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Treatment of Facial Fracture
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Treatment of Facial Fracture

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: closed (20 December 2023) | Viewed by 6574

Special Issue Editors

Prof. Dr. Carroll Ann Trotman

E-Mail Website
Guest Editor
College of Dentistry, The Ohio State University, Columbus, OH, USA
Interests: facial trauma; reconstruction of facial hard and soft tissue defects; 3D facial modelling; surgical outcomes
Dr. Hany A. Emam

E-Mail Website
Guest Editor
College of Dentistry, The Ohio State University, Columbus, OH, USA
Interests: facial trauma; bone regeneration; reconstruction of facial defects

Special Issue Information

Dear Colleagues,

The failure to properly diagnose and treat traumatic injuries to the maxillofacial complex may result in devastating quality-of-life outcomes. With post-surgical consequences that range from malocclusion to loss of vision, the academic and surgical expertise of the facial trauma surgeon is essential for this patient population. The enhancement of technology developed from the collaboration of surgeons, research scientists, and engineers has allowed for precise diagnosis and surgical planning. The results provided by these scientific efforts not only improve surgical outcomes but also have a positive socioeconomic impact on the hospital systems, such as shorter operating room times and hospital stays. This Special Issue will present the current concepts in the diagnosis and management of traumatic injuries to the face that are fundamental to providers involved in the treatment of fractures of the craniofacial complex. 

Prof. Dr. Carroll Ann E. Trotman
Dr. Hany A. Emam
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • facial trauma
  • maxillofacial injuries
  • traumatic face injuries

Published Papers (7 papers)

