Zygomaticomaxillary Complex Fractures Research Articles

Outcomes Of Early And Delayed Intervention Of Maxillofacial Trauma

Background: Maxillofacial trauma is routinely evaluated on the basis of high and low velocity injuries, types of fractures in the literature. On the other hand, we have evaluated them on the basis of timing of surgery after trauma and their outcomes. In India RTA (Road traffic accidents) scenario is quite different from other countries. The highway traffic consists of a variety of vehicles from a cyclist, a two-wheeler, a four-wheeler to a heavy loaded truck. Animals like cows and dogs frequent the highways. Hence, we have classified the patients based on Single jaw and Panfacial fractures with or without the presence of extensive soft tissue injuries. Materials and Methods: In this retrospective record-based descriptive study, 200 patients that were treated at Sri Aurobindo Hospital between January 2023 to July 2024 for maxillofacial trauma were reviewed. Of which 176 patients were surgically operated, averaging 30 years of age and ranging from 12-70 years. For the purpose of our study these 176 patients were categorized into two groups, first of single jaw fractures(108 patients) and second of Panfacial fractures (68 patients). Single Jaw fractures were further divided as mandibular (84 patients); maxilla & zygomaticomaxillary complex fractures (24 patients). These were further evaluated and categorized as those patients who were treated within 72 hours (Early) and after 72 hours (Delayed) following injury. All patients of both the groups were treated with open reduction and internal fixation. Individual complications that of soft tissue dehiscence, plate/bone exposure, bone graft rejection, oroantral/palatal fistula, non-union of fractured segments, infections were analyzed. These complications were again assessed on the basis of their timing; those occurring within 72 hours and those after 72 hours. Results: When each type of complication was compared and evaluated, there was significantly more complication noted among delayed group than in early group. Conclusion: The restoration of the aesthetics and functionality of the face, post-trauma is a critical and an arduous task. As the anatomical complexity of the face must be addressed, timely intervention to achieve optimal functional and aesthetic outcomes is pertinent. Thus, the treatment should be done at the earliest when feasible

Secondary Reconstruction of Panfacial Fractures With Virtual Reality Surgical Planning Using Both Pre and Postreconstruction Scans.

Late secondary reconstruction is sometimes required in patients with suboptimal primary panfacial fracture repair. At this stage, it can be difficult to discern original facial architecture due to malunion and bony remodeling. By utilizing the original postinjury CT scan to complete fracture reduction in the virtual reality (VR) planning environment, the surgeon may attempt to recreate an "ideal" facial bony anatomy for patients. This technique was completed in 2 patients presenting with facial deformity secondary to malunited panfacial fracture. Each had a cone-beam CT (CBCT) scan taken at presentation and the initial postinjury CT scans were obtained. Fracture reductions were completed in VR to recreate the preinjury anatomy. The resulting model was overlaid with current anatomy to create surgical aids. The first patient, a 23-year-old man, presented with malunion of all bones of the midface. Cutting guides were designed for the Lefort 1 segment, left zygomaticomaxillary complex (ZMC), and naso-orbito-ethmoid (NOE) osteotomies. The second patient, a 30-year-old woman, had bilateral ZMC and subcondylar fractures, midface retrusion, and malunion of parasymphyseal fracture. A 2-stage procedure was planned, including an initial Lefort I and bilateral sagittal split osteotomy with midline wedge excision. To address malar projection, a second surgery was planned using custom MEDPOR midface implants for the NOE and zygomatic regions. Both patients were discharged home, and all surgical goals and esthetic objectives were achieved.

Facial trauma education in radiology: using surgeon feedback as the benchmark for success.

Interpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports. Radiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings. 26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall's W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits. Compared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

Study Design Retrospective with follow-up. Objective To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods Patients with unilateral ZMC fractures between 2007-2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018-2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery.

A recent algorithm for management of orbital floor fractures with the application of a novel minimally invasive endoscopic surgery

Orbital floor (OF) fractures present a dilemma, with controversies surrounding surgical indication, approach, and ideal material for reconstruction. Our study was conducted on cases of OF fracture admitted to a tertiary referral centre. Cases of OF associated with zygomaticomaxillary complex (ZMC) fracture were managed as follows: those with ophthalmological problems were subjected to endoscopically assisted transorbital reconstruction of the floor; cases without ophthalmological problems were subjected to reduction and fixation of the ZMC fracture only. The recently developed endoscopic endonasal transmaxillary approach was used to manage cases with pure OF fracture, while the same approach with added endoscopic transethmoidal reconstruction of the medial orbital wall (MOW) was applied to cases with associated MOW fracture. Outcome measurements were the correction of diplopia and enophthalmos, along with the restoration of normal globe function. The study included 80 patients, who were divided into four groups according to the proposed algorithm. OF reconstruction was performed in 32 cases with either septal cartilage (n = 4), titanium plate (n = 11), or porous polyethylene mesh (n = 17). Our study presents the novel role of minimally invasive endoscopic surgery in the management of OF fracture, together with a recently developed management plan that could maximize positive outcomes and decrease morbidity.

Patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) versus conventional reduction: a randomized clinical trial

Background and objectives. This study was conducted to evaluate of the patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) Versus Conventional reduction. Materials and methods. In this clinical trial patients were classified into two groups; each group consist of eight patients where the study group represented the use of patient specific guide for reduction and fixation of zygomatic fracture while the Control group represents conventional reduction and fixation of zygomatic fracture. The primary outcome is patient satisfaction while intraoperative time is the secondary outcome. Results. There was no statistical significancy in the overall satisfaction level between CR and GR, also there was no significancy between time consumed in CR and GR as guided reduction technique could save only about 8 minutes. Conclusions. Patient-specific guided reduction is an satisfactory technique for the reduction of Zygomatico-Maxillary Complex (ZMC) fractures. Moreover, this technique decreased the operation time without a statistically significant difference from the conventional technique.

A clinical prospective study on the surgical management of zygomatico-maxillary complex fractures using two-point fixation

The ZMC fractures are one of the most frequently occurring maxillofacial injuries due to its prominence and facial contour. The ZMC forms a principle buttress of face and helps transmit occlusal forces to skull base. Fracture of zygomatic bone leads aesthetic and functional deformity. Restoration to premorbid condition is most predictable by ORIF. In this study was to evaluate efficacy of two-point internal fixation using conventional miniplates and screws for ZMC fractures. 35 patients with established unilateral isolated ZMC fractures were operated using two-point fixation method i.e. the maxillary buttress and the fronto-zygomatic suture, followed up for 3 months. Patients were assessed clinically and radiographically at different follow up intervals. Charts of patients were reviewed for age, gender, etiology, malar height analysis and vertical dystopia. 35 patients in this study, underwent ORIF under GA with two-point fixation. Preoperatively, mean malar height of the patients recorded was 66.55 ± 3.02. There was a significant increase in malar height postoperatively (P < 0.0001). 70.24 ± 2.05, at 1st week, and 69.87 ± 1.98. in 3rd and 6th weeks. Preoperatively, mean vertical dystopia of patients was 2.24 ± 0.71. Postoperative resolution of vertical dystopia was statistically significant (P<0.0001), with value of 0.52 ± 0.52.Integrity of ZMC is important in maintenance of normal facial width and prominence of cheek. Two‑point fixation shows satisfactory results functionally, esthetically and also provides additional advantage by eliminating another surgical site. Thus we conclude that our study provides a basis for further research.

Virtual surgical planning in tripod zygomatico-maxillary complex fractures: A prospective comparison between two different strategies

Multifragmentary and displaced zygomaticomaxillary complex (ZMC) fractures are often a challenge for the maxillofacial surgeon. The aim of this study was to evaluate the improved performance in the management of patients with tripod fracture of the orbito-zygomaticomaxillary complex, using two different methods of virtual surgical planning — virtual reduction and mirroring — compared with traditional management. A cohort of 60 patients was selected and divided into three groups, each consisting of 20 individuals. Patients in the first group were managed using the virtual reduction method, those in the second group using the mirroring method, and those in the third group using a traditional surgical approach. Having achieved virtual fracture reduction, a stereolithographic model was printed, on which preplating of the plates was performed. The results showed that virtual reduction was the most accurate in absolute terms, with a mean discrepancy in juxtaposition of the preoperative and postoperative CT images of 0.175 mm (SD ± 0.147), compared with 0.403 (SD ± 0.166) for the mirror method (and traditional method (0.875, SD ± 0.112; p > 0.0001). The average surgical time for virtual reduction (89.5 min) was faster than for mirroring (94.25 min) and for the traditional approach (96.75 min). In conclusion, the use of virtual surgical planning allows greater intraoperative accuracy, reduced surgical time, and reduced postoperative complications compared with traditional surgery. Of the two methods, virtual reduction performed best for the outcomes decribed.

Surgical correction of facial bone deformity and enophthalmos after tripod fracture using an acellular dermal matrix: a case report.

