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Purpose: Titanium implants are typically used to fix maxillofacial fractures and their routine removal is a controversial topic in maxillofacial surgery. This study aimed to estimate the removal rate and risk factors associated with removal., Materials and Methods: The authors designed and implemented a retrospective study. Adult patients who underwent open reduction and internal fixation with titanium implants for maxillofacial fractures were included and those who returned for implant removal were identified from January 2007 to December 2016. The predictor variables were gender, age, preoperative infection, injury time, trauma cause, and fracture site. The primary outcome variable was removal of titanium implants. Descriptive and bivariate statistics were computed. Kaplan-Meier survival methods were used to estimate rate of removal. Univariate and multivariate Cox proportional hazards models were used to identify risk factors associated with removal., Results: Of 2,325 patients (1,890 men and 435 women; average age, ∼35.49 yr) registered in this study, 163 (7.01%) had their titanium implants removed and 1-, 2-, and 10-year removal rates were 3, 7, and 8%, respectively. The risk factors most closely associated with removal were preoperative infection, injury by a blow from an object, obsolete fracture, and female gender., Conclusions: Routinely removing titanium implants in patients with maxillofacial fracture is not necessary. When the risk factors listed earlier are present in these patients, follow-up should be scheduled more frequently., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the accuracy of the digital diagnosis and treatment program for maxillofacial fractures., Materials and Methods: The data of 626 patients with maxillofacial fractures were analyzed retrospectively from January 2010 to August 2016. These patients were divided into 2 groups. In the experimental group, preoperative planning was conducted and transferred to patients with guiding templates and navigation according to the digital diagnosis and treatment program for maxillofacial fractures. In the control group, postsurgical planning was performed instead of preoperative planning. To assess the accuracy of the digital diagnosis and treatment program for maxillofacial fractures, preoperative planning and postoperative computed tomographic models were superimposed and imported to dedicated software (Geomagic Studio 13.0, Geomagic, Inc, Research Triangle Park, NC) to calculate the difference between the 2 models in the 2 groups., Results: Results of the experimental set showed that the mean error between the preoperative planning model and the postoperative model ranged from 0.65 to 0.97 mm (average, 0.89 mm). For the control group, the mean error was 0.78 to 1.45 mm (average, 1.01 mm). Thus, the mean error of the experimental group was statistically lower than that of the control group (P < .0001). Postoperative analysis of the subjective evaluation of occlusion recovery showed that 92.13% of patients achieved good occlusion recovery in the experimental group compared with only 84.91% in the control group. The digital diagnosis and treatment program for maxillofacial fractures was more accurate., Conclusion: Aided by the digital diagnosis and treatment program, the accuracy for maxillofacial fractures was notably improved. To facilitate the application and promotion of digital technology, further modification of the complete digital diagnosis and treatment pathway for maxillofacial fractures is highly desired., (Copyright © 2017. Published by Elsevier Inc.)

Purpose: Hard palate trauma is a relatively infrequent occurrence compared with other craniofacial injuries. Several techniques of hard palate fracture repair have been described. To date, there is no consensus on the optimal management of this type of fracture. The purpose of this study was to compile and analyze studies describing hard palate fracture repair techniques with outcomes data., Materials and Methods: A systematic review of the Medline, Scopus, and Web of Science databases was performed for articles describing hard palate fracture repair techniques., Results: Eight articles were ultimately included in the review. Of the collective 310 fractures reported, postoperative malocclusion occurred in 21 of 235 cases (8.9%) and other complications occurred in 13 of 299 cases (4.3%). The most important variability in technique was the method of palatal vault stabilization. Three studies described wiring techniques, 3 described internal fixation techniques, and 2 described external fixation techniques. Studies describing internal fixation techniques reported higher rates of wound complications. Proponents of rigid internal fixation believe that this technique provides better fracture reduction. External fixation techniques appear to impart low rates of wound complications, but their overall effectiveness remains in question., Conclusions: Hard palate fractures are associated with high rates of malocclusion and wound complications. The most established methods of palatal vault stabilization are closed reduction with wiring and internal plate fixation. Depending on the fracture type, patient comorbidities, and associated injuries, either technique might be preferable in a given circumstance., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of the present study was to explore the treatment and outcomes of bilateral craniomaxillofacial post-traumatic deformities with surgical planning, 3-dimensional (3D) model surgery, and preshaped implants., Materials and Methods: We analyzed the preoperative computed tomography (CT) data and designed preliminary surgical plans for 3 patients with bilateral craniomaxillofacial post-traumatic deformities. 3D resin skull models were produced using rapid prototyping technology, and 3D model surgery was performed to determine the location, reduction direction, and shift distance of the osteotomy and to optimize the surgical plans. Titanium plates or mesh were preshaped on the models and then implanted into the patients. The complications, symmetry of the maxillofacial regions, mouth opening, and occlusion were observed 1 month postoperatively., Results: The patients had good recovery of their facial contour, occlusion, and mouth opening and acceptable symmetry of the bilateral maxillofacial regions. No complications were observed., Conclusions: The combination of surgical planning, 3D model surgery, and preshaped implants can provide surgical accuracy and efficiency and good therapeutic outcomes in the treatment of bilateral craniomaxillofacial post-traumatic deformities., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This article gives a general description of the incidence, causes, and complexity of maxillofacial fractures in the elderly and discusses whether modification is required in assessment, surgical indications, and techniques in such cases., Patients and Methods: A retrospective clinical and radiologic study evaluated 222 patients older than 60 years of age (mean age, 70.3) hospitalized with maxillofacial trauma over the period 1987 to 1996 in the Division of Maxillofacial Surgery, University of Turin. The patients were classified according to the following parameters: age, cause of injury, site of trauma, presence of associated fractures, pertinent medical history, type of treatment, length of hospitalization, and complications. The data were compared with those from a control group consisting of 178 adult patients younger than 60 years of age., Results: The presence of a preexisting systemic pathologic condition was the most important factor in determining hospitalization time, which was greater than in the control group. In 89 patients (40.1%), no treatment was considered necessary, whereas 133 patients (59.9%) were treated by surgery. In 115 patients (86.5%), the fractures were treated by open reduction and internal fixation, whereas closed reduction was used in 18 patients (13.5%). There were complications with six patients (2.7%), and one died in the hospital., Conclusions: The findings of this study suggest that surgical intervention is less frequently indicated in facial trauma of the elderly because of physiologic, psychologic, and social changes brought on by the aging process. The principles of treatment, the results, and the complications do not differ greatly in this group when compared with the normal adult population.

