Vascular Anatomy for the Prevention of Sublingual Hematomas: Life-Threatening Complication of Genioplasty.

After genioplasty, the occurrence of bleeding is rare; however, rapid enlargement or displacement of the tongue secondary to lingual or sublingual hematoma can lead to life-threatening airway obstruction, necessitating prompt recognition, and immediate management. Therefore, the investigators aimed to evaluate the underlying etiologies of sublingual hematoma and relevant anatomy to facilitate early recognition of the initial presentation of these hematomas and appropriate management. The authors conducted a literature review on cases of delayed sublingual hematoma after genioplasty. The authors also report a case of delayed hematoma after performing genioplasty. The anatomical structures involved with the development of rare and serious hematomas therein are the sublingual and submental arteries, which are located in the sublingual area, rendering them susceptible to injury during genioplasty. The results of this study suggest that submental artery ligation should be performed for proper management of airway obstruction, if symptoms of sublingual bleeding are observed during the surgical procedure. If there is continuous bleeding despite the submental artery ligation, sublingual artery ligation should be performed.

Effects of Hat-Shaped Mortised Genioplasty with Genioglossus Muscle Advancement on Retrogenia and Snoring: Assessment of Esthetic, Functional, and Psychosocial Results.

BACKGROUND: An increasing number of patients undergo genioplasty for esthetic purposes to correct micrognathism or retrognathism. However, these conditions are considered an important risk factor for snoring. The purpose of this study was to evaluate both esthetic improvement and functional changes of snoring symptoms in patients who underwent hat-shaped mortised advancing genioplasty with genioglossus muscle advancement. MATERIALS AND METHODS: This retrospective study enrolled 25 patients. We evaluated scores for subjective snoring classification (Stanford scale) and questionnaire findings for esthetic results. RESULTS: Most people (96%) were satisfied with the esthetic improvement after surgery. The grade of subjective snoring classification (Stanford scale) improved from 8.68 (range 0-10) to 4.08 (range 0-10) after surgery. Twenty-four patients had an improved snoring grade. All patients reported a positive impact on their daily activity and self-confidence, and they were willing to recommend the same operation to someone with the same clinical problems. CONCLUSION: We conclude that hat-shaped mortised advancing genioplasty with genioglossus muscle advancement can relieve the symptoms of snoring for patients with hypoplastic chin or retrogenia. Patients were satisfied with the functional and esthetic results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Salvage of Ear Framework Exposure in Total Auricular Reconstruction.

BACKGROUND: One of the most common complications of total auricular reconstruction is delayed wound healing, which results in skin necrosis and exposure of the ear framework. Various options exist for salvage of the exposed ear framework. METHODS: From January 2009 to May 2014, 149 patients underwent total auricular reconstruction using an autogenous cartilage framework or porous polyethylene framework (Medpor; Stryker, USA). An autogenous cartilage framework was used in 48 patients, and a Medpor framework was used in 101 cases. Three cases of framework exposure (3/48, 6.3%) were observed among the patients treated with an autogenous cartilage framework. In contrast, framework exposure took place in 11 patients who were treated with a Medpor framework (11/101, 10.9%). Depending on the method of total ear reconstruction and the location of exposure, the authors used local skin flaps, temporoparietal fascia flaps, deep temporal fascia (DTF) flaps, or mastoid fascia (MF) flaps with skin grafting. RESULTS: Among the 11 patients who experienced framework exposure after being treated with a Medpor framework, a DTF flap with skin grafting was used in 6 patients and an MF flap with skin grafting in 6 patients; 1 patient was treated with both a DTF flap and an MF flap. All 3 cases of cartilage framework exposure were salvaged using a temporoparietal fascia flap with skin grafting, and a local skin flap was used in 1 case. In all 3 cases, the exposed framework was completely covered with the flap, and the reconstructed ears showed well-defined convolutions. CONCLUSIONS: Salvage of framework exposure remains a challenging issue in total auricular reconstruction. However, appropriate wound management using various flaps allows the reconstructed ear to be safely preserved.

Long-term functional outcomes after total tongue reconstruction: Consideration of flap types, volume, and functional results.