This paper presents a novel approach to the correction of zygomatic malposition and secondary reconstruction orbital floor fractures, highlighting the use of hydrated acellular dermal matrix (ADM), specifically CGDerm One-Step, in a case where traditional solid implants failed to maintain structural integrity and volume. A 27-year-old woman with persistent facial deformities following a traumatic incident underwent a transformative procedure that utilized ADM for volume correction and structural support, addressing significant challenges such as enophthalmos and facial contour depression. This approach was necessitated by the descent of the entire orbital floor and a previously placed implant (Medpor), leading to unsatisfactory volume correction. By integrating ADM with titanium-reinforced fan plates (Synpor), the surgery successfully restored the patient's facial symmetry and addressed her functional concerns, including diplopia and limited eye movement. Postoperative evaluations demonstrated the long-term effectiveness of this method, with significant improvements in facial contour and eye symmetry. Our findings suggest that ADM, particularly in its hydrated form, offers a reliable alternative to traditional bone grafts and implants for correcting complex craniofacial deformities, providing both aesthetic and functional benefits. This case underscores the importance of adaptable, tissue-mimicking materials in facial reconstructive surgery, offering insights into their potential for broader application in post-traumatic facial corrections.

Recovery of the Infraorbital Nerve Following Open Reduction and Fixation Surgery of Zygomaticomaxillary Complex Fractures-A Prospective Cohort Study Based on Quantitative Sensory Testing.

This study aimed to assess the sensory function of the infraorbital nerve in patients with fractures of the zygomatic complex who underwent open reduction and internal fixation at different time points using quantitative sensory testing, which was established by the German Neuropathic Pain Research Network, comprising a 7-item mechanical and thermal sensory test. A total of 21 patients (age range 17-46y, 14 males) with unilateral zygomatic complex fractures were included. Quantitative sensory testing was conducted before the operation and at 1 week, 3 months, and 6 months operatively, with cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold, mechanical detection threshold, mechanical pain threshold, pressure pain threshold, and vibration detection threshold being measured in bilateral infraorbital regions. Notable changes in sensitivity were observed in all values except for the mechanical pain threshold. In the majority of patients with zygomaticomaxillary complex fractures, infraorbital hypoesthesia was significantly improved within 3 months postoperatively, and almost complete recovery could be achieved by 6 months postoperatively.

Neglected zygomaticomaxillary complex fracture: Report of two cases during the COVID-19 pandemic

Neglected zygomaticomaxillary complex fracture: Report of two cases during the COVID-19 pandemic

Evaluation of Transconjunctival Approach Mixed with Lower Lateral Tarsal Incision for Zygomatico-Maxillary Complex Fracture

Evaluation of Transconjunctival Approach Mixed with Lower Lateral Tarsal Incision for Zygomatico-Maxillary Complex Fracture

Assessment of recovery time for the functional status of infraorbital nerve in open versus closed reduction of zygomatico-maxillary complex fractures: a comparative study

<p>Background and Objective: Zygomatico-maxillary complex (ZMC) fractures and associated infraorbital nerve paresthesia are the most prevalent features of facial trauma associated with road traffic accidents, accidental falls, and violent assaults. The objective of this study was to assess the recovery time of the infraorbital nerve functional status in individuals with paresthesia after open and closed reduction of ZMC fractures.</p> <p>Method: A comparative cohort study was conducted in the Oral and Maxillofacial Surgery Department of Mayo Hospital in Lahore. The study comprised 100 patients with unilateral isolated en bloc ZMC fractures and post-traumatic paresthesia. Patients were equally divided into two groups: Group A comprised of patients who underwent closed reduction while patients of Group B had open reduction with micro plate osteosynthesis. Demographic information, infraorbital nerve healing, post-op complications, and patients’ satisfaction were documented. To compare the outcomes of the two groups, statistical analyses were done and p-value <0.05 was taken as statistically significant.</p> <p>Results: The age distribution revealed a mean age of 37.43 ± 11.06 years, with 72% of the participants being males. In 63% of patients, there was overall functional nerve recovery. After 6 weeks, 74% of those in Group A (closed reduction) had functional nerve recovery, as compared to 52% of those in Group B (open reduction) (p = 0.023). Age subgroup analysis revealed no significant differences in the recovery rates. When compared to Group-A, patients in Group-B showed faster sensory improvement and better satisfaction levels. Complication rates were equal for both approaches.</p> <p>Conclusion: In ZMC fractures with paresthesia, both open and closed reduction procedures yielded good results in recovering infraorbital nerve function; however, the open reduction technique demonstrated quicker sensory recovery and more patient satisfaction.</p>

