Search

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (P =.06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (P =.019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (P =.028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence. [ABSTRACT FROM AUTHOR]

Background: Choosing an appropriate course of treatment for midface fracture can be challenging due to the variable presentations of midfacial fractures and concurrent orbital floor injuries. Objectives: To evaluate complications of midface fracture including the orbital floor. Materials and Methods: It was a cross-sectional study carried out on 456 patients diagnosed with midface fracture, including the orbital floor, clinically and radiographically. The computed tomography radiograph of each study participant was evaluated. There was a thorough clinical assessment of each study participant. Results: There were complications like laceration (47.3%), hematoma (54.2%), infraorbital nerve paraesthesia (13.05%), Contusio bulbi (13.30%), and diplopia (13.35%). No complications were observed in 8.25% of study participants. The most common complication was laceration. Conclusion: The eyeball, orbit, soft tissues, and surrounding structures should be precisely examined clinically and radiologically in midface fractures.

Introduction: The midface is a complex anatomical area consisting of several areas. Although various factors protect the eye from trauma, such as orbital rim, blink reflex, elasticity of ocular structures, and protective eye movements by hands and head, ocular injuries remain common in patients with midface fractures, with an incidence rate of up to 90.6%. This study, the first of its kind conducted in Indonesia, aims to evaluate the characteristics and incidence of ocular injuries in midface fractures and to examine the relationship between the treatment. Methods: This observational analytic study employed a retrospective cohort design, utilizing medical record data of midface fracture patients. The independent variables included age, sex, cause, incidence, segment and severity of ocular injury, number of orbital wall involvements, and treatment options. The dependent variable was midface fracture patients. The Mann–Whitney and Fisher’s exact tests were employed to analyze the multivariate data. Results: Individuals aged 32–37 were most commonly affected due to accidents, with the anterior ocular segment and maxilla bone frequently affected. There are no special factors that differentiate a person from experiencing an ocular injury in a midface fracture (P > 0.05). Ocular injuries correlated with orbital wall injury (P = 0.008) at least one discontinuity. Impaired functions included movement and visual disturbances, diplopia, and dystopia (P = 0.134). Conclusions: No significant relationship was found between age, sex, and cause of trauma with ocular injuries in patients with midface fractures. However, a significant relationship was observed between the amount of orbital rim involvement and at least one wall discontinuity occurring in midface fracture patients.

Background: Choosing an appropriate course of treatment for midface fracture can be challenging due to the variable presentations of midfacial fractures and concurrent orbital floor injuries. Objectives: To evaluate complications of midface fracture including the orbital floor. Materials and Methods: It was a cross‑sectional study carried out on 456 patients diagnosed with midface fracture, including the orbital floor, clinically and radiographically. The computed tomography radiograph of each study participant was evaluated. There was a thorough clinical assessment of each study participant. Results: There were complications like laceration (47.3%), hematoma (54.2%), infraorbital nerve paraesthesia (13.05%), Contusio bulbi (13.30%), and diplopia (13.35%). No complications were observed in 8.25% of study participants. The most common complication was laceration. Conclusion: The eyeball, orbit, soft tissues, and surrounding structures should be precisely examined clinically and radiologically in midface fractures. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: The midface is a complex anatomical area consisting of several areas. Although various factors protect the eye from trauma, such as orbital rim, blink reflex, elasticity of ocular structures, and protective eye movements by hands and head, ocular injuries remain common in patients with midface fractures, with an incidence rate of up to 90.6%. This study, the first of its kind conducted in Indonesia, aims to evaluate the characteristics and incidence of ocular injuries in midface fractures and to examine the relationship between the treatment. Methods: This observational analytic study employed a retrospective cohort design, utilizing medical record data of midface fracture patients. The independent variables included age, sex, cause, incidence, segment and severity of ocular injury, number of orbital wall involvements, and treatment options. The dependent variable was midface fracture patients. The Mann–Whitney and Fisher's exact tests were employed to analyze the multivariate data. Results: Individuals aged 32–37 were most commonly affected due to accidents, with the anterior ocular segment and maxilla bone frequently affected. There are no special factors that differentiate a person from experiencing an ocular injury in a midface fracture (P > 0.05). Ocular injuries correlated with orbital wall injury (P = 0.008) at least one discontinuity. Impaired functions included movement and visual disturbances, diplopia, and dystopia (P = 0.134). Conclusions: No significant relationship was found between age, sex, and cause of trauma with ocular injuries in patients with midface fractures. However, a significant relationship was observed between the amount of orbital rim involvement and at least one wall discontinuity occurring in midface fracture patients. [ABSTRACT FROM AUTHOR]