OBJECTIVE: The purpose of this study is to evaluate the long-term results of flap volume change, swallowing capacity, speech intelligibility, and differences between vertical rectus musculocutaneous (VRAM) and anterolateral musculocutaneous (ALT) free flaps in total tongue reconstruction. PATIENTS AND METHODS: We retrospectively analyzed the medical records of 31 patients who underwent total tongue reconstruction with VRAM (24 cases) and ALT flap (7 cases). The mean age of patients was 52.09 ± 2.25 years. The tumor types were as follows: squamous cell carcinoma (28 cases), adenoid cystic carcinoma (2 cases), and metastatic cancer (1 case). The flap volume was determined based on clinical and imaging examinations. Swallowing and speech function were analyzed using seven-point rating scales. RESULTS: All flaps survived eventually after surgery; however, 1 patient underwent VRAM flap experienced partial flap necrosis, wound dehiscence in 4 patients underwent VRAM flap, and infection in 3 patients (VRAM; 2 patients, ALT; 1 patient). The mean follow-up period was 3.97 ± 0.54 years. The volume of the flaps remained relatively constant over time. The swallowing capacity positively correlated with the flap volume (P < 0.0001); however, the speech intelligibility did not correlate with the flap volume in analysis of total cohort. There were no statistical differences in functional outcomes between the two types of reconstructed flaps (P > 0.05). CONCLUSION: The preservation of flap volume was important to achieve superior swallowing capacity; however, it was insufficient to promote the speech outcome. The functional outcomes did not differ depending on the type of flap. © 2015 Wiley Periodicals, Inc. Microsurgery 37:190-196, 2017.

Cranioplasty Enhanced by Three-Dimensional Printing: Custom-Made Three-Dimensional-Printed Titanium Implants for Skull Defects.

The authors studied to demonstrate the efficacy of custom-made three-dimensional (3D)-printed titanium implants for reconstructing skull defects. From 2013 to 2015, 21 patients (8-62 years old, mean = 28.6-year old; 11 females and 10 males) with skull defects were treated. Total disease duration ranged from 6 to 168 months (mean = 33.6 months). The size of skull defects ranged from 84 × 104 to 154 × 193 mm. Custom-made implants were manufactured by Medyssey Co, Ltd (Jecheon, South Korea) using 3D computed tomography data, Mimics software, and an electron beam melting machine. The team reviewed several different designs and simulated surgery using a 3D skull model. During the operation, the implant was fit to the defect without dead space. Operation times ranged from 85 to 180 minutes (mean = 115.7 minutes). Operative sites healed without any complications except for 1 patient who had red swelling with exudation at the skin defect, which was a skin infection and defect at the center of the scalp flap reoccurring since the initial head injury. This patient underwent reoperation for skin defect revision and replacement of the implant. Twenty-one patients were followed for 6 to 24 months (mean = 14.1 months). The patients were satisfied and had no recurrent wound problems. Head computed tomography after operation showed good fixation of titanium implants and satisfactory skull-shape symmetry. For the reconstruction of skull defects, the use of autologous bone grafts has been the treatment of choice. However, bone use depends on availability, defect size, and donor morbidity. As 3D printing techniques are further advanced, it is becoming possible to manufacture custom-made 3D titanium implants for skull reconstruction.

One-Year Results of Ear Reconstruction with 3D Printed Implants.

PURPOSE: External ear reconstruction has been a challenging subject for plastic surgeons for decades. Popular methods using autologous costal cartilage or polyethylene still have their drawbacks. With the advance of three-dimensional (3D) printing technique, bioscaffold engineering using synthetic polymer draws attention as an alternative. This is a clinical trial of ear reconstruction using 3D printed scaffold, presented with clinical results after 1 year. MATERIALS AND METHODS: From 2021 to 2022, five adult patients with unilateral microtia underwent two-staged total ear reconstruction using 3D printed implants. For each patient, a patient-specific 3D printed scaffold was designed and produced with polycaprolactone (PCL) based on computed tomography images, using fused deposition modeling. Computed tomography scan was obtained preoperatively, within 2 weeks following the surgery and after 1 year, to compare the volume of the normal side and the reconstructed ear. At 1-year visit, clinical photo was taken for scoring by two surgeons and patients themselves. RESULTS: All five patients had completely healed reconstructed ear at 1-year follow-up. On average, the volume of reconstructed ear was 161.54% of that of the normal side ear. In a range of 0 to 10, objective assessors gave scores 3 to 6, whereas patients gave scores 8 to 10. CONCLUSION: External ear reconstruction using 3D printed PCL implant showed durable, safe results reflected by excellent volume restoration and patient satisfaction at 1 year postoperatively. Further clinical follow-up with more cases and refinement of scaffold with advancing bioprinting technique is anticipated. The study's plan and results have been registered with the Clinical Research Information Service (CRIS No. 3-2019-0306) and the Ministry of Food and Drug Safety (MFDS No. 1182).

Improved scar appearance with combined use of silicone gel and vitamin C for Asian patients: a comparative case series.

BACKGROUND: In Asians, facial scars, even fine surgical scars, often can be conspicuous and uncomfortable. The authors used a topical silicone gel containing vitamin C on facial scars for the purpose of making the scar less distinct. METHODS: The study enrolled 80 patients. For the experimental group, the topical silicone gel mixture containing vitamin C was applied from the time of stitch removal to 6 months after the operation. The control group did not undergo any adjunctive treatment. Each participant was evaluated using the modified Vancouver Scar Scale (VSS) as well as erythema and melanin indices by spectrophotometer. RESULTS: With the modified VSS, the experimental group showed a significant decrease in scar elevation (p = 0.026) and erythema (p = 0.025). The hypo- or hyperpigmentation of the scars was more normalized in the experimental group. In the measured results via spectrophotometer, the experimental group showed a significant decrease in the melanin index (p = 0.045). The erythema index showed a statistically significant difference between the time of stitch removal and 6 months after the operation in the experiment group only. CONCLUSIONS: Topical use of silicone gel containing vitamin C has the effect of improving the appearance of fine surgical scars in Asian facial skin. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A retrospective analysis of redo orthognathic surgery: Underlying causes, strategy, and outcome.

The aim of this study was to investigate the underlying causes of the need for redo orthognathic surgery, address surgical strategies, and evaluate postoperative outcomes. A retrospective chart review was conducted involving patients who underwent redo orthognathic surgery between January 2018 and April 2020. A total of 32 patients were included in this study. Prior to the procedures, patients' chief complaints were unfavorable facial profile, asymmetry, relapse, malocclusion, obstructive sleep apnea, and long face. To address these issues, we performed redo orthognathic surgery: this resulted in satisfactory aesthetic and functional outcomes in most cases. Considering the challenging nature of a redo orthognathic surgery, it is crucial for surgeons to accurately evaluate the patient's chief complaints and tailor individualized surgical plans to meet the patient's expectations.

Clinical investigation of botulinum toxin (prabotulinumtoxin A) for bruxism related to masseter muscle hypertrophy: A prospective study.

This study aims to confirm the effectiveness and safety of a prabotulinumtoxin type A (praBTX-A) injection in patients with bruxism and masseter hypertrophy. The study included patients who ground or clenched their teeth while sleeping and had computed tomography (CT) scans that showed a maximum thickness of the masseter muscle of 15 mm or more. The praBTX-A was administered bilaterally into the masseter muscles; 15 U/side for group 1, 25 U/side for group 2, and 35 U/side for group 3. CT scans and bruxism questionnaires were conducted before and eight weeks after the injection. Thirty-seven patients were enrolled, but three dropped out due to loss of follow-up. After injection, masseter thickness decreased to 15.1 ± 2.0 mm for group 1, 14.3 ± 2.9 mm for group 2, and 13.4 ± 1.8 mm for group 3 (p = 0.043). Group 3 showed a statistically significant lower masseter thickness compared to group 1 (p = 0.039). Both subjective and objective frequencies of bruxism decreased for all groups, but there were no significant differences in either subjective (p = 0.396) or objective frequencies (p = 0.87) between the groups after the injection. The results of this study suggest that praBTX-A injection is a safe and effective treatment for bruxism and masseter hypertrophy. A dosage of 35 IU/side can effectively decrease masseter thickness and relieve bruxism symptoms. Even the minimum dosage of 15 IU/side can contribute to improvements in bruxism symptoms. This investigation provides valuable information for managing bruxism that is associated with hypertrophic masseter muscles.

Outcome of early rigid fixation and removal of rigid external distraction system after distraction osteogenesis of the midface.