E-Scooter facial fractures: A comparative cohort study

It was the aim of the study to analyze the distribution and pattern of facial fractures following e-scooter trauma.Prospective audit data of facial fractures were retrospectively collected to investigate the impact of e-scooter hire, specifically in the form of facial fractures associated with their use. Data collected included patient demographics, mode of injury, date of injury, facial bones involved, presence of soft tissue injury, and factors associated with injury, including intoxication and helmet use.A total of 849 patients were treated for facial fractures during the study period, of which 34 were attributed to e-scooter use. One-half of those injured riding e-scooters were intoxicated, and one-quarter were wearing helmets. There have been an increasing number of facial fractures associated with e-scooter use following the start of the shared e-scooter trial. Zygomaticomaxillary complex fractures were the most common pattern of facial fracture seen.Most patients required surgical management of their injuries. Policymakers should consider how to improve the enforcement of current regulations, given the healthcare cost associated with the management of these preventable injuries.

Maxillofacial trauma in geriatric patients in an aging country

Similar to other developing countries, the elderly population has increased in Türkiye in the last 30 years. Due to this increase, there has been a rise in the number of elderly patients suffering from maxillofacial injuries. This retrospective study aimed to evaluate the data of patients with geriatric facial trauma treated in our trauma center between 2010 and 2022 and the leading types of injuries, their causes, accompanying findings, and preferred treatment methods according to sex and age. In the study, the demographic characteristics, including age, sex, comorbidities, causes and sites of injury, treatment options, accompanying injuries, and facial injury severity scores of 292 patients were analyzed. Among more than 4000 patients undergoing treatment for maxillofacial injuries screened from January 2010 to August 2022, 292 (166 males, 56%; age range, 65-98 years) fulfilled the eligibility criteria for the study, of whom 60 had a surgical operation. Falls were the most typical cause of injury (70.20%), followed by motor vehicle accidents (18.15%) and assaults (7.87%). Zygomaticomaxillary complex fractures were the most frequently encountered fracture type (n=126, 29.92%), followed by nose fractures (n=122), orbital fractures (n=85), and mandible fractures (n=72). It was observed that the fractures were managed by surgical intervention or conservative measures and that conservative treatment was mostly preferred at an increasing rate with advancing age. As the elderly population increases, so does the incidence of geriatric facial trauma. Due to increased age, deterioration of health, and increase in the number of comorbidities, surgical interventions are less preferred.

‘Y’ Modification of the cutaneous incision of the preseptal transconjunctival approach for the management of zygomatico-maxillary complex fractures: A prospective clinical study

AimThe purpose of this clinical study was to evaluate the efficacy of the preseptal transconjunctival approach with Y modification of the cutaneous extension for the management of zygomaticomaxillary complex (ZMC) fractures. MethodsThis prospective interventional study was conducted at our institute from 2012 to 2020. The study included patients aged 15–65 years with displaced ZMC fractures. Patients with uncontrolled systemic conditions, infected and/or comminuted fractures were excluded. The variables evaluated were age, gender, mechanism of injury, fracture side, clinical features, surgical exposure time, adequacy of exposure, complications, scar evaluation scores and cosmetic outcomes. The parameters for comparison were operated versus non operated side Eye Fissure Index (EFI) and surgical exposure time was compared with respect to the types of scars. ResultsA total of 49 patients were included in this study. The average exposure time was 18.87 ± 1.92 min. The exposure of fracture site was excellent in 73.5 % and satisfactory in 26.5 %. The mean EFI of operated side was 34.2 ± 5.04 mm while that of non-operated side was 34.22 ± 5 mm. On comparison of the same there was no significant difference. Invisible scars were noted in 71.4 % and barely visible scars in 22.4 %. The comparison of exposure time with type of scars showed a significant association (p = 0.02). The complications noted were chemosis, lower eyelid edema, conjunctival granuloma and entropion. Cosmetic outcomes were fairly satisfactory. ConclusionThe Y modification of the transconjunctival approach can provide excellent surgical exposure without the need for a second incision. Although this approach is technique sensitive and requires experience, the advantages outweigh the learning curve. Since this approach has been widely studied, a systematized review is recommended to further substantiate its reliability and advantages.

