Complex Facial Injuries Research Articles

Advancing Face Transplantation: A Critical Analysis of Revisions and Long-Term Surgical Outcomes in 10 Cases.

Face transplantation has emerged as a viable solution for reconstructing the most complex facial injuries. Previous work has demonstrated that surgical revisions are necessary to optimize outcomes. The authors' group has updated the previous report of revisions in their cohort, quantified and described which revisions were performed for functional, aesthetic, or mixed indications, and described the rationale, safety, and long-term outcomes of these revisions. A retrospective analysis of the authors' 10 face transplants from April of 2009 to February of 2023 was performed. The patients' medical records, preoperative facial defects, and operative reports (index and secondary revisions) were reviewed. Nine patients were included. One patient underwent irreversible acute-on-chronic allograft rejection and received a second face transplant. The average number of revisions was 5.2 per patient (range, 2 to 11 procedures). The median time interval from transplantation to first revision was 4 months (range, 1 to 21 months). Median follow-up was 106 months (range, 39 to 142 months). Most interventions consisted of debulking the allograft or revising the periorbital tissues. In the current study, the authors report longer-term data on revision procedures needed in face transplant recipients. Patients should expect to undergo revisions for both functional and aesthetic considerations. Although the majority of revisions are performed within 2 years after transplantation, revisions can be safely performed at any time point. Shared decision-making between the patient and provider team is essential in deciding which revisions are performed and when. Therapeutic, V.

780 Are E-Scooters Safe for Widespread Public Use? A Case Series Examining Severe Facial Injuries Secondary to E-Scooter Accidents

Abstract E-scooter use is becoming commonplace across the UK as an increasing number of towns and cities launch trials with pay-as-you-go e-scooter companies. In addition, e-scooters are cheap method of transport, easily available for an individual to purchase online, without restriction. We present two cases of patients having suffered complex facial injuries secondary to e-scooter accidents. The first is a 38-year-old male, who was thrown from an e-scooter and had associated loss of consciousness. CT facial bones demonstrated extensive fractures to the bilateral maxillary and frontal sinuses, nasal bones, bilateral orbital floors, and mandible. The Le Fort II and mandibular fractures were fixed in two procedures. The patient has ongoing neuropathic pain around the right mandibular condyle and is receiving input from orthognathic specialists. The second patient is a 60-year-old male, who collided with the rear of a car and was thrown forward, hitting his face on the tarmac. CT facial bones showed a Le Fort II fracture pattern and a fractured left inferior orbital rim, with extensive surgical emphysema of the face. He underwent plating of the bilateral Le Fort II fractures and application of intermaxillary fixation wires. With little to no enforcement of personal protective equipment use and safety advice whilst utilising e-scooter services, the number of people suffering serious injuries from using such equipment is set to skyrocket. Increased awareness and education around the danger of e-scooters needs to be addressed and should be prioritised by local authorities and public health services.

Management of Complex Facial Injuries: Cutting Traumas by Angle Grinders.

The use of angle grinders can lead to complex facial injuries. The most frequent sites affected are within the head and face region. Anatomical boundaries or structures are not respected by the high-speed disc of angle grinders, and thus, injuries can be mutilating, permanently disabling, or even lethal. Functional and aesthetical satisfying results can be reached through debridement, excision of wound edges, and meticulous layered functional closure after appropriate reconstruction of additional facial bony defects. The management and short-term outcome of a complex facial cutting trauma by an angle grinder are presented and discussed.

The characteristics of facial injuries presenting to The Oral and Maxillofacial Department at The University Hospital of Wales. What has changed?

Background: Oral and Maxillofacial Surgeons repair routine and complex facial injuries on a daily basis. The University Hospital of Wales remains the largest hospital within Wales providing treatment to approximately 350,000 people in Cardiff and the surrounding areas. Over a 12-month period the incidents of facial trauma were analysed. Previous research has outlined the sharing of A&E data with violence prevention initiatives have helped reduce the number of patients receiving treatment for assault injuries by 35% (Shepherd, 2007b). In addition of this, we were able to explore A&E waiting times and outline common trends amongst all injuries in order to help with the management of emergency admissions.

Initial Assessment and Evaluation of Traumatic Facial Injuries.

The care of the facial trauma patient continues to evolve in the ever-changing face of medicine. Patients can be reassured that their care is managed by a variety of specialists knowledgeable in the assessment and management of complex facial injuries. Thanks in part to advances in imaging modalities, bone fixation techniques and technology, and a wider array of reconstructive procedures, the foundation upon which the reconstructive ladder of facial injuries rests continues to expand. The overall goal of repair is a return to a preinjury state of form and function.

Severe gunshot maxillofacial trauma, when and where to start?