Introduction: Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018–2021. Methods: This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021. Results: During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures. Conclusions: Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures. Complaints after fracture treatment and complications after plate removal were analyzed, retrospectively. A total of 205 patients were included. Plate removal was performed in 99 cases. Complaints related to the osteosynthesis material resulted in more frequent plate removal (p < 0.001). Complications were noted in 22 patients after plate removal. Duration of plate removal did not correlate with postoperative complications. In 69 patients, plates were removed without previous symptoms. Of these patients, postoperative complications were recorded in 15 cases. In patients with complaints after osteosynthesis, complications after plate removal occurred in seven (23.3%) patients. Ectropia developed significantly more often with increasing age (p < 0.05). Within the limitations of the study it seems that prophylactic plate removal is a treatment option that is not associated with an increased complication rate. [ABSTRACT FROM AUTHOR]

Introduction: Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018–2021. Methods: This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021. Results: During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures. Conclusions: Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.

Multiple facial fractures, which involve the upper, middle, and lower thirds of the face, are called Panfacial fractures, and their management is one of the biggest challenges in the field of maxillofacial surgery. The proximity of maxillofacial skeleton to important sensory or vital structures such as the visual, olfactory, masticatory and respiratory systems and intracranial components in addition to negative effects on esthetic aspects of the face have doubled the intricacy. Small or thin fractured segments that are difficult to find and stabilize make management of pan facial fractures different from anywhere else in the body. One major challenge is to find the best pattern and sequence of treatment. There are different concepts, depending on the surgeon's experience and the pattern of fracture. This study reports three patients with the diagnosis of pan facial fractures. A 54-year-old woman, an 18-year-old and a 14-year-old man that were all victims of road traffic injuries (MVA). Conventional open reduction and internal fixation methods have been used and favorable results have been obtained in follow-up periods.

