion. Bolton (Angle Orthod 28:13, 1958; 48:504, 1962) described a constant ratio between the widths of the upper and lower teeth that must be present to achieve an optimal occlusion. The purpose of this study was to determine the incidence of Bolton discrepancies in patients with Class II malocclusion scheduled for mandibular advancement surgery., Patients and Methods: This study included 126 patients (40 male, 86 female) with Class II malocclusion who had at least a mandibular advancement as part of their surgical treatment. The mesiodistal widths of the 6 anterior maxillary and mandibular teeth were measured on preoperative models using a caliper. The measurements were used to compute the anterior Bolton ratio., Results: Seventy-three of 126 patients (57.9%) were found to have an anterior Bolton ratio greater than the Bolton norm, indicating too much lower tooth mass compared with the upper mass or too little upper tooth mass compared with the lower mass., Conclusion: Tooth-size discrepancies are common in patients requiring mandibular advancement surgery. This can make it difficult to advance the mandible into a solid Class I relation at the time of surgery. Bolton discrepancies should be considered when planning treatment with presurgical orthodontics. In addition, if necessary, the width of the lower incisors should be decreased or a space distal to the maxillary lateral incisors should be created to allow the establishment of a solid Class I canine occlusion at the time of surgery., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to identify whether there is scientific evidence to support excision of the overlying mucosa (EOM) in conjunction with cyst enucleation to decrease the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs)., Materials and Methods: A systematic review with meta-analysis conforming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of 3 major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date or language restrictions from inception to December 2015. Eligible articles were selected based on the following inclusion criteria: randomized, prospective, or retrospective studies comparing enucleation with EOM to enucleation without EOM for patients with KOTs. The predictor variable was treatment group (enucleation with EOM vs enucleation without EOM). The outcome variables were RR of KOTs, presence of epithelial islands and microcysts in the excised overlying mucosa, and correlation between recurrent cortically perforated KOTs. A weighted RR and odds ratio (OR; using a random- or fixed-effect model) and the Mantel-Haenszel test with 95% confidence interval (CI) were performed using comprehensive meta-analysis software., Results: Eleven studies were included in this review. There was no significant difference between enucleation with and without EOM (random; OR = 3.259; 95%, 0.975-10.901, P = 0.055). The weighted event rates for enucleation with Carnoy's solution plus EOM and enucleation without EOM in cortically perforated lesions were 6.2% (random; 95% CI, 2.6-14) and 9.1% (random; 95% CI, 1.6-38.2), respectively. The weighted event rate for the presence of epithelial islands and microcysts in overlying mucosa of KOTs was 68.8% (random; 95% CI, 27.2-92.9)., Conclusion: The results of this study suggest that enucleation of KOTs plus the use of Carnoy's solution or liquid nitrogen (when indicated) should be combined with EOM to obtain the lowest RR, specifically for retromandibular trigone, posterior maxillary, and cortically perforated lesions. However, the results from this study do not provide sufficient scientific evidence for EOM in combination with enucleation of KOTs., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to test the hypothesis that there is no difference in skeletal stability and material-related complications for titanium or biodegradable fixation when used for various orthognathic surgeries., Materials and Methods: A systematic and electronic search of several databases with specific keywords, a reference search, and a manual search through September 2014 was performed. The inclusion criteria were clinical human studies, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing titanium and biodegradable osteosynthesis after various orthognathic surgeries. The outcome variables of horizontal and vertical relapse using cephalometrics and material usability were statistically analyzed., Results: The initial PubMed search identified 557 studies, 22 of which met the inclusion criteria (8 randomized controlled trials, 10 controlled clinical trials, and 4 retrospective studies). No statistical difference was found between the 2 groups regarding skeletal stability after various orthognathic surgeries. There was no statistical difference with regard to wound problems, plate and screw removal, and palpability between biodegradable and titanium osteosynthesis, but there was a statistical difference with regard to intraoperative fracture of plates and screws in the biodegradable group., Conclusion: The results of this meta-analysis support the hypothesis that biodegradable fixation devices offer similar skeletal stability as titanium fixation for orthognathic surgery. The results of this study also show that titanium fixation produced fewer broken screws during surgery compared with biodegradable screws., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of the present study was to identify significant differences