OBJECTIVES: This study aims to evaluate the clinical effect of low-energy semiconductor laser treatment on the promotion of wound healing after maxillofacial fracture surgery. METHODS: A prospective randomized controlled study was conducted. Patients with maxillofacial fractures who were hospitalized in the Department of Trauma and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, from August 2021 to June 2023 were selected as the study subjects and randomly divided into experimental and control groups. The experimental group was treated with a low-energy semiconductor laser once a day for six consecutive days after daily routine dressing change on the first day after surgery. The control group only underwent routine dressing change treatment and did not receive low-energy semiconductor laser treatment. Wound healing times, wound healing conditions, modified Stony Brook scar evaluation scale (mSBSES) scores, pain indices, and wound infection rates were compared between the two groups. RESULTS: A total of 211 patients were included in this study. A total of 104 and 107 cases comprised the experimental and control groups, respectively. A total of 128 males and 83 females were included. After low-energy semiconductor laser treatment, the facial skin wound healing time of the experimental group was found to be significantly shorter than that of the control group (P<0.05). Moreover, the wound grade A healing rate of the experimental group was higher than that of the control group on the seventh day after surgery (P<0.05). Among postoperative facial skin wound evaluation indices, the mSBSES scores of the experimental group at all observation points were higher than those of the control group (P<0.05), and the scores of the experimental group were higher than those of the control group in terms of wound width reduction, height reduction, color lightening, and incision line loss (P<0.05). In postoperative wound pain evaluation, the pain index of the experimental group after low-energy semiconductor laser treatment was significantly lower than that of the control group (P<0.05). No significant difference in wound infection rates was found between the two groups (P>0.05). CONCLUSIONS For facial skin wounds in maxillofacial fracture surgery, low-energy semiconductor laser treatment can effectively promote wound healing, improve wound healing quality, fade scars, and relieve wound pain.
Humans ; Wound Healing/radiation effects* ; Male ; Female ; Lasers, Semiconductor/therapeutic use* ; Prospective Studies ; Adult ; Middle Aged ; Low-Level Light Therapy ; Maxillofacial Injuries/surgery* ; Young Adult

OBJECTIVES: This study investigates independent risk factors for postoperative internal fixation device infection in patients with maxillofacial fractures and proposes an early warning model based on the synthetic minority over-sampling technique (SMOTE) algorithm. METHODS: A total of 1 104 patients who underwent surgical treatment for maxillofacial fractures at Oral and Maxillofacial Surgery Department, Affiliated Hospital of Nantong University from January 2021 to December 2024 were retrospectively analyzed. The patients were divided into two groups based on the presence of postoperative internal fixation device infection: the infection group (27 cases) and non-infection group (1 077 cases). Clinical data from both groups were collected and subjected to statistical analysis. Univariate and binary Logistic regression analysis were used to identify risk factors for postoperative internal fixation device infection in maxillofacial fractures. Subsequently, a Logistic regression model was established, and the dataset was improved based on the SMOTE algorithm to construct an early warning model with the improved dataset. The prediction performance of the models was compared and validated. RESULTS: Among the 1 104 patients who underwent surgical treatment for maxillofacial fractures, 27 cases of postoperative internal fixation device infections were identified, corresponding to an infection rate of 2.45% (27/1 104). Age, diabetes history, fracture severity, and oral hygiene status were all identified as risk factors for postoperative internal fixation device infections in maxillofacial fractures (all P<0.05). The prediction model based on the original data (P1). The prediction model based on the SMOTE algorithm (P2). Receiver operating characteristic (ROC) curve analysis shows that the area under curve (AUC) for the P2 model was 0.882, the P1 model was 0.861, indicating the superior predictive performance of the P2 model. The DeLong test results show that the difference in AUC between the two models was statistically significant (P<0.05). CONCLUSIONS Age, diabetes history, postoperative fracture severity, and oral hygiene status are all risk factors for infections associated with internal fixation devices after maxillofacial fracture surgery. The proposed early warning model demonstrated good predictive performance. Medical professionals can utilize this model to effectively intervene and anticipate infections related to internal fixation devices after maxillofacial fracture surgery.
Humans ; Algorithms ; Retrospective Studies ; Male ; Female ; Fracture Fixation, Internal/instrumentation* ; Risk Factors ; Middle Aged ; Adult ; Logistic Models ; Surgical Wound Infection/epidemiology* ; Aged ; Internal Fixators/adverse effects* ; Maxillofacial Injuries/surgery* ; Adolescent

OBJECTIVES: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. MATERIALS AND METHODS: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. RESULTS: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. CONCLUSION: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.
Cicatrix ; Congenital Abnormalities ; Constriction, Pathologic ; Esthetics ; Facial Injuries ; Facial Muscles ; Fracture Fixation, Internal ; Frontal Bone ; Human Body ; Incidence ; Nose ; Oral and Maxillofacial Surgeons ; Osteotomy ; Paresthesia ; Rhinoplasty ; Surgery, Oral

PURPOSEMaxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas.