Disruption of soft and/or hard tissues stemming from ballistic injury can dauntingly distort facial features. Such facial deformity obliterates the normal anatomic planes and introduces a unique and challenging dilemma even for the most experienced specialists in facial trauma. The ongoing war in Syria have provided the oral and maxillofacial surgeon unique challenges in reconstructing and restoring function to the wounded people with complex facial injuries. Israel through the UN has been treating wounded Syrians since 2013. More than 1500 patients were brought to Israel; where some of the wounded arrived after initial treatment in Syria and over 1000 patients were referred to Galilee Medical Center (GMC). Since March 2013, surgeons of the oral and maxillofacial department at the GMC have treated more than 70 Syrian injured patients aged between 9 and 40 years. Most of the wounded had multiple traumas with direct damages from high velocity weapons and were classified as severe head and neck injuries. Their transfer from the battlefield to GMC took 6–24 h where some patients were admitted with a tracheotomy or coniotomy from the battlefield. Wounded patients had no military protection such helmet or bulletproof vest upon their arrival to GMC. We will present here our experience, strategy and protocol, as a level I trauma centre, in treating severe gunshot injury to the maxillofacial area caused by high-velocity weapons.

Single-stage soft tissue reconstruction and orbital fracture repair for complex facial injuries

Orbital fractures with open periorbital wounds cause significant morbidity. Timing of debridement with fracture repair and soft tissue reconstruction is controversial. This study focuses on the efficacy of early single-stage repair in combined bony and soft tissue injuries. Retrospective review. Twenty-three patients with combined open soft tissue wounds and orbital fractures were studied for single-stage orbital reconstruction and periorbital soft tissue repair. Inclusion criteria were open soft tissue wounds with clinical and radiographic evidence of orbital fractures and repair performed within 48h after injury. Surgical complications and reconstructive outcomes were assessed over 6 months. The main outcome measures were enophthalmos, pre- and post-CT imaging of orbits, scar evaluation, presence of diplopia, and eyelid position. Enophthalmos was corrected in 16/19 cases and improved in 3/19 cases. 3D reconstruction of CT images showed markedly improved orbital alignment with objective measurements of the optic foramen to cornea distance (mm) in reconstructed orbits relative to intact orbits of 0.66, 95% confidence interval [CI] (lower 0.33, upper 0.99) mm. The mean baseline of Stony Brook Scar Evaluation Scale was 0.6, 95%CI (0.30-0.92), and for 6 months, the mean score was 3.4, 95%CI (3.05-3.73). Residual diplopia in secondary gazes was present in two patients; one patient had ectropion. Complications included one case of local wound infection. An early single-stage repair of combined soft tissue and orbital fractures yields satisfactory functional and aesthetic outcomes. Complications are low and likely related to trauma severity.

Evolving Concepts of Skin and Mucosal Biopsy in Facial Vascularized Composite Allotransplantation

Facial vascularized composite allotransplantation has ushered in a new era in treating complex facial injuries that cannot be reconstructed using traditional techniques. Multiple teams have reported their experiences in monitoring for allograft rejection using skin and mucosal biopsies. The association of biopsy findings and clinical observations are poorly understood and are continuously being redefined. We review the world’s experience in monitoring skin and mucosal histological findings in facial transplantation, review acute rejection, antibody-mediated rejection, chronic rejection, and describe our institutional experience in the monitoring and management of facial allograft histology.

First U.S. Near-Total Human Face Transplantation: A Paradigm Shift for Massive Complex Injuries

Severe complex facial injuries are difficult to reconstruct and require multiple surgical procedures. The potential of performing complex craniofacial reconstruction in one surgical procedure is appealing, and composite face allograft transplantation may be considered an alternative option. The authors describe establishment of the Cleveland Clinic face transplantation program that led them to perform the first U.S. near-total face transplantation. In November of 2004, the authors received the world's first institutional review board approval to perform a face transplant in humans. In December of 2008, after a 22-hour operation, the authors performed the first near-total face transplantation in the United States, replacing 80 percent of the patient's traumatic facial deficit with a composite allograft from a brain-dead donor. This largest, and most complex, face allograft in the world included over 535 cm2 of facial skin; functional units of full nose with nasal lining and bony skeleton; lower eyelids and upper lip; underlying muscles and bones, including orbital floor, zygoma, maxilla, alveolus with teeth, hard palate, and parotid glands; and pertinent nerves, arteries, and veins. Immunosuppressive treatment consisted of thymoglobulin, tacrolimus, mycophenolate mofetil, and prednisone. The patient tolerated the procedure and immunosuppression well. At day 47 after transplantation, routine biopsy showed rejection of the graft mucosa without clinical evidence of skin or graft rejection. The patient's physical and psychological recovery went well. The functional outcome has been excellent, including optimal return of breathing through the nose, smelling, tasting, speaking, drinking from a cup, and eating solid foods. The functional outcome thus far at 8 months is rewarding and confirms the feasibility of performing complex reconstruction of severely disfigured patients in a single surgical procedure of facial allotransplantation.