in skeletal stability and neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) between bilateral sagittal split ramus osteotomy (BSSO) and distraction osteogenesis (DO) for mandibular advancement surgery., Materials and Methods: We performed a systematic and electronic search of several databases using specific keywords, a reference search, and a manual search through November 2014. The inclusion criteria were clinical human studies, including randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing BSSO and DO (predictor variables) after mandibular advancement surgery with regard to skeletal stability and NSD of the IAN (outcome variables). Both linear and angular measurements of the horizontal and vertical positions of the mandible were analyzed. For binary outcomes, we calculated a standard estimation of the risk ratio using the random-effects model if heterogeneity was detected; otherwise, a fixed effects model, with a 95% confidence interval (CI), was used. Weighted mean differences or standard mean differences were used to construct forest plots of continuous data. In addition, the number needed to treat, with the 95% CIs, was calculated for NSD of the IAN., Results: Our initial PubMed search identified 215 studies, of which 9 met our inclusion criteria-3 RCTs, 1 CCT, and 5 retrospective studies. No statistically significant difference was found between the 2 groups regarding skeletal stability in either the vertical (P = .34) or horizontal (P = .88) direction. A statistically significant difference was found between BSSO and DO with regard to NSD of IAN function (P = .004)., Conclusion: The results of the present meta-analysis have shown that DO significantly reduced the incidence of NSD of the IAN after lengthening of the retrognathic mandible compared with the BBSO., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Bilateral sagittal split ramus osteotomy (BSSO) and intraoral vertical ramus osteotomy (IVRO) are used for mandibular setbacks. The purpose of this study was to determine differences in skeletal stability and neurosensory disturbance (NSD) of the mental nerve after mandibular setback using these operations., Materials and Methods: A systematic review and meta-analysis on these topics was performed. An electronic search of several databases with specific keywords, a reference search, and a manual search from database inception to December 2014 was performed with inclusion criteria of clinical human studies, randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the predictor variable being BSSO or IVRO after mandibular setback surgery. The outcome variables of horizontal and vertical relapse using cephalometrics and NSD using trigeminal somatosensory-evoked potential and subjective tests were statistically analyzed., Results: The initial PubMed search identified 716 studies of which 13 met the inclusion criteria—4 RCTs, 3 CCTs, and 6 retrospective studies. No statistically significant difference was found between the 2 groups regarding horizontal skeletal stability, but the BSSO group had more stability in the vertical dimension (P = .02). There was a statistically significant difference between BSSO and IVRO with regard to NSD of the inferior alveolar nerve (IAN; P = .001)., Conclusion: The results of this meta-analysis suggest that BSSO and IVRO have good stability when used to set back the mandible. Furthermore, the results showed that IVRO statistically decreased the incidence of NSD of the IAN after mandibular setback surgery compared with BSSO., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to answer the following question: in patients with nasal bone fractures (NBFs), does closed reduction under local anesthesia (LA) produce comparable outcomes as closed reduction under general anesthesia (GA)?, Materials and Methods: A systematic review with meta-analysis and a comprehensive electronic search without date and language restrictions was performed in August 2014. The inclusion criteria were studies in humans, including randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies whose aim was comparing clinical outcomes between LA and GA for closed reduction of NBFs., Results: Eight publications were included: 3 RCTs, 2 CCTs, and 3 retrospective studies. Three studies showed a low risk of bias, and 5 studies showed a moderate risk of bias. There was no statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with anesthesia, patient satisfaction with function of the nose, need for subsequent retreatment (septoplasty, septorhinoplasty, or rhinoplasty with refracture), and a patient's chosen treatment for a refracture of the nose. There was a statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with the appearance of the nose., Conclusion: Regardless of the cost and risks associated with GA, the results of the meta-analysis showed that GA provides better patient satisfaction with anesthesia, appearance and function of the nose, and preference of treatment for a refracture of the nose. In addition, the meta-analysis showed that GA decreased the number of subsequent corrective surgeries (septoplasty, septorhinoplasty, and rhinoplasty) required., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purposes of this study were to identify significant differences in clinical outcomes between open reduction and rigid internal fixation (ORIF) and closed treatment (CT) for adult mandibular condylar fractures (MCFs) and to