After distraction osteogenesis of the midface using a rigid external distraction (RED) system, there is a high possibility that a relapse might occur due to an incomplete fixation during the consolidation period, and it is uncomfortable for the patients to wear a head frame for 2 to 3 months. There are also risks of trauma that are developing. To overcome these problems, we suggest the protocol of early rigid fixation, with excellent treatment outcomes and a review of literatures. Of 9 patients, Le Fort III osteotomy was completed in 2 patients with Crouzon disease, and a Le Fort I osteotomy was completed in 7 patients with a cleft lip and palate. Immediately after the distraction with RED was completed, the fixation was done using a miniplate. This was followed by the early removal of the RED system. In patients who underwent the current procedure, an analysis was performed for the degree and the duration of distraction and the period of use of the RED system. Then, the presence of relapse was examined. The mean degree of bone distraction was found to be 18.05 mm (range, 9-31.5 mm). The mean period of wearing RED system was 29.78 days (range, 21-43 days). Thereafter, the mean follow-up period was 13 months (range, 6 months to 3 years). The degree of accumulated relapse was found to be 1.7 mm (10%) on postoperative year 1, 2.4 mm (13.3%) on postoperative year 2, and 2.3 mm (14.6%) on postoperative year 3. With the concept of early rigid fixation, we were able to eliminate the disadvantages of distraction osteogenesis such as the long period of wearing a head frame, the delay of returning to society, and the inconvenience of patients. Moreover, early rigid fixation could decrease the need of overcorrection and the amount of relapses.

Tissue-Adhesive Chondroitin Sulfate Hydrogel for Cartilage Reconstruction.

Chondroitin sulfate (CS), the main component of cartilage extracellular matrix, has attracted attention as a biomaterial for cartilage tissue engineering. However, current CS hydrogel systems still have limitations for application in successful cartilage tissue engineering owing to their unsuitable degradation kinetics, insufficient mechanical similarity, and lack of integration with the native cartilage tissue. In this study, using mussel adhesive-inspired catechol chemistry, we developed a functional CS hydrogel that exhibits tunable physical and mechanical properties as well as excellent tissue adhesion for efficient integration with native tissues. Various properties of the developed catechol-functionalized CS (CS-CA) hydrogel, including swelling, degradation, mechanical properties, and adhesiveness, could be tailored by varying the conjugation ratio of the catechol group to the CS backbone and the concentration of the CS-CA conjugates. CS-CA hydrogels exhibited significantly increased modulus (∼10 kPa) and superior adhesive properties (∼3 N) over conventional CS hydrogels (∼hundreds Pa and ∼0.05 N). In addition, CS-CA hydrogels incorporating decellularized cartilage tissue dice promoted the chondrogenic differentiation of human adipose-derived mesenchymal stem cells by providing a cartilage-like microenvironment. Finally, the transplantation of autologous cartilage dice using tissue-adhesive CS-CA hydrogels enhanced cartilage integration with host tissue and neo-cartilage formation owing to favorable physical, mechanical, and biological properties for cartilage formation. In conclusion, our study demonstrated the potential utility of the CS-CA hydrogel system in cartilage tissue reconstruction.

Versatility of three-dimensional total alar cartilage dissection in aesthetic rhinoplasty.

In many cases, Asians' noses are shorter; their nasal tips have a bulbous shape and typically lack the projection. To correct these problems, we completely dissected the alar cartilage in a three-dimensional manner by which the alar cartilage could be repositioned. Thus, no external force was exerted to the alar cartilage. For approximately 4 years, a total of 502 patients were treated with this surgical method. Using the open rhinoplasty, the alar cartilage was dissected in such a manner that it should be completely isolated from the skin, nasal mucosa, and upper lateral cartilage in 3 layers. Thereafter, using various nasal tip plasty techniques, the alar cartilage was reshaped and then repositioned. Patients were followed up for a mean period of 18 months. Then, the degree of subjective satisfaction of patients was analyzed with the use of 4-point visual analog scale scores. On the assessment of the degree of subjective satisfaction of patients, of a total of 502 patients, 87% responded as "very satisfactory" or "satisfactory." Through an analysis of the photographs taken before and after surgery, in patients with a short nose, the current surgical procedure was effective in extending the length of nose without the septal extension graft. The nasolabial angle was ideally expressed. Through meticulous cartilage manipulation, the tip projection improved and a bulbous shape of the nasal tip was resolved. In an aesthetic rhinoplasty for Asians, if plastic surgery of the nasal tip should be performed using a three-dimensional dissection of the alar cartilage, it would be helpful for surgeons to effectively and freely manipulate the alar cartilage according to their plans.

Vomopalatoplasty: a novel procedure to reduce velopharyngeal distance in cleft palate repair.

