Does the use of a pterygoid osteotome affect pterygomaxillary fracture patterns in Le Fort I osteotomy?

Background Maxillofacial trauma requires timely recognition of urgent conditions, yet specialized expertise is often limited in rural settings. Hub-and-spoke trauma networks supported by telemedicine may optimize triage, reduce unnecessary transfers, and integrate advanced workflows. Evidence for maxillofacial trauma teleconsultation, however, remains sparse. Methods A retrospective study of all teleconsultations for maxillofacial trauma between January 2023 and August 2025 within the major trauma network of South-Eastern Vast Area of Tuscany (AV-TSE) (population ∼809,000) was conducted. Thirteen spokes hospitals from 13 peripheral Azienda Unità Sanitaria Locale Toscana Sud-Est (AUSL-TSE) are connected to the tertiary hub in Siena, for example, the Azienda ospedaliero-universitaria Senese (AOUS). Teleconsultations used a secure platform provided by Ente di supporto tecnico amministrativo regionale (ESTAR) enabling safe exchange of clinical data, photographs/videos, and radiological images. Patients were triaged as emergency (immediate transfer), urgency (hub evaluation within 72 h), or elective (spoke follow-up). Primary outcomes were: avoided transfers, efficiency, and equity of access. Multivariable logistic regression assessed predictors of avoided transfer and loss to follow-up (LTFU). Results A total of 670 patients were analyzed (mean age = 64.4 years; 43.9% female). Zygomaticomaxillary complex (29.1%), orbital (19.4%), and maxillary fractures (15.1%) predominated. Overall, 174 patients (26.0%) were managed locally, avoiding ∼4520 km and 75 h of travel. Conservative outpatient care was most frequent (57.6%), while 13.7% required surgery under general anesthesia. Older age independently predicted both avoided transfer (OR = 1.03/year, 95% CI = 1.02–1.04) and LTFU (OR = 1.023, 95% CI = 1.010–1.035). No duplicate CT scans were required. Virtual surgical planning by computer-aided design (CAD) and computer-aided manufacturing (CAM) enabled preoperative workflows to begin before transfer, reducing delays. Conclusions In the experience of AV-TSE, a pragmatic telemedicine teleconsultation pathway between AOUS and AUSL-TSE decentralized one-quarter of cases, reducing transfers while ensuring safety. Integration with CAD/CAM planning enhanced surgical readiness. Improving follow-up reliability, especially in older patients, remains a priority for future network optimization.

Background: This study aimed to identify regional trauma patterns by evaluating demographic characteristics, trauma etiologies, fracture localisations, and surgical treatment methods in patients who underwent surgical management for maxillofacial trauma (MFT).Materials and Methods: This retrospective study included 182 patients who received surgical treatment for MFT between January 2021 and June 2025. Demographic data, trauma etiologies, fracture sites, fracture types, and surgical techniques were reviewed using patient medical records and the hospital information system. Fractures were classified based on anatomical location and number.Results: The majority of patients were male (85.7%), with a mean age of 38 years. Assault was the most common cause of trauma. Single fractures were observed in 67.6% of cases, while 32.4% presented with multiple fractures. Among isolated fractures, the mandible (34.1%) and zygoma (25.3%) were the most frequently affected sites. In multiple fractures, the most common combinations involved the maxilla (28.6%), mandible (24.4%), and nasal bones (22.7%). Of the 132 mandibular fractures, subcondylar fractures were the most prevalent (29.5%). Le Fort II fractures were the most common maxillary fractures, tripod fractures predominated among zygomatic fractures, and anterior wall involvement was most frequent in frontal sinus fractures. Of the total 235 fractures, 201 were treated with open reduction and internal fixation, while 34 underwent closed reduction.Conclusions: MFTs in Samsun province predominantly affected young male patients, with assault and traffic accidents being the leading etiologies. Mandibular and zygomatic fractures were the most common fracture types. These findings provide a better understanding of regional MFT patterns.