support or refute the superiority of one method over the other., Materials and Methods: To address our purpose, we designed and implemented a systematic review with meta-analysis. A comprehensive electronic search without date and language restrictions was performed in May 2014. The inclusion criteria were studies in humans, including randomized or quasi-randomized controlled trials, controlled clinical trials, and retrospective studies, that compared ORIF and CT regarding maximal interincisal opening, laterotrusive and protrusive movements, pain, malocclusion, chin deviation on mouth opening, and temporomandibular joint signs or symptoms for the management of unilateral or bilateral adult MCFs. Meta-analysis was conducted only if there were studies of similar comparisons reporting the same outcome measures. For binary outcomes, we calculated a standard estimation of the odds ratio by the random-effects model if heterogeneity was detected; otherwise, a fixed-effects model with a 95% confidence interval was performed. Weighted mean differences or standard mean differences were used to construct forest plots of continuous data., Results: Twenty-three publications were included: 5 randomized controlled trials, 16 controlled clinical trials, and 2 retrospective studies. Five studies showed a low risk of bias, whereas 18 showed a moderate risk of bias. There were statistically significant differences between ORIF and CT regarding maximal interincisal opening, laterotrusive movement, protrusive movement, malocclusion, pain, and chin deviation on mouth opening (P = .001, P = .001, P = .001, P = .001, P = .001, and P = .05, respectively)., Conclusions: The result of the meta-analysis confirmed that ORIF provides superior functional clinical outcomes (subjective and objective) compared with CT in the management of adult MCFs., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aims of this study were to 1) determine which fixation method has the fewest complications in the treatment of anterior mandibular fractures (AMFs) and 2) provide scientific data to enable surgeons to make evidence-based decisions regarding the best technique., Materials and Methods: A comprehensive electronic search without date and language restrictions was performed in March 2014. Studies in humans, including randomized or quasi-randomized controlled trials, controlled clinical trials, and retrospective studies, were included with the aim of comparing fixation techniques (lag screws, 3-dimensional plates, 1 plate, and 2 miniplates) in the management of AMFs. The incidence of postoperative complications was evaluated., Results: Thirteen publications were included: 8 randomized controlled trials, 3 controlled clinical trials, and 2 retrospective studies. Seven studies showed a low risk for bias, 3 studies showed a moderate risk for bias, and 3 studies showed a high risk for bias. There were statistically significant advantages for lag screws and 1 plate plus an arch bar. There was no statistically significant difference between 3-dimensional plates and 2 miniplates. The cumulative odds ratio was 0.29, meaning that the use of lag screws in the fixation of AMFs decreases the risk for postoperative complications by 71% over the use of 2 miniplates. The cumulative odds ratio for 1 plate plus an arch bar was 0.28, showing that the use of 1 plate plus an arch bar in the fixation of AMFs decreases the risk for postoperative complications by 72% over the use of 2 plates., Conclusions: The results of this meta-analysis revealed that the use of both lag screws and 1 plate plus an arch bar were superior to 2 miniplates in reducing the incidence of postoperative complications in the management of AMFs. Also, there were significantly shorter operating times with lag screws and 3-dimensional miniplates over 2 miniplates in the fixation of AMFs., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of the present study was to determine which method for internal fixation through a transoral approach has the lowest complication rate for patients with mandibular angle fractures (MAFs)., Materials and Methods: To address our study purpose, we designed and implemented a systematic review with meta-analysis. To identify the studies to include in the review, a comprehensive electronic search without date or language restrictions was performed in April 2014. The inclusion criteria were studies of humans, including randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing fixation techniques (1 vs 2 miniplates, external oblique ridge vs lateral border miniplate placement, and geometric vs conventional miniplate) in the management of MAFs. The incidence of postoperative complications was analyzed. Only those studies in which a transoral approach had been used (with or without transbuccal instrumentation) were selected., Results: A total of 20 publications were included: 9 RCTs, 3 CCTs, and 8 retrospective studies. Eight studies had a low risk of bias, 11 studies a moderate risk of bias, and 1 a high risk of bias. A statistically significant difference was found between a single superior border miniplate and the use of 2 miniplates. The cumulative odds ratio (OR) was 0.63, indicating that the use of 1 miniplate in MAF fixation decreased the risk of postoperative complications by 37% compared with using 2 miniplates. Comparing a miniplate placed on the external oblique ridge to one placed on the lateral surface of