Aim and Objective : Our study was an observational and evolutional to analyze the significance of orbital volume calculation in predicting the probability or tendency of developing late enopthalmous on patients with unilateral orbital fracture with or without associated midface injury reported to our hospital. Materials and Methods: The subjects in our study included fifteen patients between18 and 60years. They were treated surgically and conservatively. Patients were exposed to series of examination from the day of injury or reporting for a consecutive period of up to six months following injury. CT was taken prior to treatment following management to evaluate the volume change in orbit. Its correlation and significance to treatment outcome were analyzed using MIMICS software by Materialise by comparing injured orbit to opposite side normal eye. Result: Conclusive of clinical examination and summary of statistical analysis patients were categorized into three groups: Low (with volume change of less than 2%), Medium (volume change between 2 to 20%) and High (volume change more than 20%) by comparing fractured orbit to uninjured orbit and a statistically significant mean value of 27.7 ± 2.6 cu.mm for fractures eye and 25.9 ± 2.6 cu.mm for normal eye was found ( P ≤≤ 0.05). Conclusion: Orbital volume can be considered as useful criteria in evaluation of patients with orbital fracture. Evaluation and follow up in correlation with resultant volume assessment provide a better indicator for assessment of prognosis and enopthalmous. Unlike other methods for volume assessment MIMICS software by Materialise provide a better method and it can be incorporated to working station in hospital. Every CT assessment in orbital trauma should include orbital volume as a parameter and this software is easy and user-friendly software that does not require its technical knowledge for application. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to report on the pattern of occurrence of nasoorbitoethmoid (NOE) fractures in Odisha and the various factors that influence their distribution. Methods: The study period was from January 1, 2016 to December 15, 2017. After approval from the Institutional Ethics Committee, all patients diagnosed with naso-orbito-ethmoid fractures reporting to the department of OMFS and Level-1 trauma centers were included in the study. Sociodemographic data along with the etiology and type of fracture were mentioned. Associated injuries to other body parts were noted. Open reduction was possible only in five cases of NOE fractures. The treatment plan including the operative approach and postoperative results was evaluated. Results: A total of 1192 patients with facial fracture were seen, of which 52 (4.36%) patients had NOE fractures. Males far outnumbered females in a ratio of 9:1. Thirty-three patients (63.46%) had unilateral NOE fracture, while the rest 19 (36.54%) had bilateral NOE fracture. Sixteen (30.76%) cases were classified as Type I, 35 (67.30%) as Type II, and 1 (1.92%) as Type III. Road traffic accidents were the most common cause of NOE fractures (69%), followed by fall (17%) and assault (10%). The most common neurological injury to be associated with NOE fractures was pneumocephalus (29%), followed by diffuse axonal injury (8%). Telecanthus (100%) was found to be the primary clinical feature in patients of NOE fracture, followed by a depressed nasal bridge (92%). Fracture of the nasal bone was invariably associated with NOE fracture. Complications observed due to untreated NOE fractures included a shortened and retruded nose, shortened palpebral fissures, telecanthus, and enophthalmos. Conclusion: Contemporary management of NOE complex fractures demands precise diagnosis and immediate surgical management with anatomic reduction and rigid fixation of the involved bone segments. With an improvement in socioeconomic status and increased awareness among maxillofacial surgeons, hopefully, a greater number of NOE fracture patients will avail the benefits of open reduction in future. [ABSTRACT FROM AUTHOR]

Le Fort III fractures, also called cranial-facial separation, the fracture line in this injury passes from the nasofrontal area across the medial, posterior, and lateral orbital walls, the zygomatic arch, and through the upper portion of pterygoid plates. The purpose of this study was to evaluate the knowledge, awareness and practice of Le Fort III fractures and its management protocol among dental undergraduates. A cross sectional study was conducted among 150 dental students. The questionnaire consisted of 10 questions and were equally distributed among the students. The data collected was entered in an Excel sheet and subjected to statistical analysis using SPSS version 23. From the results it was found that 32.67% of the interns have responded yes on awareness of the universally used classification to be Lefort's Classification. 29.33% of the interns have awareness of CSF rhinorrhea to be manifestation of Lefort III fractures. Awareness on basic principles in management of Lefort III fracture showed that 27.33% of the interns are aware of it, for all of which the P value was found to be statistically significant (p<0.05). Within the limits of the study, it is observed that knowledge and awareness of management of Lefort III fractures were high in Interns followed by final years. This can be due to the clinical expertise that the interns have acquired through clinical experience and clinical practice. [ABSTRACT FROM AUTHOR]

Standard bicycle helmets are designed to protect the cranial vault. Numerous studies have demonstrated the beneficial effect of standard bicycle helmets on craniocerebral trauma, but their protective effect on facial injuries remains unclear. Therefore, this study used data obtained by an accident research unit to investigate the protective effect of standard bicycle helmets on facial injuries. A total of 31,634 bicycle accidents were registered between 1999 and 2015; of these, 7004 met the study requirements. Demographic characteristics, technical information (relative collision speed, collision type, collision partner, helmet use), and clinical data (injury type) relating to these accidents were analyzed. Of all affected cyclists, 1005 (14.3%) had a facial injury (fracture and/or soft tissue injury). Bicycle helmets were worn in 11.8% of accidents. Of these, 75.4% involved males and 24.6% involved females. The bicycle helmet did not protect against facial injuries. Furthermore, sex and the type of collision partner were found to be risk factors for facial injuries. In the future, helmet designs should be modified to improve facial protection, and better education should be provided to the public regarding the benefits of bicycle helmets. [ABSTRACT FROM AUTHOR]