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Research

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15 pages, 5587 KiB  
Article
Insights into Orbital Symmetry: A Comprehensive Retrospective Study of 372 Computed Tomography Scans
by Guido R. Sigron, Céline L. Britschgi, Brigitta Gahl and Florian M. Thieringer
J. Clin. Med. 2024, 13(4), 1041; https://doi.org/10.3390/jcm13041041 - 12 Feb 2024
Viewed by 758
Abstract
Background: The operation planning and production of individualized implants with the help of AI-based software after orbital fractures have become increasingly important in recent years. This retrospective study aimed to investigate the healthy orbitae of 372 patients from CT images in the bone [...] Read more.
Background: The operation planning and production of individualized implants with the help of AI-based software after orbital fractures have become increasingly important in recent years. This retrospective study aimed to investigate the healthy orbitae of 372 patients from CT images in the bone and soft tissue windows using the Disior™ Bonelogic™ CMF Orbital software. (version 2.1.28). Methods: We analyzed the variables orbital volume, length, and area as a function of age and gender and compared bone and soft tissue windows. Results: For all variables, the intraclass correlation showed excellent agreement between the bone and soft tissue windows (p < 0.001). All variables showed higher values when calculated based on bone fenestration with, on average, 1 mL more volume, 0.35 mm more length, and 0.71 cm2 more area (p < 0.001). Across all age groups, men displayed higher values than women with, on average, 8.1 mL larger volume, a 4.78 mm longer orbit, and an 8.5 cm2 larger orbital area (p < 0.001). There was also a non-significant trend in all variables and both sexes toward growth with increasing age. Conclusions: These results mean that, due to the symmetry of the orbits in both the bone and soft tissue windows, the healthy orbit can be mirrored for surgical planning in the event of a fracture. Full article
(This article belongs to the Special Issue Treatment of Facial Fracture)
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13 pages, 9165 KiB  
Article
Optimal Plate Choice for High-Neck Mandibular Condyle Fracture: A Mechanistic Analysis of 16 Options
by Jakub Okulski, Marcin Kozakiewicz, Michał Krasowski, Rafał Zieliński and Piotr Szymor
J. Clin. Med. 2024, 13(3), 905; https://doi.org/10.3390/jcm13030905 - 04 Feb 2024
Viewed by 588
Abstract
(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25–45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking [...] Read more.
(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25–45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking high-neck condyle fractures were utilized in this study. Sixteen distinct plate designs, constructed from titanium sheets, were tested. The figures underwent force assessments on a durability testing apparatus, and the relationship between used force and fracture movement was documented. (3) Results: For high-neck breaking, the two straight plates emerged as the most effective, aligning with established osteosynthesis standards. The second-best plate exhibited nearly half the strength of the gold standard. (4) Conclusions: In response to the aim of this study, considering the mechanical aspects, the double plain plate stands out as the optimal choice for osteosynthesis in cases of high-neck fractures of the mandibular condylar process. In addition, the authors propose the Mechanical Excellence Factor (MEF) as a superior metric for appraising a plate’s mechanical force, surpassing the conventional Plate Design Factor (PDF). Full article
(This article belongs to the Special Issue Treatment of Facial Fracture)
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15 pages, 16592 KiB  
Article
Which of the 37 Plates Is the Most Mechanically Appropriate for a Low-Neck Fracture of the Mandibular Condyle? A Strength Testing
by Jakub Okulski, Marcin Kozakiewicz, Michał Krasowski, Rafał Zieliński and Tomasz Wach
J. Clin. Med. 2023, 12(21), 6705; https://doi.org/10.3390/jcm12216705 - 24 Oct 2023
Cited by 1 | Viewed by 728
Abstract
(1) Background: The mandible is the most frequently injured component of the facial skeleton, with 25–45% of mandibular fractures involving the condylar process. This study aims to mechanically compare which plates are most suitable for use in low-neck fractures of the condyle. (2) [...] Read more.
(1) Background: The mandible is the most frequently injured component of the facial skeleton, with 25–45% of mandibular fractures involving the condylar process. This study aims to mechanically compare which plates are most suitable for use in low-neck fractures of the condyle. (2) Methods: Polyurethane mandibular models with simulated low-neck fractures were tested using 37 distinct plate designs. These plates were fabricated from 1 mm thick, grade 23 titanium sheets. The models were then subjected to force tests on a strength machine, and the correlation between applied force and fracture displacement was recorded. (3) Results: For low-neck fractures, XCP side-dedicated 3+5 and ACP-T plates demonstrated strength comparable to that of two straight plates, the current gold standard in osteosynthesis. (4) Conclusions: The Mechanical Excellence Factor (MEF) introduced by the authors provides a more accurate metric for theoretically predicting a plate’s mechanical strength compared to the Plate Design Factor (PDF). Eight plate characteristics were utilized to calculate the MEF. Employing the MEF allows for rapid, preliminary validation before undertaking strength tests. Furthermore, the findings of this study can guide the selection of the most durable plate designs for subsequent fatigue testing. Full article
(This article belongs to the Special Issue Treatment of Facial Fracture)
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11 pages, 2336 KiB  
Article
Lateral Pterygoid Muscle Alteration in Patients Treated Surgically Due to Mandibular Head Fractures
by Marcin Kozakiewicz and Paulina Pruszyńska
J. Clin. Med. 2023, 12(14), 4789; https://doi.org/10.3390/jcm12144789 - 20 Jul 2023
Viewed by 978
Abstract
The goal of surgical treatment of mandibular head fracture is to restore anatomical relations; however, it also carries other implications. The purpose of this study is to present the alteration in the size of lateral pterygoid muscles after surgical treatment of unilateral mandibular [...] Read more.
The goal of surgical treatment of mandibular head fracture is to restore anatomical relations; however, it also carries other implications. The purpose of this study is to present the alteration in the size of lateral pterygoid muscles after surgical treatment of unilateral mandibular head fractures and the impact of this change on the range of motion of the mandible. Another issue addressed is the persistence of changes in the appearance of the lateral pterygoid muscles after surgical treatment. In this study, 66 patients with unilateral mandibular head fracture were included. An additional 15 patients from this group who were treated only conservatively were separated as an extra reference group to exclude completely the effect of surgery on the appearance of the pterygoid lateral muscle (even on the opposite side to the surgically treated side). The range of mandibular movements was measured at specific time intervals up to 24 months post-operationally. Then, the lengths and widths of the lateral pterygoid muscles on the operated and healthy site were measured in CT images. The results were compared with a control group which consisted of muscles of the intact site (opposite site to the fracture). A significant reduction in the length-to-width ratio of the lateral pterygoid muscle on the operated side by approx. 20% is observed. This suggests that the muscle becomes more spherical, and thus the range of lateral movement to the contralateral side is permanently reduced. Full article