the mandible resulted in a cumulative OR of 2.10, indicating that the use of the transbuccal miniplate decreased the risk of postoperative complications by 110% compared with a miniplate placed on the external oblique ridge. Comparing geometric and standard miniplates, the OR was 0.29, indicating that the use of a geometric miniplate decreased the risk of postoperative complications by 71% compared with using conventional miniplates., Conclusions: The results of the meta-analysis have shown that the use of 1 miniplate is superior to using 2 in reducing the incidence of postoperative complications in the management of MAFs. In addition, our results showed that the transbuccally placed lateral miniplate was better at reducing the incidence of postoperative complications than one placed on the external oblique ridge using a transoral approach. Finally, geometric miniplates performed better than conventional miniplates in reducing postoperative complications., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To present algorithms for the treatment of zygomatico-orbital (ZMO) fractures and to review how many of our patients were treated using each. We have presented 2 algorithms: 1 for when intraoperative computed tomography (CT) scans are not available and 1 for when intraoperative CT scans are available., Patients and Methods: The data from all patients treated by us for isolated, unilateral ZMO fractures from January 1991 to December 31, 2013 with adequate medical records were retrospectively analyzed. The demographic information and treatment methods were collected and tabulated to determine how these patients' fractures had been classified using the 2 algorithms. Simple descriptive statistics were applied., Results: A total of 883 patients with sufficient records who had undergone treatment of isolated, unilateral ZMO fractures were included. Of these 883 patients, 71 were classified as having high-energy ZMO fractures that had not been treated using 1 of the algorithms. A total of 758 patients with sufficient records to be included in the present study were treated using the algorithm before intraoperative CT scanning was available. Finally, 54 patients were treated using the algorithm after intraoperative CT scanning was available. The patients were similar demographically. The number of patients treated at each point in the algorithms is shown. Overall, only 40% of patients required internal orbital reconstruction., Conclusions: The treatment of most ZMO fractures can be sequential, using an algorithm to avoid unnecessary surgical approaches and procedures that can potentially cause iatrogenic deformities. The use of intraoperative CT scans will allow the surgeon to be less invasive, with greater predictability and precision., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

An algorithm for the treatment of noncondylar mandibular fractures is presented based on outcomes from studies that have been performed during the past 30 years. It is designed to assist clinicians in formulating a treatment plan that can be expected to provide the patient with a predictable outcome., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: There is very limited evaluation of the management of fractures of the bilateral mandibular angles. The purpose of this study was to determine the incidence, etiology, and outcomes of bilateral mandibular angle fractures treated with the transoral application of rigid fixation on one side and nonrigid fixation on the other., Patients and Methods: Patients 18 years of age or older with isolated, noncomminuted fractures through the right and left mandibular angles and treated solely with 2.0-mm miniplates through intraoral incisions (and trocar) were collected from 2 sources. Patients treated at Allegheny General Hospital (Pittsburgh, PA) were prospectively collected from August 1, 2006 through December 31, 2012. Patients treated at Parkland Memorial Hospital (Dallas, TX) and University Hospital in San Antonio (San Antonio, TX) from January 1, 1992 through December 31, 2012 were retrospectively added to the sample. Data collected included age, gender, race, cause of fracture, presence or absence of mandibular third molars, occlusal relation documented at last visit, and occurrence and management of complications. Standard descriptive statistics were used and the relation between initial displacement and adequacy of reduction was evaluated with the Fisher exact test., Results: Of 1,565 patients with 2,195 mandibular fractures, 33 (2.1%) presented with bilateral mandibular angle fractures. The average age of the cohort was 25.2 ± 1.8 years (range, 18 to 48 yr). The mechanisms of injury were assaults (30 of 33, 90.9%), motor vehicle collisions (2 of 33, 6%), and a fall (1 of 33, 3%). Twenty-seven patients (81.8%) had at least 1 mandibular third molar at the time of injury. Three patients (9.1%) had minor postoperative wound problems, with 1 incident (3.0%) of malocclusion. There was no statistically significant relation between the initial displacement and the adequacy of reduction., Conclusions: Bilateral mandibular angle fractures are a rare traumatic event that may be successfully treated with transoral rigid and nonrigid fixation with 2.0-mm miniplates., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the internal fixation requirements for combined mandibular angle and contralateral body or symphysis fractures of the