Craniomaxillofacial (CMF) trauma is primarily associated with high-energy injuries and constitutes a significant proportion of hospital presentations in Japan. The coronavirus disease 2019 (COVID-19) pandemic and related public health restrictions profoundly altered daily life and social behavior, potentially influencing trauma patterns and surgical interventions for CMF injuries. We retrospectively analyzed nationwide data from the Japanese National Database, covering the period from 1 January 2014 to 31 December 2023. Inpatient and outpatient CMF surgical procedures were identified using procedural codes and categorized into pre-pandemic (2014–2019), pandemic (2020–2021), and post-pandemic recovery (2022–2023) periods. Statistical analysis included descriptive evaluation and comparative analysis across these periods. In total, 30,398 CMF surgical procedures were recorded during the 10-year study period. The pre-pandemic period averaged 3,528.0 cases per year, which declined to 2,756.5 cases per year during the pandemic period, representing a 21.87% reduction (p < 0.001). The post-pandemic period showed partial recovery, averaging 3,358.5 cases per year, remaining 4.80% below pre-pandemic levels. The largest pandemic-period declines were observed for bilateral mandibular condylar fracture surgery (− 100%), bilateral mandibular fracture surgery (− 40.5%), and non-invasive reduction of maxillary fractures (− 43.8%). Notable recovery patterns emerged post-pandemic, with zygomatic fracture procedures surpassing pre-pandemic levels (+ 2.7%), while most other procedures remained below baseline. The COVID-19 pandemic significantly reduced CMF surgical procedures in Japan, with differential impacts across procedure types. The post-pandemic period reveals heterogeneous recovery patterns—some procedures exceeding pre-pandemic levels while others persistently lag—suggesting enduring changes in trauma patterns and healthcare utilization.

Objective: To find out the incidence of diplopia in ZMC fracture patients reporting to the trauma center and maxillofacial outpatient department. Study Design: Cross Sectional study. Setting: Department of Trauma Center and Maxillofacial Outpatient, Ayub Teaching Hospital (ATH), Abbottabad. Period: December 2024 to May 2025. Methods: A total of 113 patients between the ages of 18–60 years with radiologically proven ZMC fractures were recruited using non-probability consecutive sampling. Data regarding age, gender, etiology of trauma, fracture pattern (unilateral/bilateral), and presence/direction of diplopia was obtained on a structured proforma. Diplopia was evaluated clinically by history and nine-gaze examination. Data were analyzed using SPSS version 22. Chi-square test was employed to evaluate associations, with p &lt; 0.05 being statistically significant. Results: Of the 113 patients, diplopia occurred in 32.74% (n = 37). Horizontal diplopia was the most frequent (54.87%), followed by vertical (32.74%) and oblique (12.39%). Both-sided ZMC fractures were strongly related to diplopia (52.17%) than single-sided fractures (27.78%) (p = 0.026). No significant association was found with age, gender, cause of trauma, or direction of diplopia gaze. Conclusion: Diplopia is a relatively frequent ZMC fracture complication, especially in the case of bilateral trauma. Early detection can support ophthalmic referral and improved functional results.

Establishment and External Validation of a Nomogram for Predicting In-Hospital Mortality in Patients With Maxillary Fractures Combined With Basilar Skull Fractures.

Le Fort I fractures with concurrent palatal fractures are rare, necessitating precise stabilization of facial buttresses to restore function and aesthetics. Conventional management includes maxillary open reduction and internal fixation combined with intermaxillary fixation. However, palatal fractures pose additional challenges, particularly during masseter muscle contraction, often resulting in dental arch widening. Lingual splints are commonly utilized to stabilize the dental structures and prevent dental arch widening, but traditional acrylic splint fabrication is time-consuming. In this study, we report on a 36-year-old female patient who suffered from facial contusions following a traumatic accident, which led to the diagnosis of Le Fort I fracture combined with palatal fracture. To address these challenges, we introduced thermoplastic polycaprolactone (PCL) as an innovative and instant material for lingual splint fabrication. The use of PCL significantly reduced the intraoperative preparation time by eliminating the need for preoperative dental impressions and reducing fabrication time from hours to just a few minutes. Compared to traditional acrylic splints, the PCL-based splint proved to be biocompatible, efficient, and cost-effective, thereby simplifying the management of maxillary fractures and promoting optimal healing outcomes.

Maxillofacial trauma represents a significant proportion of body injuries and often presents with complex fractures that require prompt and accurate diagnosis for effective management. Computed tomography (CT) provides detailed imaging and is increasingly used to guide clinical decision making. This study aimed to evaluate the role of CT imaging in the diagnosis and management of patients with maxillofacial trauma and to assess its correlation with initial physical examination findings. We conducted a retrospective analysis of patients aged 18 years and older who presented to the Emergency Department of Muğla Training and Research Hospital with maxillofacial trauma between January 2015 and June 2021 and received a Plastic, Reconstructive, and Aesthetic Surgery consultation. Demographic data, clinical examination findings, and CT scan reports were recorded. The relationship between initial physical examination and CT findings was evaluated. Cases with previous maxillofacial trauma, incomplete imaging, or treatment performed externally were excluded. CT evaluation of 401 patients demonstrated that 321 (80.0%) had at least one fracture, whereas 77 patients (19.2%) showed no fractures. Maxillary fractures were the most common, occurring in 169 patients (42.3%), followed by zygomatic fractures in 152 patients (37.9%), orbital fractures in 109 patients (27.2%), frontal bone fractures in 46 patients (11.5%), and mandibular fractures in 31 patients (7.7%). Surgical intervention was indicated in 222 patients (55.4%), of whom 156 (38.9%) underwent surgery, while 245 (61.1%) did not. Conclusion: CT is the gold standard for maxillofacial trauma evaluation, yet not all patients require imaging or surgical intervention. Careful clinical assessment ensures appropriate CT use, reduces unnecessary imaging, and optimizes patient management.

This study evaluates the performance of a curvature-based 3D dental comparison method - the keypoint pipeline - for forensic identification, assessing the effects of standardised blunt force trauma on human dentitions. The dental arches in ten human jaw specimens (five maxillae, five mandibulae) were scanned using two intraoral 3D scanners before and after exposure to controlled blunt trauma delivered via a drop tower mechanism applying approximately 3154 Newton of force. Trauma outcomes were documented through high-speed video, digital photography, and 3D scanning. Post-trauma scans were processed using the keypoint pipeline, which quantifies dental surface similarity by comparing curvature signatures. An all-vs-all comparison was conducted between pre- and post-trauma scans, including cross-scanner evaluations. Despite consistent trauma application, fracture patterns varied by jaw type, with mandibular fractures typically occurring in the frontal plane in the side segments and maxillary fractures in the sagittal plane in the midline suture. The keypoint pipeline successfully scored 92.5% of the true matches to be the best matching comparison, even in the presence of significant structural damage and tooth displacement. Matching pairs yielded lower dissimilarity scores (mean: 0.55) compared to mismatches (mean: 0.78), indicating that curvature features were sufficiently preserved post-trauma. These findings support the integration of curvature-based 3D dental surface analysis into forensic odontology workflows, particularly in disaster victim identification scenarios involving blunt force trauma.

Maxillary third molar extractions can lead to complications, particularly maxillary tuberosity fractures. While the periodontal ligament is essential for load distribution, histological evaluations of the periodontal ligament in relation to these fractures are notably absent from the literature. This report presents a case where a significant fracture occurred during a third molar extraction. Histopathological analysis of the specimen revealed marked tissue alterations, including free and attached concentric calcifications and pronounced cementum irregularities. These findings, indicating a localized disruption of the periodontal ligament integrity, were not detectable through standard preoperative imaging. Therefore, these histological changes may represent a novel and previously undocumented risk factor. This case underscores the importance of a thorough preoperative evaluation and transparent risk communication during the informed consent process. Further studies are warranted to validate these findings and understand their prevalence.

BackgroundZygomaticomaxillary complex (ZMC) fractures are among the most frequently encountered midfacial injuries, often resulting from high-energy trauma such as road traffic accidents or assaults. Effective management requires a balance between aesthetic reconstruction and functional rehabilitation. Despite advancements in surgical techniques, postoperative complications remain a concern. This study aims to evaluate demographic patterns, etiological factors, fracture distribution, and surgical approaches, and to identify predictors of postoperative complications using multivariate analysis and survival methods.MethodsA retrospective observational study was conducted on 77 patients surgically treated for ZMC fractures between 2021 and 2024. Data regarding patient demographics, mechanism of injury, fracture classification, incision type, and postoperative complications were extracted from hospital records. Chi-square tests and multivariate logistic regression were employed to assess associations between clinical variables and complication risk. Time-to-resolution of complications was analyzed using Kaplan-Meier (KM) survival curves. Relative risks (RR) were computed for each surgical incision type.ResultsZMC fractures predominantly affected males (n=69, 90%), most frequently in the 20-29-year age group (n=22, 28.6%). Road traffic accidents, assaults, and falls were the primary causes. Maxillary fractures were most common (n=25, 32.4%), and the buccal sulcus incision was preferred (n=36, 46.7%). Infraorbital paresthesia was the most frequent complication (n=5, 27%). Significant predictors of complications included age ≥50 years, infraorbital fractures, infraorbital incisions, and alcohol-related trauma (p < 0.05). KM analysis revealed delayed resolution of paresthesia and diplopia; hemianopia persisted at 12 weeks. Overall, open reduction and internal fixation (ORIF) demonstrated a favorable safety profile.ConclusionsZMC fractures primarily affect young adult males and are most often trauma-induced. While ORIF remains the standard for managing displaced fractures, increased complication risks in older adults and alcohol-related injuries highlight the need for individualized surgical planning and targeted postoperative care.

Sports-related maxillofacial and dental injuries remain a major clinical challenge despite advances in protective equipment and growing awareness of prevention. This review summarizes current knowledge on the epidemiology, mechanisms, and management of the most common injuries affecting athletes, including dental trauma, mandibular and maxillary fractures, zygomatic and orbital injuries, nasal fractures, and a wide range of soft tissue lesions. Particular attention is given to patterns of dental trauma—such as crown and root fractures, luxations, and avulsions—which are highly prevalent and often require urgent intervention to preserve function and aesthetics. The article highlights the importance of early diagnosis, appropriate imaging, and evidence-based treatment strategies, as well as interdisciplinary collaboration between sports medicine specialists, dentists, and surgeons. Emphasis is also placed on prevention, especially the use of custom-fitted mouthguards and athlete education. Understanding injury mechanisms and implementing effective protective measures are essential for reducing trauma incidence and ensuring safe return to sport.

BackgroundInfraorbital nerve dysfunction frequently occurs after maxillary fractures. This study aimed to determine whether maxillary fractures involving the infraorbital foramen affect the recovery of infraorbital nerve function.MethodsIn this prospective study, 60 patients who received treatment for unilateral maxillary fractures between January 2020 and December 2022 were analyzed, with a follow-up period of over 1 year. Computed tomography scans were employed to categorize the fractures into three types according to the location of the fracture line relative to the infraorbital foramen. Sensory changes in four predetermined areas, supplied by the infraorbital nerve, were evaluated preoperatively and at 1 week, 1 month, 3 months, 6 months and 1 year postoperatively using the two-point discrimination test and the monofilament test.ResultsParesthesia was observed in all patients with maxillary fractures. In the majority of instances, sensory deficits resolved spontaneously within 1 year. However, in patients whose fracture lines encroached upon the infraorbital foramen, the severity of paralysis was greater, and the rates of recovery were slower.ConclusionThe degree of infraorbital nerve function after a maxillary fracture was influenced by the involvement of the infraorbital foramen. Therefore, in the management of patients with maxillary fractures, computed tomography scans can serve as a predictive tool for the potential severity of paresthesia and the anticipated recovery rate.

Maxillofacial fractures are among the most serious injuries involving facial bones and are often caused by trauma, particularly traffic accidents. This condition not only affects the aesthetic and physiological functions but also has a significant impact on the patient’s quality of life. The high incidence of maxillofacial fractures has become an important concern in the fields of dentistry and oral and maxillofacial surgery. This study aimed to describe the characteristics of patients with maxillofacial fractures at Haji General Hospital Medan in 2022–2024, including the number of cases, age distribution, gender, causes of fractures, and types of fractures. This research employed a descriptive design with a retrospective approach. Data were obtained from the medical records of patients diagnosed with maxillofacial fractures who were treated at Haji General Hospital Medan during the 2022–2024 period. A total of 62 patients who met the inclusion criteria were included as research samples. Data were analyzed univariately in the form of frequency and percentage distributions, and presented in tables and bar charts. The results showed that the number of maxillofacial fracture cases increased each year, with 16 cases (25.8%) in 2022, 20 cases (32.3%) in 2023, and 26 cases (41.9%) in 2024. Based on age, the highest number of cases occurred in the 21–30 years age group (33.9%), followed by the 11–20 years group (30.6%). Based on gender, males experienced more maxillofacial fractures (46 cases, 74.2%) compared to females (16 cases, 25.8%). The main cause of fractures was traffic accidents (58.1%), followed by falls (17.7%). The most common types of fractures were maxillary fractures (41.2%) and zygomatic fractures (40.5%), followed by mandibular (6.9%), frontal and nasal (3.8% each), naso-orbito-ethmoidal (NOE) fractures (2.3%), and orbital fractures (1.5%). In conclusion, maxillofacial fractures at Haji General Hospital Medan in 2022–2024 were predominantly found in male patients of productive age (21–30 years), mainly caused by traffic accidents, with the most frequent fracture types being maxillary and zygomatic fractures. It is recommended that the public increase awareness and safety measures, especially while driving, including the use of protective equipment. Health institutions should strengthen educational programs on facial trauma prevention. Patients are advised to seek immediate medical attention to prevent complications. Further research is suggested to analyze more specific risk factors and evaluate post-treatment clinical outcomes.

Background:Craniofacial trauma is a major global health concern, most commonly resulting from high-energy impacts such as road traffic accidents. These injuries often involve complex maxillofacial and cranial fractures, leading to functional, neurological, and aesthetic challenges. Objectives:To present a complex case of panfacial trauma with intracranial and ocular involvement, highlighting the staged surgical approach and importance of multidisciplinary management. Results:A 26-year-old male sustained severe craniofacial injuries following a motorcycle accident. Imaging revealed multiple fractures including Le Fort II maxillary fracture, bilateral orbital rim and blow-out fractures, zygomatic tripod fracture, mandibular symphysis fracture, comminuted frontal sinus fractures, and anterior cranial base fracture, along with intracerebral hemorrhage, brain edema, and vitreous hemorrhage. Initial stabilization was achieved with interdental wiring and mandibular arch bar fixation. Definitive management included craniotomy with frontal sinus reconstruction, orbital exploration with scleral repair and hyphema evacuation, and orthopedic procedures for associated toe dislocations. The staged “bottom-to-top and outside-in” approach facilitated restoration of occlusion prior to cranial and orbital reconstruction. Conclusion: This case illustrates the complexity of managing multiregional craniofacial trauma involving the skull base and orbit. Optimal outcomes depend on early imaging, a staged surgical strategy, and close multidisciplinary collaboration between maxillofacial, neurosurgical, ophthalmologic, and orthopedic teams.

Traumatic injuries, which commonly occur in school-going children, usually result from accidents, falls from heights, contact sports, violence and other outdoor sports activities. The most common type of injury considered a dental emergency is dentoalveolar fractures. Fracture of the alveolar process usually involves the facial or lingual plates or both; most of these fractures are accompanied by injuries to teeth; thus, they are referred to as dentoalveolar fractures. Dentoalveolar trauma usually requires intraoral periapical and occlusal images to obtain adequate anatomic detail. Most of the fractures of the alveolar process are open with trauma to the gingiva and the alveolar mucosa. Radiographic examinations of traumatised teeth may demonstrate the extent of injury to the bone (maxilla or mandible) and the tooth, which may involve the root, periodontal ligament, and alveolar process. A tooth that has been concussed, subluxated, or luxated may demonstrate varying degrees of widening of the periodontal ligament space. This case report describes an eight-year-old male patient who presented with a mobile left upper segment with avulsed primary teeth, which followed the management of an anterior maxillary dentoalveolar fracture and uneventful eruption of the maxillary lateral incisor. The novelty in managing the paediatric dentoalveolar fracture using Ivy eyelet wiring lies in combining the standard Ivy loop with functional refinements- notably the extended eyelet for horizontal support, the loop designed for rapid and safe use, and the clovehitch for minimal dentition scenarios. Together, these modifications elevate an already trusted method, tailoring it effectively to the needs of an eight-year-old patient.

ABSTRACTBackground:Maxillofacial trauma is a significant public health concern, leading to functional and esthetic impairments. Understanding the incidence, prevalence, and fracture patterns is crucial for developing preventive and management strategies.Objective:This study aims to retrospectively evaluate the incidence, prevalence, and patterns of maxillofacial trauma at a tertiary care hospital over 5 years.Methods:A retrospective analysis of 500 patient records from January 2018 to December 2022 was conducted. Data on demographics, etiology, and fracture patterns were collected. Statistical analysis was performed using SPSS software, and results were presented as frequencies and percentages.Results:Males (70%) were more commonly affected, with the 21–30 years age group (30%) having the highest incidence. Road traffic accidents (RTAs) (52%) were the primary cause, followed by interpersonal violence (18%) and falls (16%). Mandibular fractures (36%) were most frequent, followed by zygomatic (22%) and maxillary fractures (16%).Conclusion:RTAs remain the leading cause of maxillofacial trauma, with young adult males being most affected. Preventive strategies, including road safety enforcement, public awareness programs, and multidisciplinary trauma management, are essential to reducing trauma incidence and improving patient outcomes.

Nonunion is a major complication following craniofacial fracture repair. While ketorolac has been associated with impaired bone healing in other fractures, its effect on craniofacial bones remains unclear. This study evaluated the association between postoperative ketorolac use and nonunion after craniofacial fracture repair. The TriNetX database was used to identify patients who underwent orbital, nasal, zygomatic, maxillary, and mandibular fracture repair. For each type of fracture, patients were classified into ketorolac-exposed and unexposed (control) cohorts. Propensity score-matching was used to adjust for various nonunion risk factors. The primary outcome was nonunion; secondary outcomes were malocclusion, hardware complications, wound dehiscence, and tooth extraction, assessed at 3, 6, and 9 months. For mandibular fractures, 33,740 patients were included after propensity score matching, with 16,870 in the exposed cohort and 16,870 in the control cohort. At 3 months post-repair, patients with ketorolac use had an increased risk of nonunion (RR 2.35, P<0.001), malocclusion (RR 1.67, P<0.001), hardware complications (RR 2.61, P<0.001), wound dehiscence (RR 2.10, P<0.001), and tooth extraction (RR 1.67, P=0.002) with similar risks observed at 6 and 9 months. For other fracture types (orbital, nasal, zygomatic, maxillary), ketorolac use was not associated with increased nonunion risk, though secondary complications were significantly higher. Postoperative ketorolac use is associated with a significantly increased risk of nonunion after mandibular fracture repair and a higher incidence of secondary complications across all craniofacial fracture types.

Objectives: The aim of this study was to examine etiology, patterns, and associated demographic factors of facial fractures in Northern Saudi Arabia. Method: This was a retrospective study of patients admitted to a tertiary care trauma center in Northern Saudi Arabia with a diagnosis of facial fracture. Medical patient records were retrieved for the period 19/1/2000 to 24/11/2015. Retrieved data were demographics (age, gender, nationality), types and etiology of fractures. Results: A total of 2066 patient records were included. Patients had a mean age of 24.7 ± 11.7 years, (range = 1-90 years). Most patients were males (n = 1755, 84.9%), and young (19-30 years old; 52%). Fractures of the zygomatic maxillary complex and mandibular parasymphysial fractures were the most commonly encountered fractures (n = 609, n = 603 respectively). Road traffic accidents (RTAs; 66.1%), falls (15.2%), and assault (13.0%) were the main causes of fractures. RTAs were significantly identified among age group (19-30; P &lt; .001). Assault was significantly associated with males, age group (19-30) and Saudi nationality ( P &lt; .001, P &lt; .001and P = .032 respectively). Lastly, falls had a significant association with male, children and older adults who were &gt;30 years old ( P = .001, P &lt; .001 respectively). Conclusions: RTAs, assaults, and falls are the most frequently reported causes of facial fractures among trauma patients in Northern Saudi Arabia. RTAs are the leading cause of facial fractures in the young adult population, while assaults are significantly seen in young Saudi males. Maxillary and mandibular fractures are the most commonly observed types of facial fractures. Targeted public health interventions are recommended to address road safety education and enforcement of traffic regulations. Community-based prevention programs could mitigate assault-related trauma, particularly among the young male population.

Objectives: To present a case of complex anterior maxillary defect caused by a gunshot injury and discuss the surgical approach using an autologous bone graft and a mini free flap for reconstruction. Materials and Methods: A 15-year-old male presented with maxillofacial trauma, including mandibular and anterior maxillary fractures, following a gunshot injury. Initial management involved mandibular fixation, nasal base stabilization, and primary mucosal repair. Subsequent imaging revealed a 4x2 cm anterior maxillary defect and upper lip contracture. Reconstruction was performed using a 4x2 cm autologous iliac crest bone graft and a 5x4 cm mini free flap harvested from the lower extremity. Microvascular anastomosis was conducted with the facial artery and vein. Results: Postoperative recovery was uneventful, and at the one-year follow-up, the patient exhibited significant improvements in aesthetic and functional outcomes. The bone graft demonstrated successful integration, and the free flap-maintained viability without complications. Conclusion: Combining autologous bone grafts with free flaps provides effective functional and aesthetic restoration for gunshot-induced maxillofacial defects. This case underscores the importance of a multidisciplinary approach and highlights strategies for optimizing outcomes in complex maxillofacial reconstructions.