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Background: Orbitozygomatic fractures often lead to infraorbital nerve (ION) injury, and affected sensibility is a common long-term complaint within this patient group. We present a long-term follow-up study where the validated von Frey filament system was used for testing ION sensibility. Furthermore, we examined the incidence of persistent nerve injury and whether more complex fractures led to more pronounced ION sensibility disturbances., Methods: Patients treated for facial fractures involving the orbitozygomatic complex were included and the follow-up time was 3 years or more. Depending on the location and severity of the fractures, the patients were divided into 4 groups. The patients answered a questionnaire before ION sensibility testing with von Frey filaments., Results: Eighty-one patients were examined: 65 males (80%) and 16 females (20%). Examinations were conducted between 3.0 and 7.6 years (mean 4.9 years) after injury. Sixteen patients (20%) had affected and 6 patients (7.4%) had severely affected ION sensibility according to von Frey testing. No statistically significant differences were found in terms of questionnaire score between the groups. There was also no statistically significant correlation between questionnaire results and log von Frey values. Although the effect of groups could not be statistically verified using the log von Frey values, a larger proportion of patients with complex fractures had higher log von Frey values than the other groups., Conclusions: Patients with complex fractures report more permanent sensory disturbance of the ION after surgery than those with isolated orbitozygomatic fractures, although this could not be verified statistically with von Frey filament testing at several locations. Hence, a validated method for testing facial sensibility such as von Frey filaments, although sensitive, is inadequate to determine all aspects of sensory malfunction after orbitozygomatic fractures. This suggests that the patient's experience of long-term sensation after trauma may not be correlated with objective measures., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Fractures in the facial skeleton are common and may lead to orbital sequelae caused by the injury and/or the surgery. In this long-term follow-up, we examined the nature of sequelae after facial fractures involving the orbit and whether a higher complexity of the fractures produced more sequelae compared to simpler fracture patterns, and if so, to what extent., Methods: Patients surgically treated for facial fractures involving the orbit at the Karolinska University Hospital with a follow-up duration of ≥3 years were included in this retrospective study and were examined by a neuro-ophthalmologist. Based on the location and severity of the fractures, the patients were divided into four groups according to fracture complexity: 1) isolated zygomatic fracture, 2) isolated orbital floor blowout fracture, 3) zygomatic fracture combined with blowout fracture and 4) bilateral or multiple fracture patterns., Results: Out of 154 patients, 81 patients (53%) attended follow-up examinations, 65 male (80%) and 16 female (20%). The duration of follow-up was 3.0-7.6 years (mean of 4.9 years). The incidence of diplopia was 3.7%, visual loss 2.5%, dystopia 4.9% and visible enophthalmos (>2 mm) 8.6%. Severe diplopia (2.5%) was due to nerve injuries. Visual loss was encountered only in group 4 with complex fractures. Fracture complexity had an effect on the presence of any sequelae, with group 4 presenting a higher percentage of patients with sequelae than the other three groups. However, no statistically significant effect of group could be found on the individual, quantitative output values of dystopia and enophthalmos., Conclusions: In this study, severe persistent diplopia in patients was due to nerve injuries, which emphasizes the need for preoperative ophthalmologic examinations, in all patients with fractures involving the orbit. A higher fracture complexity was found to lead to a higher percentage of patients presenting sequelae., (Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The use of osteoinductive growth factors may be preferable for alveolar cleft repair because it eliminates the need of bone harvesting. In the present prospective randomised pilot study, patients with alveolar clefts were treated with either bone morphogenetic protein 2 (BMP-2) delivered by a hyaluronan-based hydrogel or autologous bone from the iliac crest., Methods: Seven patients with cleft lip or cleft lip and palate were included. Computed tomography (CT) was performed preoperatively and 6 months postoperatively. The residual cleft volume was compared with the initial volume. Surgery time, bleeding and hospital stay were compared between the two groups., Results: Four patients were randomised to treatment with BMP-2. A low BMP-2 concentration of 50 μg ml(-1) hydrogel did not induce bone formation in treated patients (n = 2) after 6 months, as seen by CT scans. Therefore, the BMP-2 concentration was raised to 250 μg ml(-1) hydrogel in the subsequently randomised patients (n = 2). Bone formation with volume ratio of 59% and 33% was here verified by CT scans after 6 months. However, a severe gingival swelling appeared during the first week in patients treated with higher BMP-2 doses. In the autologous bone group (n = 3), the volume ratio was 29%, 48%, and 69%. Mean surgery time was 100 min in the BMP-2 group and 123 min in the autologous bone group. The mean hospital stay was 2.75 and 3.33 days, respectively., Conclusions: BMP-2 at a concentration of 250 μg ml(-1) delivered by a hydrogel can be used to treat alveolar cleft defects with good bone quantity and comparable to autologous bone grafts. However, severe gingival swelling may limit the use of BMP-2 for these patients. Therefore, the study was prematurely closed., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

This review aims to compare bone grafts and different biomaterials for reconstruction of craniofacial bones in congenital defects, after trauma, and after tumour surgery. A Pubmed search was performed and publications over the last 11 years describing reconstructions of craniofacial bones in non-load-bearing areas were reviewed. Only human studies using bone grafts and biomaterials were included. Studies on skull base reconstruction, distraction osteogenesis, free and pedicled bone flaps and bone-anchored epithesis were excluded. Out of 83 studies, three were prospective, 65 retrospective and 15 studies were case reports. There were seven comparative studies found and some efforts on statistical analysis were made. Except for a few studies, the statistical significant differences in outcomes were found to be related to size and location of bone defects rather than reconstruction method and biomaterial used. An increasing number of alloplastic materials have been available as alternatives to the gold standard autologous bone transplantation for craniofacial bone repair. Comparative studies with statistical analyses on differences in success rates between different biomaterials or bone grafts for specific indications are needed., (Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)