mandible., Patients and Methods: Two sample groups of patients treated for combined angle and body/symphysis fractures were compared for the development of major complications, defined as a need for another surgical intervention. The groups were divided based on whether they were treated with rigid or nonrigid fixation of the body or symphysis fracture., Results: Nine hundred seventy-six patients were treated in the rigid group, and 149 were treated in the nonrigid group. There was a 4.9% major complication rate in those in the rigid fixation group versus 15.4% in the nonrigid fixation group (P < .001)., Conclusion: The fixation requirements of patients treated with double fractures of the mandible are different than when treating isolated fractures of the mandible. Double fractures require that at least one of the fractures undergoes rigid fixation to decrease the incidence of complications., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Orbital injuries are common and a common cause of blindness. The first priority for these injuries is the health of the globe. Imaging is imperative for diagnosing orbital fractures, as clinical examination cannot thoroughly assess their presence or severity. When treatment is indicated, an anatomic reconstruction of the internal orbit is critical to the proper position and function of the ocular globe., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Orbital floor injuries, alone or combination with other facial fractures, are one of the most commonly encountered midface fractures. Techniques for orbital reconstruction have migrated away from autogenous bone grafts to well-tolerated alloplasts, such as titanium and Medpor. Material for reconstructing the orbit can then be selected based on requirements of the defect matched to the mechanical properties of the material. Material selection is largely and ultimately dependent upon surgeon preference., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this investigation was to evaluate outcomes for patients treated with lag screw or plate and screw fixation for fractures of the mandibular symphysis., Patients and Methods: The investigator implemented a retrospective cohort study and enrolled a sample of patients with symphysis fractures. The primary predictor variable was treatment group categorized as lag screw or plate fixation of the fracture. The primary outcome variables were postoperative complications. Other variables collected were grouped into demographic, anatomic, radiographic, and preoperative variables. Appropriate descriptive and bivariate statistics were computed and statistical significance was set at P < .05., Results: Eight hundred eighty-seven patients met the inclusion criteria. Four hundred seventy-six were treated with bone plates and 411 were treated with lag screws. There were no significant differences in demographic data for the 2 groups. There were no statistically significant differences in occlusal or osseous healing outcomes. However, there were significant differences in treatment outcomes for several variables, including wound dehiscence, plate exposure, and the need for hardware removal between the groups., Conclusions: Plating and lag screw techniques showed very good outcomes. There were more intraoperative difficulties placing lag screws than bone plates, but the application of lag screws was associated with fewer postoperative complications., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this investigation was to evaluate outcomes for 2 bone plating techniques used in the treatment of mandibular symphysis/body fractures., Patients and Methods: All patients with adequate records treated for fractures of the mandibular body or symphysis by 2 miniplates or 1 stronger plate over an 11-year period were included. Demographic and outcome variables were collected and statistically analyzed to determine if the 2 treatments produced different outcomes., Results: Six hundred eighty-two patients had sufficient follow-up for inclusion in this study. There were no significant differences in demographic data for the 2 groups. There were no statistically significant differences in occlusal or osseous healing outcomes. However, there were significant differences in treatment outcomes for several variables, including wound dehiscence, plate exposure, the need for plate removal, and tooth root damage between the groups., Conclusion: The use of 2 miniplates was associated with more postoperative complications than the use of 1 stronger plate, but both techniques produced sufficient stability for healing., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this investigation was to evaluate treatment outcomes prospectively when isolated fractures of the mandibular angle are treated by 1) nonrigid fixation that includes 5 to 6 weeks of maxillomandibular fixation, 2) nonrigid but functionally stable fixation using a single miniplate, and 3) rigid fixation using 2 miniplates., Patients and Methods: All patients treated for isolated fractures of the mandibular angle at Parkland Hospital over a 12-year period were treated by 1 of the 3 methods sequentially assigned. Demographic, fracture characteristic, and treatment and outcome data were prospectively collected and statistically analyzed to determine whether the 3 treatments produced different outcomes., Results: One hundred eighty-five patients had sufficient follow-up for inclusion in this study. There were no significant differences in demographic data for the 3 groups. There were significant differences in treatment outcomes for several variables, including the amount of time it took to perform the surgery and postoperative wound problems., Conclusion: The use of single miniplate was the easiest to perform and was associated with the lowest number of complications., (Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this investigation was to determine if there is evidence suggestive of blood flow within pericranial flaps., Patients and Methods: An index of blood flow using laser-Doppler blood flowmetry was obtained in pericranial flaps from 10 patients who were undergoing a coronal flap for reconstructive procedures. The data were analyzed using fast Fourier transformation to indicate the presence or absence of blood flow., Results: All but 1 pericranial flap showed evidence of blood flow within. Most flaps had blood flow even several centimeters distal to the origin of the flaps' pedicles., Conclusion: The data clearly indicate that pericranial flaps contain at least some blood flow. However, the quantity of blood flow could not be assessed using this technology., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of the present study is to report an intraoperative method of determining which condylar process fractures of the mandible do not require open reduction and internal fixation., Patients and Methods: A total of 332 patients with unilateral extracapsular fractures of the mandibular condylar process were retrospectively studied. After any other mandibular fractures had undergone open reduction and internal fixation, the maxillomandibular fixation was released and the occlusion checked to determine whether deviation of the mandible was present toward the side of the condylar fracture. In addition, digital posteriorly directed force was applied to the chin to determine how easily the mandible would deviate. Those cases in which the mandible dropped posteriorly toward the side of fracture, creating a malocclusion ("drop-back"), were treated either closed or by open reduction, according to several factors. Those whose mandibles either did not deviate toward the side of fracture or those in whom the mandible could be pushed posteriorly on the side of fracture but readily regained a midline position on release of pressure (nondrop-back) were treated closed. Displacement of the condylar process was examined using pretreatment Towne's and panoramic radiographs. The relationship between the intraoperative drop-back results and the pretreatment level and displacement of the condylar process fractures was statistically assessed., Results: Of the 332 fractures, 105 were in the nondrop-back group and 227 were in the drop-back group. The only demographic difference between the 2 groups was the displacement of the condylar process, which was greater in the drop-back group. All patients in the nondrop-back group, except for 1, had good occlusal and functional outcomes, with minimal need for interarch elastic guidance., Conclusions: Determining which patients would not benefit from open reduction and internal fixation can be assessed clinically during surgery more reliably than using preoperative imaging studies.

Fracture through the angle of the mandible is one of the most common maxillofacial injuries sustained in modern societies. Among issues related to the treatment of maxillofacial injuries, those concerning angle fractures are the most hotly debated, with the exception perhaps of those concerning the condylar process of the mandible. There are several reasons for this controversy about treatment of angle fractures, a controversy too often made up of arguments founded on emotion rather than on scientific information. This article discusses some of the controversies in the management of such fractures.

Purpose: The purpose of this study is to compare the access afforded by the Le Fort I osteotomy with the more traditional sublabial and endonasal approaches to the pituitary fossa., Patients and Methods: Five fresh cadaveric heads were obtained for this study. Endonasal, sublabial, and Le Fort I osteotomy approaches to the pituitary fossa were performed on each specimen. Retractors were placed in the surgical field to simulate the intraoperative speculum position for each approach. Fluoroscopic images were obtained in 2 views. For each specimen, all images for a given approach were digitally superimposed to compare the magnitude of exposure obtained by each approach. Angular measurements were then compared among the 3 approaches., Results: In the axial plane the degree of lateral exposure with the Le Fort I approach ranged from 15 degrees to 35 degrees, with a mean of 22.6 degrees. By comparison, minimal or no lateral movement of the speculum was possible with the sublabial and endonasal approaches. In the sagittal plane the degree of vertical exposure with the Le Fort I approach ranged from 13 degrees to 22 degrees, with a mean of 17 degrees. The sublabial approach provided 6 degrees to 17 degrees of vertical exposure, with a mean of 11.4 degrees. Minimal or no vertical movement of the speculum was possible with the endonasal approach., Conclusions: The Le Fort I osteotomy is a valuable midline approach for pituitary lesions that require broad exposure. Access in both the axial and sagittal planes is greater than with traditional trans-septal approaches.