Refining Operative Indications for Zygomaticomaxillary Complex Fracture Repair

Study Design Case-control. Objective Although zygomaticomaxillary complex (ZMC) fractures are among the most common facial injuries, the optimal approach to management remains controversial. This study analyzes the relationship between displacement measures derived from pre-operative CT imaging and clinical symptomatology to enhance surgeon understanding of the need for operative intervention. Methods A retrospective analysis was conducted on 95 patients with ZMC fractures seen at a single institution between 2015 and 2020. Patient demographics, CT characteristics, and symptoms prompting surgery were recorded from the medical record. Statistical analysis was conducted to determine relationships between radiographic characteristics, symptomatology, and need for operative intervention. Results Malar flattening or facial asymmetry was significantly predicted by lateral maxillary wall impaction (OR = 1.36 , P < .001) and anterior-posterior displacement (OR = 1.18, P = .01). Infraorbital rim step-off was significantly associated with lateral maxillary wall impaction (OR = 1.23, P < .01). Vertical displacement predicted complaint of malocclusion (OR = 1.47, P = .03). Moreover, fractures with posterior displacement greater than 2.5 mm (OR = 14.3, P < .001) or lateral maxillary wall impaction greater than 4.5 mm (OR = 12.0, P < .001) were significantly more likely to be considered operative. Fractures displaced less than 15 mm total in all directions (OR = 16.0, P < .001) were less likely to require surgery. Conclusions CT characteristics of ZMC fractures reliably predict a patient’s likelihood of developing symptoms, indicating surgical intervention. We hope these findings will aid in surgical decision-making regarding the management of ZMC fractures.

Enhancing Surgical Approach: Breakthrough Markerless Surface Registration With Augmented Reality for Zygomatic Complex Fracture Surgeries.

Innovative technologies with surgical navigation have been used for enhancing surgical accuracies for zygomaticomaxillary complex (ZMC) fractures and offers advantages in precision, accuracy, effectiveness, predictability, and symmetry improvement. Moreover, augmented reality (AR) navigation technology combines virtual reality, 3-dimensional (3D) reconstruction, and real-time interaction, making it ideal for bone tissue operations. Our study explored the usefulness and clinical efficacy of AR technology in intraoperative guidance for reducing ZMC fractures. We retrospectively studied 35 patients with zygomatic complex fractures, comparing outcomes of AR-guided and conventional methods. Furthermore, the AR system provided real-time visualization and guidance. The evaluation included reduction accuracy using root mean square (RMS) value and symmetry analysis using a mirror image of 3D models. Results demonstrated the feasibility and effectiveness of the AR-guided method in improving outcomes and patient satisfaction. In 35 patients (25 males, 10 females), AR-guided (n = 19) and conventional (n = 16) approaches were compared. Age, sex, and fracture type exhibited no significant differences between groups. No complications occurred, and postoperative RMS error significantly decreased ( P < 0.001). The AR group had a lower postoperative RMS error ( P = 0.034). Augmented reality-guided surgery improved accuracy and outcomes in zygomatic complex fractures. Real-time visualization enhanced precision during reduction and fixation. This innovative approach promises enhanced surgical accuracy and patient outcomes in craniofacial surgery.

Pediatric Facial Fractures: Demographics, Injury Patterns, and Associated Injuries in 3334 Patients.

Pediatric craniofacial fractures are fundamentally distinct from their adult counterparts because of unique injury patterns and effects on future growth. Understanding patterns and injury context informs management and risk mitigation. Previous studies include only inpatients, operative patients, or are specialty-specific. In contrast, our study presents a comprehensive assessment of all pediatric facial fracture patients seen at a single institution. Patients under 18 years old who were evaluated for facial fractures at a level I pediatric trauma center between 2006 and 2021 were reviewed. Subanalysis was performed for groups defined by age. Variables studied included demographics, etiology, fracture pattern, associated injuries, management, and outcomes. Three thousand thirty-four patients were included. Mean age at presentation was 11.5 to 4.9 years. The majority were Caucasian (82.6%) and male (68.4%). Sports were the leading cause of injury in older patients (42.2% of patients over 12y), compared with activities of daily living in patients under 6 years (45.5%). Thirty-two percent of patients were hospitalized, 6.0% required ICU care, and 48.4% required surgery. Frequency of ICU admission decreased with age (P<0.001), whereas operative intervention increased with age (P<0.001). Zygomaticomaxillary complex (P=0.002) and nasal fractures (P<0.001) were common in older patients, whereas younger patients experienced more skull (P<0.001) and orbital fractures (P<0.001). The most associated injuries were soft tissue (55.7%) and neurologic (23.6%). This large-scale study provides updated characterization of craniofacial fractures in the pediatric population, providing a necessary framework for future studies on outcomes assessments and preventative care.

Traumatic Hemifacial Avulsion and Degloving Injury With Left Zygomaticomaxillary Complex Fracture: A Case Report

Traumatic Hemifacial Avulsion and Degloving Injury With Left Zygomaticomaxillary Complex Fracture: A Case Report