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Mandibular fractures are among the most common facial fractures resulting from trauma. The nature of the injury, involved facial structures, presence of associated injuries, the dental status of the patient, comorbid conditions, and psychosocial context all must be considered by the surgeon when planning the optimal treatment for these patients. While consensus exists for many aspects of the management of mandibular trauma, some elements remain controversial. Three such topics—antibiotic therapy, treatment of subcondylar fractures, and management of the third molar—remain particularly controversial, with significant heterogeneity in practice patterns and without widely accepted evidence-based guidelines to standardize care. The goals of this work are to (1) review the historical perspective underlying these controversies, (2) summarize recent evidence shaping the current debate, and (3) highlight opportunities for continued efforts to identify best practices. [ABSTRACT FROM AUTHOR]

Facial skeletal fractures continue to affect humankind, and many methods to alleviate and prevent the injuries outright have been sought after. Prevention is desired, but the implementation and general compliance may contribute to missed opportunities to decrease the burden of facial skeletal trauma. In this article, we explore the preventative as well as postoperative options for the protection of the facial skeleton. [ABSTRACT FROM AUTHOR]

Acute soft tissue trauma to the head and neck is a common reason for emergency department presentation and should be appropriately evaluated by a facial plastic surgeon. The evaluation of a patient who has suffered facial trauma should always include a comprehensive facial nerve exam and carry a low threshold of suspicion for parotid duct injury when involving the cheek. Injuries to the facial nerve and parotid duct can result in significant long-term functional, cosmetic, and emotional morbidity, particularly when diagnosis is delayed. In the repair of facial nerve transection, neurorrhaphy technique is primarily based on the ability to obtain tension-free anastomosis and outcomes are in large part related to timing of repair. Parotid duct injuries are generally repaired based on the site of ductal injury. In this article, we present a guide to the relevant anatomy of the facial nerve branches and the parotid duct, the important factors guiding treatment decisions alongside their related risks and benefits, as well as the management of complications of facial nerve neurorrhaphy and parotid duct injuries and repair. [ABSTRACT FROM AUTHOR]

Successful management of lip and perioral trauma requires a nuanced understanding of anatomy and surgical techniques. Surgical correction is particularly challenging in instances of tissue loss, due to a narrow tolerance for aesthetic deformity and highly specialized functions of the perioral region, including facial expression, communication, and oral competence. Restoring continuity of the orbicularis oris musculature is critical for dynamic sphincter function of the upper and lower lips. Lip and perioral tissue symmetry are also critical for aesthetic balance, and failure to restore a natural appearance can adversely affect personal identity, with attendant psychological trauma. This discussion of lip and perioral trauma management encompasses lip and perioral anatomy, evaluation of injuries, reconstructive techniques, and prevention and management of complications. Perioral injuries are classified by size, depth, and extent of injury, and the corresponding reconstructive approaches are a function of complexity. These approaches proceed sequentially up rungs of the reconstructive ladder including primary repair, local flaps, grafting, regional flaps, as well as microvascular free tissue transfers. Procedures may be single stage or require multiple stages or subsequent refinement. Regardless of the defect size or location, the guiding principle of repair in the perioral region is restoring natural function and aesthetic appearance. This still-evolving area of facial plastic and reconstructive surgery lends itself to artistry and technical precision, offering opportunities for further innovation to improve the outcomes of patients with lip and perioral trauma. [ABSTRACT FROM AUTHOR]

Facial soft tissue injury is a challenging and complex problem for the facial plastic and reconstructive surgeon for cosmetic and functional reasons. This article will focus on the management of soft tissue injuries of the cheek, one of the most important presenting areas of the face. The cheek, like any other part of the face, is susceptible to several types of injury and any of these injuries have the potential to disfigure and debilitate. Knowledge of anatomical structures and wound healing principles is critical to devising an appropriate management plan and achieving superior patient outcomes in scar revision cases. Multiple techniques to improve long-term scarring from facial soft tissue injuries are available. [ABSTRACT FROM AUTHOR]

The goal of any reconstructive procedure is a complete return to premorbid form and function. Unfortunately, a return of pretraumatic form is routinely not considered during surgical planning. This leads to uncontrolled contracture of the soft tissue elements and permanent disfigurement. The goal of this article is to review interventions that improve soft tissue healing and long-term outcomes. [ABSTRACT FROM AUTHOR]

Efficacious management of malocclusion following maxillofacial trauma requires understanding of the interaction between teeth and alveolar bone, facial skeleton, temporomandibular joints, and facial neuromusculature. Success is best achieved with a multidisciplinary approach. This article describes the management of malocclusion after primary repair by highlighting important clinical features and offering guidelines for secondary repair through revision surgical reduction, prosthodontic rehabilitation, orthodontic therapy, restorative dentistry, and orthognathic surgery. [ABSTRACT FROM AUTHOR]

Facial fractures and soft tissue injuries around the eyes, nose, and mouth can be difficult to manage in the primary setting, but if untreated, the secondary correction of facial trauma is very challenging. Prevention of soft tissue contraction by restoring the skeletal framework is ideal. Staged, individualized camouflage techniques can be effective in improving outcomes. [ABSTRACT FROM AUTHOR]

The objective was to review our favorable experience in the use of prophylacticmidface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures. [ABSTRACT FROM AUTHOR]

Airway management in craniofacial trauma patients is a challenge for an anesthetist. Treating these patients requires a close interdisciplinary communication and cooperation. Maintaining the airway and oxygenation of the patient is the initial challenge in craniofacial trauma patients. The management of the difficult airway is facilitated and patient's safety improved by following one of several published difficult airway algorithms. We describe the St. Gallen difficult airway algorithm for the management of difficult airway in general and the airway in facial trauma patients in particular. Whenever possible, the airway should be secured in a conscious and spontaneously breathing patient. It is important to be familiar with different techniques and to change the approach after two unsuccessful attempts with one technique. Once the airway is established, all available preventive measures should be used to avoid losing the airway. A tracheotomy has its place in a significant number of patients in whom an immediate postoperative or a delayed extubation appears unfeasible. [ABSTRACT FROM AUTHOR]

Zygomatic bone and arch fractures are among the most common facial fractures treated by facial plastic surgeons. Controversy still remains regarding the optimal management of these fractures. Computed tomographic scanning (including three-dimensional reconstruction) represent a fundamental tool for diagnosis and treatment planning of zygomatic fractures. Main indications for treatment are functional impairment, cosmetic deformity, or both. Fracture reduction can be performed through an open or closed approach depending on the amount of exposure necessary to achieve accurate reduction. The common goal among all treatment plans is the exact three-dimensional restoration of the disturbed anatomy and function while minimizing complications. [ABSTRACT FROM AUTHOR]