Purpose: The aim of this retrospective study was to evaluate the complications of open reduction and internal fixation of maxillofacial fractures with microplates., Patients and Methods: In 44 patients with maxillofacial trauma, fractures of the maxillofacial skeleton were treated by open reduction and internal fixation using a 1.0-mm and 1.5-mm microsystem. Simultaneously occurring fractures of the mandible or frontozygomatic suture were treated with a 2.0-mm miniplate system. Perioperative and postoperative complications were traced using patient charts, operation reports, and radiographs. The average follow-up was 46.8 months (range, 31 to 54 months)., Results: A total of 124 1.0-mm microplates and 546 1.0-mm microscrews, and 17 1.5-mm microplates and 75 1.5-mm microscrews, was used. The perioperative complication rate was 1.2% for the 1.0-mm screws (use of four emergency screws, breakage of one screw in the dense frontozygomatic suture area, and an insertion of a screw in a premolar root). The postoperative complication rate was 0.8% for the 1.0-mm screws (screw dislocation without clinical implication). No complications were observed with the 1.5-mm system. Plate-related infection did not occur. All fractures healed well. Three patients asked for plate removal because of a vague, persisting pain in the treated area. After removal, only one patient was free of pain. A loose 1.5-mm screw was found in this patient., Conclusion: The overall complication rate for microsystems was 2.0%. Both microsystems proved to be a reliable modality to fix fractures of the maxillofacial skeleton. Complications can be considered incidental and of neglectable clinical significance.

Purpose: This article reports the authors' experience with the use of the tongue flap for intraoral soft tissue reconstruction., Patients and Methods: From May 1992 to December 1996, 16 patients were treated with a tongue flap for reconstruction of a variety of intraoral soft tissue defects. Ages ranged from 16 to 65 years with a mean of 39.6 years., Results: The procedure was successful in 15 patients. There were six complications: one total necrosis, four partial necroses, and one infection. Partial necrosis and infection were well controlled by conservative treatment., Conclusion: Use of the tongue flap is a versatile method for reconstruction of a variety of intraoral soft tissue defects.

Purpose: The purpose of this study was to evaluate the usefulness of a bioabsorbable poly-L-lactide (PLLA) miniplate system for osteosynthesis., Materials and Methods: Ultra-high-strength PLLA rods were fabricated using a drawing technique. This osteosynthesis system, consisting of bioabsorbable PLLA miniplates and screws, was used clinically on 50 patients., Results: The only post operative complications were two cases of postoperative infection, but these were controlled by an oral antibiotic regimen or plate removal. Bone healing was satisfactory in all cases, without delay of bony union or obvious displacement of segments after surgery., Conclusion: The PLLA miniplates provided effective osteosynthesis of the maxillofacial skeleton.

Purpose: Limited data are currently available regarding the nature of craniomaxillofacial fractures in the geriatric population. This retrospective study reviews 109 hospital records dating from 1981 to mid-1993. The goal of this study was to provide details relevant to these types of injuries., Results: Most patients were injured in motor vehicle accidents (MVA) or fall-related episodes. Females sustained 43.9% of the fractures while males sustained 56.1%. In females, falls were the most common cause of fractures, while in males MVAs caused the majority of fractures (P < .01). Most fractures were found in the upper midface region (60.3%) and the mandible (27.5%). MVAs and falls were responsible for 82.7% of all mandibular fractures. The majority of fractures were treated nonsurgically (49.5%); however, 37.6% were treated with open reduction and internal fixation. The in-hospital mortality rate was 11.1%, and there were three postoperative complications., Conclusion: The geriatric craniomaxillofacial trauma patient is readily treatable with both aggressive surgical measures and more conservative approaches. Elderly patients often have an underlying medical condition that may subsequently alter the patient's treatment. The findings of this study also suggest that more preventive measures and methods of minimizing mortality and morbidity need to be implemented.

A case of facial chain saw injury has been presented, along with a review of the literature and a discussion of the preoperative and postoperative management. The mechanism of injury and recommendations to reduce the incidence of maxillofacial injuries are also discussed.