A Survey of North American Burn and Plastic Surgeons on Their Current Attitudes Toward Facial Transplantation

Feasibility of composite tissue allotransplantation (CTA) has been substantiated by transplantations of the hand, abdominal wall, and face. CTA has the potential to reconstruct "like with like," but the risk-to-benefit ratio and clinical indications have yet to be determined. We sought to examine the current attitudes about the emerging field of CTA from those who treat complex facial injuries. In 2007, a Web-based blinded survey was sent to both burn and plastic surgeons involved in facial reconstruction. We examined the practice profile with regard to complex facial injuries and asked respondents to assess the level of risk in CTA and indications for facial transplantation. Surgeons were asked to evaluate three clinical cases (two closely mirroring clinical face transplantations) for suitability for treatment with CTA. One hundred sixty-four surgeons responded (54% response rate) and averaged 17.3 years in practice. They saw 12.1 severe facial-injury patients per year. A total of 78.7% agreed that current techniques do not provide adequate reconstruction for severe facial injuries, and 26.2% were in favor of performing CTA on immunosuppression. Acceptable indications for CTA were multiple failed reconstructions (70%), total facial burn (59%), and absence of remote tissue (55%). Ten percent saw no acceptable indication for CTA. The scenarios that mimicked recent transplantations had moderate support in favor of CTA (20.7% for the Chinese patient and 29.3% for the French patient). This survey demonstrates support for use of CTA to reconstruct complex facial deformities. Surgeons continue to be wary of immunosuppression and chronic rejection, and many want to wait for better immunologic treatment options.

Facial transplantation: adding to the reconstructive options after severe facial injury and disease

The ability to reconstruct complex facial injuries is still a considerable challenge despite the development of microsurgical techniques. The reconstructive options for conditions such as panfacial burns are severely limited. The result after multiple surgical procedures in this group is often poor in terms of function and cosmesis. Facial transplantation provides a potential solution, but opinion is currently divided about the extent to which the potential benefits to the quality of life can be justified when weighed against the technical, psychological and immunological risks. This paper reviews the current status of the debate and argues that a rigorous research strategy is the only logical basis for countering the ethical objections to a procedure that offers considerable benefits over existing reconstructive options.

Contemporary management of maxillofacial hard and soft tissue injuries secondary to trauma

Trauma can lead to complex facial injuries with missing tissue. Many of these injuries involve both hard and soft tissue. Most defects may be reconstructed immediately leading to better restoration of form and function with early rehabilitation. Advances in plating methods, soft tissue procedures, and exposure techniques allow for optimal reconstruction of even the most severe injuries. This course is designed to provide attendees with current techniques for treating hard and soft tissue injuries. Surgical principles combined with case presentations will be discussed. Management of fractures including mandibular, midface, orbital, and nasoorbitoethmoid (NOE) will be reviewed. Soft tissue injuries and techniques for repair, including local flaps, are discussed.

Acrylic splints for dental alignment in complex facial injuries.

Twenty-four patients with complex facial injuries were managed by wide subperiosteal exposure, precise anatomical reduction, rigid internal fixation, and immediate bone grafting when indicated, in conjunction with dental impressions, model surgery, and fabrication of dental splints to establish proper preinjury occlusion. The study population consisted of 18 men and 6 women, whose ages ranged from 18 to 49 years (mean, 30.7 yr) at the time of injury. High velocity motor vehicle accidents were responsible for facial injuries in 18 patients, gunshot wounds in 2, low velocity blunt trauma in 3, and falls in 1. All facial fractures involved the occlusion, and unstable and/or comminuted palatal/maxillary and mandibular fractures, often with edentulous segments, were the major indications for fabrication of acrylic splints. Depending on the nature of the fracture pattern, model surgery was performed on the maxillary and/or mandibular models and segmented along fracture lines. These fragments were then repositioned according to dental wear facets and preinjury occlusion. When possible, preinjury occlusal records were obtained before splint fabrication. Models were mounted on a Galetti articulator and palatal, lingual, and/or occlusal splints were fabricated. Edentulous segments were compensated for by local buildup of the splints to produce an occlusal stop. Arch bars were fixed directly to the splint with acrylic. Twenty-six splints were used in the 24 patients to establish proper occlusal relationships before internal fixation of fractures. The types of splints were palatal (n = 8), palatal-occlusal (n = 6), lingual (n = 8), lingual-occlusal (n = 1), and occlusal (n = 3).(ABSTRACT TRUNCATED AT 250 WORDS)