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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.)

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.

Purpose: This article gives a general description of the incidence, causes, and complexity of maxillofacial fractures in the elderly and discusses whether modification is required in assessment, surgical indications, and techniques in such cases., Patients and Methods: A retrospective clinical and radiologic study evaluated 222 patients older than 60 years of age (mean age, 70.3) hospitalized with maxillofacial trauma over the period 1987 to 1996 in the Division of Maxillofacial Surgery, University of Turin. The patients were classified according to the following parameters: age, cause of injury, site of trauma, presence of associated fractures, pertinent medical history, type of treatment, length of hospitalization, and complications. The data were compared with those from a control group consisting of 178 adult patients younger than 60 years of age., Results: The presence of a preexisting systemic pathologic condition was the most important factor in determining hospitalization time, which was greater than in the control group. In 89 patients (40.1%), no treatment was considered necessary, whereas 133 patients (59.9%) were treated by surgery. In 115 patients (86.5%), the fractures were treated by open reduction and internal fixation, whereas closed reduction was used in 18 patients (13.5%). There were complications with six patients (2.7%), and one died in the hospital., Conclusions: The findings of this study suggest that surgical intervention is less frequently indicated in facial trauma of the elderly because of physiologic, psychologic, and social changes brought on by the aging process. The principles of treatment, the results, and the complications do not differ greatly in this group when compared with the normal adult population.

Results of early combined maxillo-facial and neurosurgical treatment of 53 craniofacial fractures are referred. The fracture location was in 31 cases central midfrontal, 10 lateral supraorbital and 12 combined central and lateral fractures. 35 fractures interested the floor and the posterior wall of frontal sinus, lacerating the underlying dura and cortical tissue. In 19 fractures orbital displacement was present. The key points in the management of these patients are: 1) Early (within 1 to 5 days) and one stage neurosurgical-maxillofacial procedure. Immediate intervention is indicated only in case of evolutive neurological lesions; 2) wide exposition of all the injuries through bicoronal incision and bone flap; 3) assessment of fractures pattern and amount of bone loss; 4) reconstruction of craniofacial frame with osteosynthesis and autologous bone grafts (35 cases iliac crest, 7 split calvarial graft); 5) interosseous wiring is used in sutured mosaic, small bone fragments and intraoperative temporary fixation; miniplates are used for rigid fixation of craniofacial pillars; 6) for optimal cosmetic result reconstruction of supraorbital ridge, nasoglabellar region and zygomatic arch is essential; 7) fractures involving the sinus floor, posterior wall and the nasofrontal duct result in direct communication between the nose and intracranial cavity with high risk of infection and mucocele formation. Cranialization of the sinus removing the posterior wall and all the mucosa is mandatory. The nasofrontal duct, the floor and sinus dead space are obliterated with autologous bone chips. Osteoneogenesis occurred in all the cases.