Background: The question of reconstruction of human tissues and organs with the use of medical materials is still open, because of the accurate requirements for their biological and physical features. The aim of this study was to prove the efficiency of titanium nickelide constructors in treatment of isolated orbital floor fractures or combination with zygomatico-orbital complex fractures. Methods: Patients with a fracture of zygomatico-orbital complex and/or low orbital floor (n = 44) carried out different treatments: in the first group, osteosynthesis and endoprosthesis with titanium nickelide structures; in the second group, titan mini-plates osteosynthesis; in the third group (‘blow-out’), endoprosthesis with a titanium nickelide mesh; and in the fourth group (‘blow-out’), conservative treatment and monitoring (archive data) (p > 0.05). The paraesthesia, diplopia, enophthalmos and exophthalmos degree were measured in points. Results: In one year, the first and second groups had no differences in level of paraesthesia (p > 0.05). The absence of exophthalmos and differences between first and second groups, and between the third and the fourth groups with positive dynamics inside the groups were proved (p < 0.05). In the first and third groups, enophthalmos was absent, and it increased in the second and fourth groups (p < 0.01, p < 0.11). Diplopia in the first and third groups was absent, and it increased in the second and fourth groups (p < 0.05, p < 0.01). Conclusion: The elasticity and biocompatibility of titanium nickelide make the implant insertion and restoration of the lower orbital wall anatomy easier, with good postoperative clinical results.

Abstract Introduction Treatment decisions for fractures of the orbital floor are based on clinical appearance, ophthalmological examination, and computed tomography (CT) scans. In extensive fractures, decisions are easily made between conservative and surgical treatment. However, objective parameters are rare in inconclusive cases. Materials and methods Our retrospective study included 106 patients with unilateral isolated orbital floor fractures. Correlations between preoperative ophthalmological examinations and specific CT parameters were performed. Results The defect size of the fracture appeared to be significantly associated with the presence of diplopia. CT-morphological parameters and preoperative ophthalmological results showed statistical significance for diplopia and incarceration of inferior rectus muscle (IRM), diplopia and displacement of IRM, decreased mobility and incarceration of IRM, and decreased mobility and displacement of IRM. Discussion Our clinical assessment scheme for CT scans of orbital floor fractures is aimed at facilitating treatment decision making using four CT-based variables. As critical size defects of the orbital floor of ≥2 cm2 are likely to cause clinically significant posterior displacement of the globe, resulting in enophthalmos, the proposed parameters offer a readily accessible and easy to evaluate scheme that helps to identify patients in need of surgical intervention. [ABSTRACT FROM AUTHOR]

Facial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used.

Patients with multiple fractures involving upper third of the face, the mid-face and the lower third are generally referred to as Panfacial fractures and managing these cases is extremely complicated. Proximity of the maxillofacial region to the important features or senses such as visual function (diplopia), olfaction, respiration (airway management), chewing or mastication (occlusion), deglutition and aesthetics; makes the scenario a little more complex for the surgeon operating in this particular region than the surgeon operating any other part of the body. Inability to directly visualize and reduce all the components of a pan facial injury along with inadequate stability of the fractured bones leads to persistent deformity. It is challenging to follow an established pattern for repairing the pan facial fractures. Each case with this type of fracture is unique and requires skill and expertise of the surgeon to restore the pre-traumatic anatomy and facial aesthetics. Despite all the aggressive treatment, most of the patient’s with pan facial trauma may have some residual deformity which may require another correction surgery later. This article briefs about the management and simple approaches used to reduce and fix a case of pan facial trauma in a 23-yearold male.