Purpose: To present a useful technique for widening the thin alveolar ridge for placement of an implant or bone graft., Materials and Methods: A partial soft tissue flap is elevated over the alveolar ridge and the ridge is split with an osteotome. The technique out-fractures the buccal plate and maintains the labial soft tissue to preserve the blood supply to the buccal bone., Results: The book flap has been employed in over 500 cases over the past 12 years. Approximately 90% were successful in providing adequate width to accommodate an implant. Infection occurred in approximately 2% of cases. The average gain in width was around 3 mm., Conclusion: This technique can be employed often and has a very low complication rate.

Purpose: This study was conducted to evaluate the outcomes after treatment of fractures through the atrophic mandible using open reduction, internal fixation, and immediate bone grafting., Patients and Methods: All patients treated surgically for fractures through an atrophic (<15 mm at the fracture site) mandible over a 17-year period were included if their records contained adequate information. Demographic data and details of treatment were tabulated, as were outcomes., Results: A total of 32 patients (19 males, 13 females; age range, 43 to 92 years) met the inclusion criteria. Of the 32 cases, 26 were bilateral fractures, and most occurred through the region of the body of the mandible. Most patients had significant medical comorbidities. Most of the fractures were treated through an extraoral approach with a rigid internal fixation technique. Immediate bone grafts were used in 23 of the 32 patients. No intraoperative or postoperative complications occurred. All patients healed uneventfully. In 4 patients, plates had to be removed for various reasons after fracture healing was complete., Conclusions: The use of a seemingly more aggressive approach for managing fractures through the atrophic mandible produced healing in all patients and, in the end, may be more "conservative" than a less aggressive approach. Despite the advanced age and medical comorbidities of most of the patients, all patients tolerated the surgery and did well postoperatively.

Purpose: The purpose of the study was to explore the association between condylar fractures and temporomandibular joint (TMJ) ankylosis in a sample from 1 hospital in China., Patients and Methods: All patients treated for post-traumatic TMJ ankylosis in a 5-year period at Peking University, School of Stomatology, who had sufficient information available were included. Demographic information and details of their original injury and resultant ankylosis were tabulated and analyzed by descriptive statistics., Results: Twenty-five patients with 40 ankylosed joints met the inclusion criteria (15 were bilateral). The majority of patients were male, and ranged from 5 to 52 years of age with a mean of 23 years. Twenty-five of 40 cases were the result of a sagittal fracture of the condyle, where the medial pole was fractured off. Nineteen ankylosed joints (47.5%) showed lateral or superolateral displacement of the lateral aspect of the ramus/condylar process. Sixteen of 25 patients (64%) had fractures of the mandible other than condylar fractures located in the anterior mandible that were often untreated or not properly reduced. Fifty percent of the patients had widening of face or crossbites., Conclusions: The results of this study indicate that the combination of an intracapsular fracture with concomitant widening of the mandible leads to the lateral pole of the condyle or the condylar stump to become displaced laterally or superolaterally in relation to the zygomatic arch, where it fuses. Proper treatment of the anterior mandibular fracture(s) may help prevent the development of TMJ ankylosis in such patients.

Purpose: The aim of this retrospective study was to analyze the characteristics of delayed panfacial fractures and evaluate treatment results., Patients and Methods: Thirty-three patients with delayed panfacial fractures were treated in the Maxillofacial Trauma Center of Peking University, School and Hospital of Stomatology between 1998 and 2004. Each patient was examined by computed tomography (CT) scans before operation. For those who had no severe opening restriction, dental impressions were taken to fabricate dental casts. For those with severely comminuted fractures, 3-dimensional (3D) models of the facial skeleton were used. Re-establishing the continuity of the mandible was the first step and then used as a platform to reconstruct the maxillary fractures via maxillomandibular fixation after Le Fort I osteotomy. The third step was to restore the mid- and upper-facial width and projection by coronal approach to expose the zygomatic complex and frontal bone/sinus and/or naso-orbito-ethmoid (NOE) fractures., Results: There were 3 types of mandibular fractures that affected the treatment plan: 1) type I, mandibular body/symphysis fracture(s) (17/33, 51.52%); 2) type II, mandibular angle and/or condylar fracture(s) (6/33, 18.18%); and 3) type III, both mandibular body/symphysis and angle/condylar fractures (10/33, 30.30%). Fourteen cases were associated with NOE fractures (42.42%) and 3 cases had frontal sinus fractures (9.1%). Twelve cases had enophthalmos (36.36%) and 3 lost 1 eyeball. The order of treatment was dependent on the mandibular fracture type. For type I fractures, reconstructing the mandibular arch was the first step. For type II fractures, repairing the angle, ascending rami, and condylar areas was the first step. For type III fractures, when both mandibular height and arch were disrupted, freeing the malunited angle or condyle was the first step before restoring the mandibular arch form. Reconstruction of the mandibular height and projection was then carried out. For all 3 types, the second step was to restore the mid- and upper facial width and projection by reducing the zygomatic complex and frontal bone/sinus or NOE fractures. Maxillary fixation across the Le Fort I level was the last step. Le Fort I osteotomy was used for all 33 cases. Bone grafts and soft tissue suspension also were used. Twenty-one cases (63.64%) had good results, 7 (21.21%) cases were acceptable, and 5 (15.15%) were not good. There were 7 cases (21.21%) that still had soft tissue problems that needed secondary operations., Conclusions: Reconstruction of the mandible first with Le Fort I osteotomy is a good way to treat delayed panfacial fractures. Computed tomography and 3D CT, model surgery, and occasionally 3D models are necessary aids for diagnosis and treatment. Soft tissue problems, including lacerations and asymmetries, were often the factors that caused an unfavorable outcome.