(This article belongs to the Special Issue Treatment of Facial Fracture)
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22 pages, 3902 KiB  
Article
Which of 51 Plate Designs Can Most Stably Fixate the Fragments in a Fracture of the Mandibular Condyle Base?
by Marcin Kozakiewicz, Jakub Okulski, Michał Krasowski, Bartłomiej Konieczny and Rafał Zieliński
J. Clin. Med. 2023, 12(13), 4508; https://doi.org/10.3390/jcm12134508 - 05 Jul 2023
Cited by 2 | Viewed by 1144
Abstract
In the surgical treatment of the most common fracture of the mandible, which is a fracture of the condylar base, a great choice of different plate shapes is observed. The aim of this study was to determine which shape gives the greatest fixation [...] Read more.
In the surgical treatment of the most common fracture of the mandible, which is a fracture of the condylar base, a great choice of different plate shapes is observed. The aim of this study was to determine which shape gives the greatest fixation stiffness. To ensure homogeneity in comparison, tests were performed on polyurethane models divided at the level of the condylar base fracture and each were fixed with 51 plates. The plates were cut from a 1 mm thick grade 23 titanium sheet. The models were then loaded and the force required for 1 mm of fracture displacement was recorded. It was noted that in addition to osteosynthesis from two simple plates, there were also two dedicated single plates with similar rigidity. Among the large number of described designs of plates, there is considerable variation in terms of the stability of the fixation performed with them. The proposed Mechanical Excellence Factor allows a pre-evaluation of the expected rigidity of fixation with a given plate shape without the need for a loading experiment. The authors expect this to be helpful for surgeons in the application of relevant plates, as well for inventors of new plates for the osteosynthesis of basal fractures in mandibular condyle. Full article
(This article belongs to the Special Issue Treatment of Facial Fracture)
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10 pages, 7183 KiB  
Article
Evaluation of the Relationship of Screw Pullout and Plate Fracutre in Fixation of Mandible Condyle Fractures: A Mechanistic Study
by Jakub Okulski, Marcin Kozakiewicz, Rafał Zieliński, Michał Krasowski and Bartłomiej Konieczny
J. Clin. Med. 2023, 12(13), 4380; https://doi.org/10.3390/jcm12134380 - 29 Jun 2023
Viewed by 820
Abstract
Background: The mandible is the most injured part of the facial skeleton, and 25–40% of mandibular fractures involve the condyle process. The aim of this study is to answer the question of the relationship between screw pullout and/or plate fracture during osteosynthesis. Methods: [...] Read more.
Background: The mandible is the most injured part of the facial skeleton, and 25–40% of mandibular fractures involve the condyle process. The aim of this study is to answer the question of the relationship between screw pullout and/or plate fracture during osteosynthesis. Methods: We tested polyurethane models of mandibles whose condylar process was cut (simulating a fracture) and fused using plates and screws. Results: A total of 672 plates were tested. A total of 25.6% of them were fractured during the test, with most being fractures of the base of the condyle. More screws (81.97%) are pulled out from the ramus than from the condyle—69.15%. Conclusions: The gold standard in the osteosynthesis of condylar fractures is two straight plates. Other than these, there is no one-size-fits-all plate for every type of fracture. Plates fixed with fewer screws (smaller plates used in higher-lying fractures) are more likely to result in screw pullout. On the other hand, in plates fixed with more screws, plate fracture is more common. Full article
(This article belongs to the Special Issue Treatment of Facial Fracture)
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11 pages, 8502 KiB  
Brief Report
The Usefulness of the Navigation System to Reconstruct Orbital Wall Fractures Involving Inferomedial Orbital Strut
by Tae Hwan Park
J. Clin. Med. 2023, 12(15), 4968; https://doi.org/10.3390/jcm12154968 - 28 Jul 2023
Cited by 3 | Viewed by 947
Abstract
Background: Little attention has been paid to combined orbital floor and medial wall fractures with the involvement of the inferomedial orbital strut. Managing this particular fracture can prove challenging. However, various innovative techniques have been introduced to assist with the process. Our study [...] Read more.
Background: Little attention has been paid to combined orbital floor and medial wall fractures with the involvement of the inferomedial orbital strut. Managing this particular fracture can prove challenging. However, various innovative techniques have been introduced to assist with the process. Our study focuses on sharing our approach to orbital wall reconstruction using navigation guidance and titanium-reinforced porous polyethylene plates, specifically cases involving the inferomedial orbital strut. We believe that implementing a navigation system can effectively lead surgeons to the fracture site with utmost safety. Also, we hypothesized that this navigation system is beneficial to use singe fan titanium-reinforced porous polyethylene plates with orbital wall fractures involving IOS while minimizing possible complications. Methods: We retrospectively reviewed 131 patients with medial orbital wall and orbital floor fractures with or without combined other facial bone fractures who underwent orbital wall reconstruction by a single surgeon from May 2021 to May 2023. Amongst, we identified fourteen orbital wall fractures involving the inferomedial orbital strut. We used a subciliary incision as the only approach method for performing titanium-reinforced porous polyethylene plates for navigation-guided orbital wall reconstruction. Patients were followed up for at least three months. Results: All cases were effectively resolved using titanium-reinforced porous polyethylene plates. There were no complications during the patient’s complete recovery, confirmed clinically and radiologically. Based on the serial CT results, it was discovered that implanted titanium-reinforced porous polyethylene plates successfully covered the defect. Conclusion: Based on our retrospective analysis, it has been determined that among the 131 recorded cases of orbital fractures, 14 of them (or 10.7%) involved the inferomedial orbital strut. Navigation-guided reduction using titanium-reinforced porous polyethylene (TR-PPE) plates can lead to predictable, reliable, and excellent outcomes for treating orbital fractures involving the inferomedial orbital strut without complications. Full article
(This article belongs to the Special Issue Treatment of Facial Fracture)
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