Current clinical assessment and imaging techniques were described in part 1, and this article presents a systematic review of the surgical treatment principles in the management of midface and internal orbit fractures from initial care to definitive treatment, including illustrative case examples. New developments enabled limited surgical approaches by standardization of osteosynthesis principles regarding three-dimensional buttress reconstruction, by newly developed individualized implants such as titanium meshes and, especially for complex fracture patterns, by critical assessment of anatomical reconstruction through intraoperative endoscopy, as well as intra- and postoperative imaging. Resorbable soft tissue anchors can be used both for ligament and soft tissue resuspension to reduce ptosis effects in the cheeks and nasolabial area and to achieve facial aesthetics similar to those prior to the injury. [ABSTRACT FROM AUTHOR]

This case describes an injury to a 40-year-old woman, employed as a softball team coach, who presented to an emergency department (ED) after sustaining a line drive hit to the right side of the face with a softball during practice. Upon arrival to the ED, the patient complained of moderate pain, swelling, and bruising over the right side of her midface area. After evaluation in the ED, the patient received a diagnosis of a zygomatic arch fracture that was further managed by an occupational medicine nurse practitioner, a plastic surgeon, and an ear, nose, and throat (ENT) physician specialist. [ABSTRACT FROM AUTHOR]

Facial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used. [ABSTRACT FROM AUTHOR]

Abstract: As many as 30% of all maxillofacial fractures (MFFs) and skull base fractures (SBFs) are reported to be sports-related. Participation in sporting activities has grown worldwide and the number of cases of sports-related injuries has also increased. The aim of this study was to evaluate the data of 3596 patients hospitalized by MFF or SBF over a 6-year period; 147 (4%) of these cases were sports-related (mean age 29.7±12.8 years). The highest incidence was found in patients aged 20–29 years (35%), and the fractures resulted mostly from ball sports (74%), especially soccer (59%) and handball (8%). The injuries involved different areas, with a significant prevalence of the midface complex (67%) compared with the mandible region (29%) and the skull base (4%). The commonest diagnoses associated with MFF and SBF were brain concussion (19%), laceration of the skin and soft tissue (16%), and dental injury (8%). Surgery was required for 88% of midface fractures. In cases of mandible fractures 52% were supplied with osteosynthesis. This study identified the significant number of severe sports-related injuries that occur each year, suggesting that changes of rules and safety standards are needed for the prevention of such injuries. [ABSTRACT FROM AUTHOR]

