Modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex fractures: A 5-year retrospective study.

Our study aimed to evaluate modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex (ZMC) fractures. The retrospective non-randomized study was conducted in a single hospital in China. All patients diagnosed with unilateral comminuted ZMC fractures between January 1, 2018 and December 31, 2022 were retrospectively reviewed. All patients underwent preoperative spiral computed tomography (CT). CT data were processed using software to DICOM format and transferred to Proplan CMF3.0 for preoperative virtual surgical planning and postoperative evaluation. All data were extracted from standardized electronic medical records. All statistical analyses were performed using SPSS version 20.0. The chi-square test and t-test were used for statistical analyses. The 54 included patients were divided into two comparable, equal cohorts of 27 patients, and followed up for at least 6 months. Fracture reduction was assisted using the modified patient-specific surgical guides in the guide group (23 males, four females; mean age 37.74 ± 12.07 years) and without the modified patient-specific surgical guides in the control group (20 males, seven females; mean age 37.44 ± 13.58 years). In the guide group, the mean eminence deviation between the affected and unaffected sides was 1.01 ± 0.92 mm, and the mean width deviation between the affected and unaffected sides was 1.29 ± 1.32 mm. In the control group, the mean eminence deviation between the affected and unaffected sides was 1.99 ± 1.69 mm, and the mean width deviation between the affected and unaffected sides was 2.68 ± 2.01 mm. The differences in facial protrusion (p = 0.001) and width (p = 0.003) symmetry between the affected and healthy sides of the two groups were statistically significant (p < 0.05). In conclusion, applying the modified patient-specific surgical guides to unilateral comminuted zygomaticomaxillary complex fracture reduction has the advantages of greater predictability and effectiveness, and improved bilateral ZMC symmetry. It should be noted that this approach would be especially beneficial for less-experienced surgeons.

Digitally reconstructed severe trauma-induced oro-maxillofacial defects with free vascularised composite tissue flaps.

The aim of this study was to outline the characteristics of severe trauma-induced oro-maxillofacial defects and explore the application of microsurgical reconstruction of these defects by selecting appropriate free vascularised composite tissue flaps. A retrospective analysis was performed in 11 cases with severe trauma-induced oromaxillofacial defects from 2005 to 2018, All cases were reconstructed with free vascularised composite flaps using a supermicro-surgical/micro-surgical and digital technology. This study consisted of 11 patients (8 men, 3 women) with a median age (range) of 28 (6-64) years. Patients with long-standing trauma experienced severe scars and displacements. The trauma-induced oro-maxillofacial defects ranged in size from 4.0 × 5.0 cm2 to 7 × 15 cm2. Six radial forearm flaps, three fibular osteocutaneous flaps, a lateral thoracic flap, and an anterolateral thigh flap were harvested individually. All patients were treated effectively and followed up for over two years, with a 100% survival rate of these free vascularised composite tissue flaps. No uncontrollable complications occurred, and all patients were satisfied with the postoperative shape and function. The trauma-induced oro-maxillofacial defects display unique features, and microsurgical techniques play an important role in the reconstruction of shapes and function. In addition, some patients may need multi-stage surgeries to attain aesthetic refinement.

Associations between condylar fractures and external auditory canal fracture: A 7-year retrospective study.

The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.

Analysis of Maxillofacial Fractures Based on the Etiology in Southeast China: A 10-Year, Multi-Center Study.

BACKGROUND: The aim of this study was to explore the characteristics and correlation of maxillofacial fractures and concurrent injuries with different injury causes. METHODS: In this retrospective study, data were collected from patients treated for maxillofacial fractures in 3 oral and maxillofacial surgery departments in Southeast China, from January 2010 to December 2019. The information was obtained from clinical notes and surgical records using a standardized data collection form, and some causes of injuries were confirmed by telephone follow-ups and police records. These patients were divided into 7 groups according to the etiology: bicycle accident, electric bicycle accident, motorcycle accident, automobile accident, fall at ground level, fall from a height, and assault-related accident. Statistical tests were performed using R software (version 3.1.1), and all P-values were computed based on Chi-square tests and set at 0.05. RESULTS: During this 10-year retrospective study, a total of 1772 patients with definite causes were analyzed. The average age was approximately 35.04 years (9 months-94 years). All patients were treated with open reduction and rigidly internal fixation, and the average duration was approximately 6.51 days (range 0 day-50 days), that from the time of the injury to the time of treatment. Traffic accidents were identified as the main cause of maxillofacial fracture (57.62%; n = 1021 of 1772 cases). In different etiology groups, there were statistically significant differences in the distribution of age, sex, maxillofacial fracture type, and concurrent injuries (all P < 0.001). However, the main cause of maxillofacial injuries was falls (fall at ground level and fall from a height) in children, and the highest incidence of the cause of maxillofacial injuries was bicycle accident in adolescents. Compared with the other groups, zygomatic complex fracture was more common in the electric bicycle accident group, panfacial fracture was more common in the automobile accident group, and mandible fracture was more common in the other groups. CONCLUSION: The results of this study suggest that patients with maxillofacial fractures caused by different injuries had their own unique characteristics. These findings may assist us in avoiding misdiagnosis and treatment delays, and may make treatment plans faster.