METHODSWe retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different institutions, pediatric trauma patients and adult patients who were transferred in accordance with pre-existing agreements in case of paucity of beds were excluded. Finally we included 447 (0.2%) patients over the 8 years. Data were evaluated with emphasis on epidemiology (age, gender, mechanism of trauma), primary survey and abnormalities and pattern of trauma.

RESULTSThe most frequent cause of maxillofacial trauma was road accidents (319 patients, 71.4%), among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients; 443 (99.1%) patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries (χ = 557.2, p < 0.0001). Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas (χ = 17.13, p < 0.0001 vs minor lesions). All of the neglected lesions occurred in paucisymptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hematoma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms.

CONCLUSIONAmong the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit, diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial major lesions.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Maxillofacial Injuries ; etiology ; surgery ; Middle Aged ; Multiple Trauma ; etiology ; surgery ; Retrospective Studies

OBJECTIVE: Assessed the feasibility of application of free fibular flap and clinical significance of pre-operational contrast enhanced CT angiography in functional reconstruction of oral and maxillofacial hard and soft tissue defects. METHOD: Eight cases with mandibular and soft tissue defects received a free fibula flap using arteriovenous anastomosis anastomosis method. The relationship between fibula flap design, size, repair parts and survival were analyzed. Preoperative enhanced CT angiography (CTA) examination was conducted to detect any abnormal blood vessels in fibula flap valve area. RESULT: Peroneal artery and posterior tibial artery variation was identified in one case of gums cancer, who used other muscle flap. Free fibula flap in the other 7 cases survived, which carried a skin island with an area ranging from 6 cm x 2 cm to 10.0 cm x 3.5 cm. Postoperative facial appearance, functionality, dental occlusion and voice function was normal. Lower limb function returned to normal from 2 weeks to 4 months after surgery. CONCLUSION CTA examination of the free vascularized fibula flap in the preoperative evaluation of the donor site is a valuable tool. Free fibula flap of bone, periosteum and bone marrow has a dual blood supply and are highly resistant to infection after transplantation. Personalized shaping osteotomy allowed for accurate recovery of mandibular alveolar patterns. Furthermore, the height and width of the fibula and the thickness of cortical bone is suitable for dental implants. Free fibula flap skin island can also be used to monitor the post-operative blood supply and is an ideal technique for mandible and soft tissue defects reconstruction as well as functional restoration.
Adult ; Aged ; Angiography ; methods ; Female ; Free Tissue Flaps ; blood supply ; Humans ; Male ; Maxillofacial Injuries ; surgery ; Middle Aged ; Mouth Neoplasms ; surgery ; Reconstructive Surgical Procedures ; methods

China ; Fracture Fixation, Internal ; education ; Humans ; Maxillofacial Injuries ; therapy ; Societies, Medical ; Surgery, Oral ; education

Adult ; Aged ; Dermatologic Surgical Procedures ; methods ; Facial Asymmetry ; surgery ; Facial Injuries ; surgery ; Humans ; Male ; Maxillary Neoplasms ; radiotherapy ; surgery ; Maxillofacial Prosthesis ; Middle Aged ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Retinal Neoplasms ; radiotherapy ; surgery ; Retinoblastoma ; radiotherapy ; surgery ; Young Adult

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Imaging, Three-Dimensional ; Male ; Maxillofacial Injuries ; diagnostic imaging ; surgery ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Skull Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

Eyelids ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Maxillofacial Injuries ; surgery ; Orbit ; surgery ; Scalp ; surgery ; Skull Fractures ; surgery ; Surgical Procedures, Operative ; methods

Foreign Bodies ; surgery ; Head ; Humans ; Imaging, Three-Dimensional ; Jaw Fractures ; surgery ; Maxillofacial Injuries ; diagnostic imaging ; surgery ; Radiography, Dental, Digital ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed