The zygomaticofacial foramen (ZFF) serves as a critical anatomical landmark in zygomatic implant surgery and facial flap procedures. This study aimed to compare the effectiveness of computed tomography (CT) and cone-beam computed tomography (CBCT) in visualizing the ZFF, and to determine which imaging modality provides greater reliability for clinical and surgical planning. A total of 100 CT and 100 CBCT scans were retrospectively analyzed, providing radiological data from 400 zygomatic bones. The number and location of ZFFs were assessed by 2 independent observers. The relationship between ZFF number and variables such as side, sex, and age was statistically analyzed. Computed tomography and CBCT detected a comparable number of foramina (270 and 267, respectively), with no statistically significant difference between the modalities (P > 0.05). A significant correlation between right and left sides was observed (r = 0.672, P < 0.001), indicating a tendency for bilateral symmetry. The most common finding was the presence of a single foramen (48%), followed by 2 foramina (31.2%). Females exhibited a significantly greater number of foramina than males (P = 0.012), whereas age showed no significant correlation. Both CT and CBCT provide comparable accuracy in detecting the ZFF. This finding is clinically significant as it provides an evidence-based rationale for selecting CBCT, a modality with a lower radiation dose and reduced cost, for preoperative evaluation. These results confirm that clinicians can confidently use CBCT for individualized, imaging-based surgical planning to minimize neurovascular complications without sacrificing diagnostic reliability.

To objectively quantify early and mid-term facial tightening after dual-wavelength Er:YAG/Nd:YAG laser treatment in Chinese women using three-dimensional (3D) imaging. In this prospective observational study, 13 women with lower facial aging underwent four full-face treatment sessions of dual-wavelength Er:YAG/Nd:YAG (Fotona 4D) at 1-month intervals. Standardized 3D facial images were obtained at baseline and at 1 week, 1, 3, and 6 months after completion of the final treatment session. The primary objective outcomes were vertical displacements (mm) of predefined periocular and midfacial landmarks relative to baseline. Secondary outcomes included Wrinkle Severity Rating Scale (WSRS) scores for nasolabial folds and VISIA pore scores, evaluated at baseline and at 3 and 6 months. Adverse events were recorded. 3D analysis demonstrated significant early and mid-term tightening in the lateral periorbital region. The vertical distance from the lateral canthus to the nasal base decreased by approximately 0.50-0.63 mm at 1 week and by 0.60-0.63 mm at 3 months bilaterally (all p < 0.05), with partial rebound but persistence of mild improvement at 6 months. The highest point of the zygomatic bone showed a delayed, mild elevation that peaked around 1-3 months. WSRS scores for nasolabial folds decreased by about 1 grade at 3 and 6 months on both sides (all p < 0.001). VISIA pore scores improved from 4.97 ± 0.36 at baseline to 3.37 ± 0.43 at 3 months and 3.73 ± 0.54 at 6 months (both p < 0.001). Only transient erythema and edema were observed. Dual-wavelength Er:YAG/Nd:YAG laser tightening produced early and mid-term improvements in periocular and midfacial laxity, as captured by 3D landmark displacement, with concomitant improvements in wrinkles and pores. 3D imaging provides a sensitive, objective tool to visualize region-specific dynamic responses to energy-based facial rejuvenation.

Filamentous soil moulds such as Saksenaea and Fusarium are angioinvasive fungi responsible for severe disseminated infections. Saksenaea causes zygomycosis, with disseminated cases having over ninety percent mortality. Fusarium, a hyphomycetes mould, can also cause disseminated infections in immunocompromised individuals, with high mortality. We describe the case of a normally healthy 20-year-old male who survived major traumatic injuries resulting from an aviation incident. He subsequently developed disseminated cutaneous zygomycetes (Saksenaea) and Fusarium infection with associated immunosuppression, multiorgan dysfunction and sepsis. Treatment strategies included repeated and extensive surgical debridement (inferior orbital region to carotid sheath in the neck, to a depth of buccal mucosa and zygomatic bone in the cheek), antifungal agents including intravenous (IV) liposomal amphotericin B and voriconazole, and IV immunoglobulin and granulocyte colony stimulating factor. Despite maximal medical and surgical treatment, disease control was not achieved. After multi-specialty consensus that current management had failed to control the disease process, hyperbaric oxygen treatment (HBOT) was added to standard therapy on an experimental basis based on several case reports, pathophysiological rationale, and institutional experience with angioinvasive Mucor. The patient was on venovenous extracorporeal membrane oxygenation for all HBOT sessions; details are reported separately. Thirteen treatment sessions (243 kPa [2.4 atmospheres absolute], 95 min) were successfully delivered. Local and systemic disease control was achieved within several days of commencing HBOT, and after a prolonged period of rehabilitation and reconstruction, the patient was discharged home. We conclude that HBOT may have an important role in the management of angioinvasive fungal disease.

Zygomatic implants provide a viable solution for the rehabilitation of patients with severe maxillary atrophy, offering improved function and aesthetics in cases where conventional implant placement is not feasible due to insufficient bone quantity and quality. Severe maxillary atrophy, often resulting from tooth loss and sinus expansion, presents significant challenges for implant supported prostheses. Zygomatic implants eliminate the need for extensive bone grafting by anchoring into the zygomatic bone, enabling fixed or removable prostheses. This case report presents two patients with atrophic maxilla rehabilitated using zygomatic implants: one with a history of failed implants and grafts and another with cleft lip and palate. Both patients achieved satisfactory outcomes with minimal complications. Zygomatic implants offer a reliable, long-term solution for severe maxillary atrophy, provided that detailed pre-surgical planning and experienced surgical teams are involved to minimize risks and optimize outcomes.

This review redefines facial "ligaments" as fibrous pseudo-ligaments that compartmentalize and support facial tissues, enabling mobility and maintaining contour. Their density and tensile strength vary across facial subunits, critically influencing the outcomes of minimally invasive procedures like fillers and thread lifts. Significant interethnic differences exist; Caucasians often exhibit flatter malar eminences, while Asians tend to have broader faces with prominent zygomas, leading to divergent presentations of "sunken cheeks." Consequently, procedural strategies must differ. For Asians, augmenting the sub-arch hollow refines contour and provides an efficient lift, whereas Caucasian patients typically require augmentation of the malar eminence and zygomatic arch itself. Effective treatment requires a biomechanical understanding of these ligamentous structures and their ethnic variations.

BackgroundMiniscrew-assisted palatal expansion techniques such as MARPE (Miniscrew-Assisted Rapid Palatal Expansion) and MASPE (Miniscrew-Assisted Slow Palatal Expansion) represents non-surgical alternatives for the correction of transverse maxillary deficiencies in adults. However, concerns have arisen regarding their potential to cause craniofacial complications due to the high forces applied for midpalatal suture opening in skeletally mature patients.MethodologyThis article aims to present and describe isolated clinical cases of cranialfacial complications observed in adult patients following MARPE and MASPE procedures, and to discuss the potential biomechanical mechanisms behind these events. Eleven clinical cases involving adult patients who underwent skeletal midface expansion with miniscrew-assisted devices are presented. All cases exhibited craniofacial unwanted dislocations identified through CBCT imaging, including zygomatic fractures, parasutural bone fractures, and asymmetrical disjunction of craniofacial sutures. These events were retrospectively documented through clinical follow-up and radiographic analysis.ResultsAmong the eleven cases presented, complications included seven asymmetric fractures of the frontonasal process, two orbital fractures, one zygomatic bone fracture, and one parasagittal fracture of the palatine bone. These complications were primarily observed in patients who underwent MARPE with rapid activation protocols. One minor complication occurred in a MASPE case, where the patient followed the prescribed slow activation schedule.ConclusionNon surgical mid facial expansion is a potential source of unwanted and unpredicted dislocations in the craneofacial complex. According to this report the observed complications do not seem to be age related and are difficult to predict from the CBCT. A close clinical follow up including force monitoring and force limitation should be mandatory when performing MARPE. MASPE and minimally invasive SARPE could be alternatives to minimise the incidence of creaniofacial complications.

The rehabilitation of patients with severe maxillary bone atrophy presents significant challenges due to the anatomical characteristics of the maxilla and the limitations of conventional implant techniques. Progressive bone resorption, associated with pneumatization of the maxillary sinus, often makes the use of conventional dental implants unfeasible, due to insufficient bone height and thickness for their installation. Bone grafting techniques have been used as a solution, but involve greater surgical morbidity, high costs and prolonged rehabilitation times. In this context, zygomatic implants emerge as an effective alternative for treating severely atrophic maxillas. This technique, which requires in-depth knowledge of anatomy and biomechanical considerations, allows anchorage in the zygomatic region, reducing morbidity and accelerating the rehabilitation process. Although some surgeons are still hesitant to adopt this approach due to controversies regarding its feasibility, studies have shown that its success rates are comparable to those of conventional implants. The benefits of zygomatic implants are clear, especially in cases of major resorption of the alveolar process and exacerbated pneumatization of the maxillary sinus. They reduce the need for extensive bone grafting, hospitalizations, and associated complications, providing a faster and more efficient solution for the rehabilitation of patients with severe maxillary atrophy. Keywords: Edentulous maxilla, immediate loading, dental implant, zygomatic bone.

Evaluating an osteoid osteoma of the zygomatic bone: A macromorphological and micro-CT study.

A comparison of facial contour and patient-reported outcomes following zygomatic implant perforated (ZIP) flaps and fibular osseous flaps for maxillary reconstruction.

Reliability of Comprehensive Facial Soft Tissue Landmark Detection and Analysis Using Frontal View Photographs.

A digitally designed fixed subperiosteal implant solution for the treatment of the severely atrophic full-arch with an immediate-load protocol.

Background. Osteomyelitis of the jaw is a complication of odontogenic infections, primarily involving the dentate portion of the mandible. Osteomyelitis of the mandibular condyle is exceptionally rare, and spread may occur via hematogenous or contiguous routes (1). We here present a case of osteomyelitis of the mandibular condyle initially diagnosed as Horton's arteritis. Case report. An 87-year-old woman with a recent diagnosis of giant cell arteritis underwent rheumatological evaluation (Figure 1). The patient had been complaining for 1 year of non-NSAIDs-responsive headache in the temporal and preauricular regions and jaw claudication. A few months earlier the headache onset, she underwent a tooth extraction with the positioning of a mobile prosthesis. The patient reported that she was first evaluated by a neurologist who, considering the elevation of inflammatory lab tests (CRP 2.8 mg/dL), diagnosed Horton's arteritis and started prednisone 50 mg/day, with remission of the symptoms, but relapse at steroids tapering. At the first rheumatological evaluation, the patient reported pain in the right temporal region, greater at night, with a sense of ear fullness, hyporexia, and weight loss. In laboratory tests conducted under a low-dose steroids regimen (prednisone 7.5 mg/day), a modest increase in inflammation (CRP 1.5 mg/dL) was observed. For a better diagnostic review, the steroids were discontinued, and the patient underwent a temporal artery Doppler ultrasound, which detected no arteritis-compatible abnormalities. Given the worsening of pain, the rise in inflammation (CRP 4 mg/dL) and the swelling of the soft tissues upon discontinuation of the steroids, the patient underwent an 18FDG-PET/CT scan, which excluded vascular uptake but demonstrated intense uptake of the mandibular condyle, pterygoid muscle, and zygomatic bone. She also underwent a contrast-enhanced CT scan, which revealed erosions and periosteal reaction in the jaw, suggestive of osteomyelitis, along with inflammation of the adjacent soft tissues. Conclusions. Mandibular condyle osteomyelitis is a rare complication of dental infections and invasive dental procedures. The associated symptomatology (temporal headache, difficulty in chewing) may resemble giant cell arteritis. An accurate medical history, which also examines previous dental history and pain features, may guide the diagnosis. Anyway, radiologic exams and/or temporal artery biopsy are still necessary for differential diagnosis.

BackgroundGeriatric populations face heightened vulnerability due to aging, socioeconomic challenges, and marginalization. In 2023, 18.1% of Germans over 65 were at risk of poverty, with women and those aged 80 + disproportionately affected. The SARS-CoV-2 pandemic (2020–2022) exacerbated these issues, restricting healthcare access. This study investigates geriatric head and neck trauma trends (2018–2024) across pre-pandemic, pandemic, and post-pandemic periods.MethodsConducted at a level 1 trauma centre, data were sourced from the Dortmund Maxillofacial Trauma Registry (14,500 + cases, 2007–2024). Fractures were categorized per AO guidelines, and demographic analyses, fracture distribution and other medical conditions were presented.ResultsThis study analysed 973 geriatric head and neck trauma cases (2018–2024). Falls were predominant (82.6%), with significant comorbidities (2.6 per patient), including hypertension (64%). Males experienced a 73% decrease in case numbers in 2021. Injuries primarily affected the midface, with 52% requiring surgery. Pandemic disruptions influenced trends, highlighting geriatric trauma complexity and care demands are detailed analysed.DiscussionOur study presents comprehensive data on geriatric head and neck traumatology, analyzing 65–75 y.o. and > 75 y.o. groups. Male predominance was significant at 65–70 y.o. (p < 0.001) but reversed above 75 y.o., with significant female dominance. Since the SARS-CoV-2 pandemic, case numbers showed extreme volatility, with a 30% rise in females and 90% in males in 2021, followed by a record low in 2022. Cerebral injuries occurred in 49.3% of patients, with 2.6 comorbidities per capita and 52% requiring surgery. Anticoagulant therapy was frequent (≈ 74% antiplatelet, 26% anticoagulant). Falls caused 82% of injuries, predominantly affecting the nasal bone, zygomatic bone (218), and orbital floor (262), indicating high vulnerability in this population.ConclusionOur study reveals volatility in case numbers post-SARS-CoV-2, with males disproportionately affected. A high proportion of elderly patients take anticoagulants. Among the injured, there is a high rate with cerebral injury. Most fractures occur in exposed facial regions. Ongoing surveillance is essential to address increasing geriatric vulnerability.

Summary:Pediatric midfacial tumor reconstruction is challenging due to complex anatomy and the need to preserve growth potential. This study presented a novel approach using a 3D-printed surgical guide jigsaw puzzle model and recycled frozen autografts for precise, minimally invasive reconstruction. A 6-year-old boy with spindle cell sarcoma of the right zygomatic bone underwent neoadjuvant chemotherapy before surgery. Preoperative computed tomography imaging and computer-assisted planning determined the resection margin. A polylactide 3-dimensional–printed skull model facilitated preoperative simulation, whereas a stereolithography-fabricated, 5-piece surgical guide enabled precise osteotomy through minimal incisions. The tumor-bearing bone was treated with liquid nitrogen cryotherapy and reimplanted as a recycled autograft. At 20 months postoperatively, the patient demonstrated symmetrical facial appearance, intact sensation, and no visible scarring. Imaging confirmed graft survival, osteotomy healing, and no recurrence. This technique offers an effective, tissue-sparing solution for pediatric craniofacial reconstruction, enhancing precision while minimizing morbidity.

Population-level morphological differences in human cranio-skeletal morphology are reflective of a multitude of genetic, epigenetic, functional and environmental factors. While such differences have been described in postnatal and adult skeletons, how early they originate during cranio-skeletal ontogeny is unknown. Here we compare early human facial morphogenesis utilizing a collection of fetal specimens of Japanese (JP) and North American - European ancestry (NAP). Utilizing 3D micro-CT images and geometric morphometric analyses, we have identified subtle, yet significant differences in the morphology of the upper and midfacial regions in fetuses in the second trimester of gestation. Notably, the orbital rims and lateral areas of the zygomatic bones in the JP specimens have more prominent superior and inferior orbital rims, with a more prominent lateral project of the zygomatic bone, compared to the NAP. These data suggest that the cranioskeletal structures display early facial patterning unique to genealogically distinct populations. Since these specimens are derived from very early developmental stages, the impacts of functional factors are expected to be minor, while inherited genetic and epigenetic programming predominate in driving the observed morphological differences.

Osteocytes express numerous G protein-coupled receptors (GPCRs) and mice lacking the stimulatory subunit of G-protein (Gsα) in osteocytes (DMP1-GsαKO mice) have severe osteopenia. We previously demonstrated that the severe osteopenia in these mice was mediated by increased sclerostin expression, which suppresses osteoblast functions. In this study we analyse both the craniofacial and tooth characteristics of these mutant mice. A total of 28, 6-8-week-old mice were used (Gsα fl/fl or Control, DMP1-Cre;Gsα fl/fl or DMP1-GsαKO). Total bone mineral density (BMD), total bone mineral content (BMC), condyles' BMD and incisor mineralisation were quantitatively assessed by DEXA. Bone microarchitecture of the mandible and full head of mice was quantitatively assessed with high-resolution micro-computed tomography (μCT). For the condylar region, we assessed total BMD and bone volume fraction (BV/TV, %). Three linear measurements of the mandible were measured: mandibular length, condyle head length and condyle head width, and samples were assessed by histomorphometric analysis. DMP1-GsαKO mice have decreased total mandibular BMD, total mandibular BMC, condylar BMD and total tooth mineralisation as assessed by DEXA. μCT analysis revealed that condylar bone volume and tooth mineralisation were reduced in DMP1-GsαKO mice and showed that skull size and specifically the zygomatic bone were larger in control. H&E histological sections of the jaws of DMP1-GsαKO mice confirmed the osteopenic phenotype. Tartrate-resistant acid phosphatase (TRAP) staining showed that the number of TRAP-positive osteoclasts was increased in the DMP1-GsαKO mice compared to controls, suggesting increased bone resorption. Our studies identified Gsα signalling in osteocytes, mature osteoblasts and odontoblasts, as important in maintaining normal bone and tooth homeostasis.

Background and aims: Long-term follow-up after 3D reconstruction in the orbital area show improvements in cosmetic appearance, ocular motility, and resolution of issues like enophthalmos and diplopia, with some residual symptoms and rare complications. The study aims to assess clinical outcomes of 3D printing for reconstructing orbital bone defects in patients receiving PEEK and PMMA implants. Materials and methods: A study conducted at the Military Hospital in Sana'a, Yemen, involved seven patients with orbital fractures who underwent 3D-printed orbital bone repair. Conventional treatments had previously failed in these patients. Examinations included computed tomography (CT), functional assessments, and preoperative evaluations. GOM and ATOS technologies were used to develop customized 3D-printed implants, and general anesthesia was used during the surgeries. Results: The group, consisting of 100% males and 0.0% females, had a mean age of 30.3 years. Six cases showed positive outcomes, while the third case failed due to issues like loose orbital rim, blocked tear duct, allergies, and patient disengagement. The study reveals that 42.9% of patients underwent orbital bone reconstruction surgery using 3D printing technology, with 42.9% experiencing pain, 7.7% experiencing aesthetic deformity, and 23.6% experiencing infection. The reconstruction material used was polyether ether ketone (PEEK), polymethyl methacrylate (PMMA), or poly-cule. The study found that 28.6% of patients had fractures in the mandible, maxilla, nose, zygomatic bone, orbit, and frontal bone. Comminuted fractures were found in all seven patients, and no simple, compound, or complex fractures were recorded. The study found that 57.1% of patients were highly satisfied with their surgical results, with 14.3% satisfied and 28.7% dissatisfied, with all patients demonstrating good quality of life. Conclusion: The study found seven patients had imperfect orbital fractures, with a third having fractures in various areas. Comminuted fractures were common, with high instability rates. Most patients were satisfied with their surgical results and quality of life, supporting the use of 3D navigation for complex orbital reconstruction. Peer Review History: Received 2 August 2025; Reviewed 10 September 2025; Accepted 19 October; Available online 15 November 2025 Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com Reviewers: Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, summitpharm@yahoo.com Prof. Syamsudin Abdillah, Pancasila University, Indonesia, syamsudin.abdillah@gmail.com

Osteoradionecrosis (ORN) of the maxilla is relatively uncommon. To the authors' knowledge, no previous reports have described reconstruction of malar and maxillary ORN using a thoracodorsal artery perforator flap combined with scapular bone. This flap has been used in oncologic resection, craniofacial dysplasia, and trauma, and it is also suitable for ORN reconstruction. The authors report a case involving a 60-year-old woman who developed malar and maxillary ORN 3 years after chemoradiotherapy for maxillary sinus carcinoma. The defect was reconstructed using this chimeric free flap, with additional correction of the lower eyelid for aesthetic refinement. A subsequent minor revision requested by the patient, using non-vascularized tissue, resulted in local infection that required drainage. Although this led to contour irregularity, further surgical correction achieved satisfactory cosmesis. At more than 14 years postoperatively, the flap remained stable without significant bony resorption. The authors present the long-term clinical course and surgical considerations of this rare case.

The use of computed tomography in the placement of miniscrew is an integral part of orthodontic treatment. At the moment, the most common places for the placement of miniscrew in orthodontic practice on the upper and lower jaw are: inter-root miniscrew, pterigo-maxillary, buccal shelf, zygomatic IZC, retromolar, in the area of the hard palate. We analyzed CT of 28 people aged 18-33. As a result, it was found that bone type D1 is less common in orthodontic practice, where mini-screws are required. Type D2 is more common in the anterior-upper or posterior-upper segment of the jaw. According to the Hounsfield scale, bone type D3 is more common in the anterior-upper or posterior-upper segment of the jaw or in the posterior-lower segment of the jaw, while bone type D4 is more common in the zygomatic bone. Based on these findings, we selected specific types of mini-screws and their placement locations.

Osteoradionecrosis (ORN) of the jaws is a severe complication of radiotherapy for head and neck cancers and is characterised as hypovascular, hypocellular and hypoxic tissue. ORN is more commonly seen in the mandible and only occasionally in the maxilla and zygomatic bone. The present case describes atypical features of ORN that developed in the zygomatic bone in a relatively young patient after Intensity-Modulated Radiation Therapy (IMRT). A 42-year-old male with squamous cell carcinoma of the right buccal mucosa underwent IMRT (60 Gy in 30 fractions). Ten days after radiotherapy, he presented with extraoral wound dehiscence, purulent discharge and severe pain. Clinical examination revealed erythema and inflammation, with a 7.8 mm oro-cutaneous fistula near the maxillectomy site. Histopathology showed necrotic bone with bacterial invasion and culture identified MethicillinSusceptible Staphylococcus Aureus (MSSA). Conservative management with antibiotics and local wound care was initiated because there was no evidence of severe necrosis or a pathologic fracture. Hyperbaric Oxygen Therapy (HBOT) was unavailable, but the patient responded well. Sequestrectomy was planned, illustrating that early-stage ORN can be managed conservatively when HBO is inaccessible. The present case highlights the need for personalised management plans and underscores close surveillance in the initial stages of ORN. The report discusses early diagnosis, culture-guided antibiotics and an individualised approach to treatment for patients with ORN.