Arcus zygomaticus is one of the weakest parts in the facial bone that can be easily affected and fractured by traumas. The typical shape of the fracture is midline depression and separation from zygomatic and temporal bone. Sometimes by the whole arcus fracture can be occur. The arcus fractures can be seen the component of the zygomatic complex fracture and also may happen as an isolated damage even if occurs minimal trauma to the lateral face parts. Most of the cases, as a result of fracture the arcus zygomaticus force the coronoid process and result in limited mouth opening and trismus. If these kinds of symptom will be seen the treatment is necessary. Conventionally, Keen, Gilles, Hook traction and open reduction treatment method and also new treatment modality can be use. For satisfied functional and aesthetically clinical results, meticulous approach is necessary. Our study's aim is to present 9 isolated arcus zygoma fracture cases a point of clinical findings, treatment methods, and result. In addition, classification and treatment methods will be discussed in the light of literature reviews. In our study group we have 1 female and 8 male patient. Etiological factors are violence, falling, and sport accidents respectively 6 cases, 1 and 2 cases. Main compliment was limiting of the mouth opening in all patients. Keen's method (Intraoral approach) and hook tractions method were preferred as a choice of treatment modalities. Only for one case, which is delayed arcus zygomaticus fracture, temporal approach was performed. After the operation along to 5-7 day, we performed intermaxiller fixation all the patients. After operation maximal mouth opening and functional rehabilitation was obtained. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the severity of infraorbital nerve injury following zygomaticomaxillary complex fractures and to estimate the treatment methods facilitating its functional recovery. A total of 478 patients with unilateral zygomaticomaxillary complex fractures were treated. Infraorbital nerve sensory disturbances were diagnosed in 64·4% of the patients. Injury of the infraorbital nerve was expressed as asymmetry index, which was calculated as a ratio between the affected side and the intact side electric pain detection thresholds at the innervation zone skin before treatment and 14 days, 1, 3, 6 and 12 months postoperatively. A mean asymmetry index of 0·6 ± 0·03 and 1·9 ± 0·5 was registered for 57 (11·9%) patients with hyperalgesia and for 251 (52·5%) patients with hypoalgesia, respectively. As a result of retrospective analysis of infraorbital nerve sensory disturbances and its functional recovery, infraorbital nerve injury severity was classified as mild, moderate and severe. It was found that the dynamics and outcome of the functional infraorbital nerve recovery depend on the severity of the injury and the presence of infraorbital canal damage. Function was completely recovered within 3 months after treatment in cases with mild nerve injury. In moderate cases, complete recovery was seen within 6 months and in 34·6% of the severe cases, within a 12-month period after treatment when infraorbital nerve decompression was performed according to the stated indication. Treatment based on infraorbital nerve injury classification offers a better prognosis for complete recovery of the infraorbital nerve function. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The question of reconstruction of human tissues and organs with the use of medical materials is still open, because of the accurate requirements for their biological and physical features. The aim of this study was to prove the efficiency of titanium nickelide constructors in treatment of isolated orbital floor fractures or combination with zygomatico-orbital complex fractures. Methods: Patients with a fracture of zygomatico-orbital complex and/or low orbital floor (n = 44) carried out different treatments: in the first group, osteosynthesis and endoprosthesis with titanium nickelide structures; in the second group, titan mini-plates osteosynthesis; in the third group ('blow-out'), endoprosthesis with a titanium nickelide mesh; and in the fourth group ('blow-out'), conservative treatment and monitoring (archive data) (p > 0.05). The paraesthesia, diplopia, enophthalmos and exophthalmos degree were measured in points. Results: In one year, the first and second groups had no differences in level of paraesthesia (p > 0.05). The absence of exophthalmos and differences between first and second groups, and between the third and the fourth groups with positive dynamics inside the groups were proved (p < 0.05). In the first and third groups, enophthalmos was absent, and it increased in the second and fourth groups (p < 0.01, p < 0.11). Diplopia in the first and third groups was absent, and it increased in the second and fourth groups (p < 0.05, p < 0.01). Conclusion: The elasticity and biocompatibility of titanium nickelide make the implant insertion and restoration of the lower orbital wall anatomy easier, with good postoperative clinical results. [ABSTRACT FROM AUTHOR]

Maxillary Le Fort II fracture reconstruction plays one of the challenging surgery in the field of maxillofacial trauma. The goal of treatment is reduction, reposition, fixation of fractures and restoration of occlusion. However, it is often not enough to bring back the appearance aesthetically. The challenge that we face today is that patients frequently complain about their nose postoperatively, hence, they believe that the deformity still remains. Secondary rhinoplasty post-trauma is often performed to overcome this deformity. We proposed direct rhinoplasty using diced cartilage fascia graft in Maxillary Le Fort II fracture reconstruction to provides better post-op aesthetic appearance. Reporting three cases of Maxillary Le Fort II fractures. All patients had undergone open reduction and internal fixation combined with rhinoplasty using diced cartilage wrapped with fascia. The graft provides a better nasal contour and shape, also camouflage irregularities. There was no clinical signs of graft absorption or infection. The patients were satisfied, and none of the patients complaint about their nose after surgery. Rhinoplasty using diced cartilage fascia graft simultaneously with ORIF is a breakthrough in Maxillary Le Fort II reconstruction. It brings off the incorporation of aesthetic surgery concept into reconstruction, annihilating post-op complaint from patients and preventing secondary rhinoplasty due to previous trauma., Competing Interests: No potential conflict of interest., (© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

We report a patient with multiple fractures of the midface and Guerin sign bilaterally after maxillofacial trauma. To the best of our knowledge, this is the first time that this rare presentation of Guerin sign has been published. [ABSTRACT FROM AUTHOR]