Despite numerous improvements in the palatoplasty procedure, speech dysfunction tends to develop in many patients, requiring another surgery. In addition, vomer flaps have been used in palatoplasty in various shapes and on purposes. Nonetheless, they have been used mostly to cover the defect in wide and complete type of cleft palate. We introduce the vomopalatoplasty procedure that uses a vomer flap to reduce the nasopharyngeal space in incomplete or submucous type of cleft palate patients.The mucoperiosteal flaps on the nasal and oral sides were elevated by the conventional palatoplasty procedure, which subsequently elevated the bilateral vomer flaps to the posterior edge of vomer. Then, the vomer flap was sutured with the mucoperiosteal flap of the nasal side to the anterior half of the soft palate, and thus, the soft palate was fixed in more posterosuperior direction than in conventional palatoplasty. For patients whose junction of vomer and hard palate had to be exposed, a part of the bone at the bifid posterior nasal spine of the hard palate may be removed sometimes.Ostectomy of the bifid posterior nasal spine or the posterior end of the hard palate was performed in 11 patients. Another 12 patients did not need ostectomy. After the surgery, the surgical wounds healed well in all patients without any major complications such as dehiscence or loss of flap.Our vomopalatoplasty is easy to perform, and the procedure could be combined to the conventional palatoplasty procedure. Thus, we consider vomopalatoplasty as a useful procedure that could reduce the nasopharyngeal space in patients with incomplete or submucous type of cleft palate.

Correlation of neotongue volume changes with functional outcomes after long-term follow-up of total glossectomy.

As the survival rate of tongue cancer has increased, longer-term results of tongue reconstruction are also being considered. The aim of this study was to report the long-term outcomes of total glossectomy.Of 14 patients who underwent total glossectomy, 11 were reconstructed with the rectus abdominis musculocutaneous free flap and 3 with the anterolateral thigh free flap. We reviewed survival rate, swallowing capacity, speech intelligibility, and volume reduction in flaps. Swallowing capacity and speech intelligibility were evaluated by visual analog scale scores (7 points) at 1 to 7 years after surgery, and changes in neotongue volume were examined by dividing volume into 4 stages.The 5-year disease-specific survival rate was 71%. Almost all patients were able to eat a soft diet and resume verbal communication. However, a sufficient volume of the reconstructed tongue was decreased over the course of time. Volume change was more definitive in the cases using the anterolateral thigh free flap than the rectus abdominis musculocutaneous free flap. Neotongue volume was also correlated with swallowing capacity and speech intelligibility.In total tongue reconstruction, wide and thick flaps such as the rectus abdominis musculocutaneous flap had better outcomes. Overcorrection with a sufficient flap volume is recommended for adequate oral intake owing to volume loss caused by radiation therapy, and functional muscle transfer should also be considered to prevent muscle atrophy. Lastly, static suspension procedures are emphasized to prevent airway aspiration for larynx preservation.

First percutaneous reduction and next external suspension with Steinmann pin and Kirschner wire of isolated zygomatic fractures.

We have introduced a less invasive, simple, and effective method for zygomatic fractures using percutaneous reduction with a Steinmann pin (S-pin) and temporary external suspension with a Kirschner wire (K-wire).For 2 years, 51 patients underwent first percutaneous reductions and then fixations, which is a method that we developed. After the S-pin no. 1 was percutaneously inserted at the most prominent point of the zygoma, closed reduction was first attempted using lever movement and temporary external suspension with a K-wire. If required, 1-site rigid fixation was performed on the zygomaticomaxillary buttresses via gingivobuccal incisions. Only 13 patients received K-wire suspensions and 38 patients received K-wire suspensions and lateral buttress fixations. We evaluated the postoperative result in 4 aspects (flattening, symmetry, scar, and paresthesia) using the 4-point visual analog score after at least 6 months.The mean maintenance period of the S-pin and K-wire was 12.3 days, and the mean operation time was 33 minutes. No serious complications, such as infections or external wire instability, were observed. Excellent or good results were achieved in more than 95% of patients in all 4 aspects mentioned.We believe that our method, which is the first percutaneous reduction using S-pin and temporary external suspensions with a K-wire with or without a lateral buttress rigid fixation, is a simple and effective method for noncomminuted zygomatic fractures.

In vitro characterization of osteoblast cells on polyelectrolyte multilayers containing detonation nanodiamonds.