The concept of prosthesis-directed implant-supported restoration is well accepted. The implementation of this principle for patients requesting full fixed implant-supported maxillary prosthetics has not been thoroughly described. We present a technique for the evaluation and preprosthetic surgical management of patients who are edentulous in the maxilla and wish to have fixed implant-supported crown and bridge prosthetics.

Purpose: To analyze the outcomes of treatment for double unilateral mandibular fracture., Materials and Methods: Retrospective chart review of patients who were treated between 1994 and 2004 for 2 mandibular fractures on the same side of the mandible. Data collected involved age, gender, race, cause of fracture, treatment modality, length of follow-up, occlusal relationship at last visit, preoperative and postoperative clinical photographs and radiographs, and incidence and management of complications. Standard descriptive statistics were used., Results: From a total of 1,287 mandibular fractures for which charts were available, 31 double unilateral mandibular fractures were treated during a 10-year period, for an occurrence rate of 2.4%. Demographic characteristics of these patients were similar to those of patients in other published studies on mandibular fracture. Fractures involved angle + body (18/31, 58%), condyle + body (11/31, 35%), and condyle + angle (2/31, 6%). Various treatments were provided for these fractures, but open reduction and internal fixation were applied to at least 1 of the fractures. Follow-up ranged from 6 weeks to 5 months (average, 9.6 weeks). Eight patients (8/31, 25.8%) developed complications involving visible gonial flaring; 3 of these also had cross-bite., Conclusion: Double unilateral mandibular fracture is a rare event. The difficulty inherent in treating these fractures can be alleviated with the use of proper techniques of open reduction and internal fixation; however, treatment continues to be associated with a high complication rate.

Purpose: The physical mechanism of orbital blowout fractures has been debated for years by surgeons. Three main theories have been promulgated, including the hydraulic theory, the contact of globe-to-orbital wall theory, and the bone buckling theory. One might anticipate a strong association of blowout fractures and traumatically induced ocular injuries with the hydraulic and globe-to-wall theories because in both, the force is delivered directly to the ocular globe. This study was performed to assess the association between orbital blowout fractures and ocular injuries., Patients and Methods: Records of patients with orbital blowout fractures were collected from a single hospital. Those with complete records that included a thorough ophthalmologic examination were collected, and information about the nature of the injury to the bone and the ocular globe was tabulated., Results: A total of 225 patients ranging in age from 13 to 98 years (mean, 34.9 yr) who had sustained 240 blowout fractures (15 were bilateral) met the inclusion criteria. In all, 53 fractures (22%) involved ocular injuries that were thought to be directly associated with ocular trauma. The most common positive ocular finding was commotio retinae, which was present in 21 of 60 globes with significant traumatic ocular findings. This was followed in frequency by traumatic mydriasis (19 globes) and traumatic iritis (15 globes). Most ocular injuries were minor., Conclusions: The low incidence of significant ocular injury may indicate that direct contact of the globe with the traumatic force is not common. This finding gives credence to the buckling theory of blowout fracture, which seems more likely in most cases.