A case of panfacial trauma is reported comprising of multiple facial fractures and a clearly evident Guerin's sign along with an oronasal communication. The case reinforces the importance of recognising this sign and its classical presentation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

We introduce a novel computer-based method to digitally fixate midfacial fractures to facilitate more efficient intraoperative fixation. This article aims to describe a novel computer-based algorithm that can be utilized to model midface fracture reduction and fixation and to evaluate the algorithm's ability to produce images similar to true postoperative images. This is a retrospective review combined with cross-sectional survey from January 1, 2010, to December 31, 2015. This study was performed at a single tertiary care, level-I trauma center. Ten patients presenting with acute midfacial traumatic fractures were evaluated. Thirty-five physicians were surveyed regarding the accuracy of the images obtained using the algorithm. A computer algorithm utilizing AquariusNet (TeraRecon, Inc., Foster City, CA) and Adobe Photoshop (Adobe Systems Inc., San Jose, CA) was developed to model midface fracture repair. Preoperative three-dimensional computed tomographic (CT) images were processed using the algorithm. Fractures were virtually reduced and fixated to generate a virtual postoperative image. A survey comparing the virtual postoperative and the actual postoperative images was produced. A Likert-type scale rating system of 0 to 10 (0 being completely different and 10 being identical) was utilized. Survey participants evaluated the similarity of fracture reduction and fixation plate appearance. The algorithm's capacity for future clinical utility was also assessed. Survey response results from 35 physicians were collected and analyzed to determine the accuracy of the algorithm. Ten patients were evaluated. Fracture types included zygomaticomaxillary complex, LeFort, and naso-orbito-ethmoidal complex. Thirty-four images were assessed by a group of 35 physicians from the fields of otolaryngology, oral and maxillofacial surgery, and radiology. Mean response for fracture reduction similarity was 7.8 ± 2.5 and fixation plate similarity was 8.3 ± 1.9. All respondents reported interest in the tool for clinical use. This computer-based algorithm is able to produce virtual images that resemble actual postoperative images. It has the ability to model midface fracture repair and hardware placement.

Patients with multiple fractures involving upper third of the face, the mid-face and the lower third are generally referred to as Panfacial fractures and managing these cases is extremely complicated. Proximity of the maxillofacial region to the important features or senses such as visual function (diplopia), olfaction, respiration (airway management), chewing or mastication (occlusion), deglutition and aesthetics; makes the scenario a little more complex for the surgeon operating in this particular region than the surgeon operating any other part of the body. Inability to directly visualize and reduce all the components of a pan facial injury along with inadequate stability of the fractured bones leads to persistent deformity. It is challenging to follow an established pattern for repairing the pan facial fractures. Each case with this type of fracture is unique and requires skill and expertise of the surgeon to restore the pre-traumatic anatomy and facial aesthetics. Despite all the aggressive treatment, most of the patient's with pan facial trauma may have some residual deformity which may require another correction surgery later. This article briefs about the management and simple approaches used to reduce and fix a case of pan facial trauma in a 23-yearold male. [ABSTRACT FROM AUTHOR]

Objective: The objective of this article is to describe the CT appearance of the midfacial skeleton after surgical repair of posttraumatic Le Fort, nasoorbitoethmoidal (NOE), and frontal sinus fractures. Several of the more commonly encountered complications will also be described., Conclusion: Surgery after midfacial trauma is aimed at restoring both form and function. Knowledge of the principal tenets of Le Fort, NOE, and frontal sinus fracture repair is vital for radiologists to accurately assess the adequacy of treatment on postoperative CT and provide meaningful reports for the surgeon.

This article presents an overview of surgical management for complex midfacial fractures for the practicing otolaryngologist-head and neck surgeon. Discussion includes the important anatomic relationships; pathophysiology; clinical features; pertinent physical examination findings; imaging; surgical approaches; and techniques for repair of zygomaticomaxillary complex, orbital, naso-orbital-ethmoid, and Le Fort fractures., (Published by Elsevier Inc.)