Nanoparticle-enhanced coatings of bone implants are a promising method to facilitate sustainable wound healing, leading to an increase in patient well-being. This article describes the in vitro characterization of osteoblast cells interacting with polyelectrolyte multilayers, which contain detonation nanodiamonds (NDs), as a novel class of carbon-based coating material, which presents a unique combination of photoluminescence and drug-binding properties. The cationic polyelectrolyte, namely polydiallyldimethylammonium chloride (PDDA), has been used to immobilize NDs on silica glass. The height of ND-PDDA multilayers varies from a minimum of 10 nm for one bilayer to a maximum of 90 nm for five bilayers of NDs and PDDA. Human fetal osteoblasts (hFOBs) cultured on ND-PDDA multilayers show a large number of focal adhesions, which were studied via quantitative fluorescence imaging analysis. The influence of the surface roughness on the filopodia formation was assessed via scanning electron microscopy and atomic force microscopy. The nano-rough surface of five bilayers constrained the filopodia formation. The hFOBs grown on NDs tend to show not only a similar cell morphology compared to cells cultured on extracellular matrix protein-coated silica glass substrates, but also increased cell viability by about 40%. The high biocompatibility of the ND-PDDA multilayers, indicated via high cell proliferation and sound cell adhesion, shows their potential for biomedical applications such as drug-eluting coatings and biomaterials in general.

Ideal scaffold design for total ear reconstruction using a three-dimensional printing technique.

Ear reconstruction using three-dimensional (3D) printing technique has been considered as a good substitute for conventional surgery, because it can provide custom-made 3D framework. However, there are difficulties with its application in clinical use. Researchers have reported 3D scaffolds for ear cartilage regeneration, but the designs of the 3D scaffolds were not appropriate to be used in surgery. Hence, we propose the design of an ideal 3D ear scaffold for use in ear reconstruction surgery. Facial computed tomography (CT) images of the unaffected ear were extracted using a "segmentation" procedure. The selected data were converted to a 3D model and mirrored to create a model of the affected side. The design of 3D model was modified to apply to Nagata's two-stage surgery. Based on the 3D reconstructed model, a 3D scaffold was 3D printed using polycaprolactone. The 3D scaffold closely resembled the real cartilage framework used in current operations in terms of ear anatomy. To account for skin thickness, the 3D scaffold was made 4 mm smaller than the real ear. Furthermore, 2 mm pores were included to allow the implantation of diced cartilage to promote regeneration of the cartilage. 3D printing technology can overcome the limitations of previous auricular reconstruction methods. Further studies are required to achieve a functional and stable substitute for auricular cartilage and to extend the clinical use of the 3D-printed construct. Additionally, the ethical and legal issues regarding the transplantation of 3D-printed constructs and cell culture technologies using human stem cells remain to be solved. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1295-1303, 2019.

The effect of light-emitting diode (590/830 nm)-based low-level laser therapy on posttraumatic edema of facial bone fracture patients.

PURPOSE: Posttraumatic edema in facial bone fracture patients may interfere with the operation field and delay the schedule. Thus, swiftly reducing the edema alleviates patient discomfort and advances the operation date. Ice packing and compression bandages are often used for such a purpose, but such methods are often inconvenient for the face. In this study, we aim to analyze the effect of light-emitting diode (LED) (590/830 nm)-based low-level laser therapy (LLLT) in posttraumatic edema in facial bone fracture patients. MATERIALS AND METHODS: We conducted a prospective cohort study of 40 patients who were admitted to a single institution for facial bone fracture. The patients were divided into two groups of 20 each, treated either with LLLT or with sham treatment light. We used an LLLT device that consists of planar LED-based arrays with double wavelengths 590 nm and 830 nm. The patients were treated with either true or sham light from posttraumatic day 1-5, twice a day. After each treatment, the volume of a patient's face was measured with a 3-dimensional camera. We analyzed and compared the changes in facial edema. The Wilcoxon rank sum test was conducted for statistical comparison of the two groups, and significance was set to the level of p < 0.05. RESULTS: The sex ratio and mean age of the two groups were of little difference. The fracture sites included the nasal bone, orbital wall, zygomaticomaxillary bone, mandible, and frontal sinus. Mechanisms of injury included fall, assault, traffic accident, sports, and gunshot. The total operation rate of both groups was equal to 85%. Our analysis showed a 16.5% reduction of edema in the LLLT group and 7.3% in the sham light group. The edema reduction was statistically significantly greater in the LLLT group than in the sham light group (p < 0.047). CONCLUSION: LED-based LLLT is recently receiving attention worldwide for its cost-effectiveness and large coverage area compared to traditional laser therapy. Recent studies support its effectiveness in various areas such as wound healing, skin rejuvenation, and pain alleviation. In this study, we treated facial bone fracture patients with LED-based LLLT, and showed its effectiveness in reducing posttraumatic edema.