Maxillofacial Bone Involvement in Fibro-Osseous Lesions: Emphasizing the Significance of Differential Diagnosis.

The World Health Organization's (WHO) 2022 update on the classification of odontogenic and maxillofacial bone tumors has revolutionized diagnostic and treatment paradigms by integrating novel molecular insights. Fibro-osseous lesions of the maxillo-facial bones constitute a heterogeneous group encompassing fibrous dysplasia, Psammomatoid Ossifying Fibroma (PSOF), Juvenile Trabecular Ossifying Fibroma (JTOF), and other variants. Despite histological similarities, their distinct clinical manifestations and prognostic implications mandate precise differentiation. The intricacies of diagnosing fibro-osseous lesions pose challenges for pathologists, maxillofacial surgeons, dentists and oral surgeons, underscoring the importance of a systematic approach to ensure optimal patient management. Herein, we present two cases, fibrous dysplasia and Cemento-Ossifying Fibroma, detailing their clinical encounters and management strategies. Both patients provided informed consent for publishing their data and images, adhering to ethical guidelines.

Systematic review of non-invasive ventilation and craniofacial fractures: a multidisciplinary perspective and recommendations for management.

The anatomically complex craniofacial skeleton demands special consideration when caring for cases of polytrauma or medically compromised patients with craniofacial fractures. This paper utilises a systematic review and multidisciplinary opinions to create an algorithm for the hospital-based care of patients with craniofacial fractures (base of skull, orbit, paranasal sinus, and mandible) who require non-invasive ventilation (NIV). Each fracture location has a unique predisposition to a different type of emphysema and associated morbidity. The risk of developing emphysema, combined with its potential severity, is stratified against the harm of not providing NIV for the holistic care of the patient. The aim of this paper is to synthesise evidence from a systematic review of existing literature with multidisciplinary opinions to develop a concise algorithm that outlines the optimal treatment of patients with craniofacial fractures who require NIV.

O trauma de face submetido a cirurgia: Uma análise epidemiológica de 10 anos no interior do Brasil / Facial trauma undergoing surgery: A 10-year epidemiological analysis in the interior of Brazil

Introdução: O trauma de face representa significativa incapacitação para a vítima, além de um desafio para as equipes de saúde devido a sua complexidade e envolvimento de estruturas nobres. Analisar a sua epidemiologia permite coordenar medidas em saúde pública para melhorar o atendimento e a prevenção. Método: Estudo observacional, descritivo, longitudinal, com abordagem retrospectiva a partir dos prontuários dos pacientes vítimas de trauma de face atendidos pela clínica cirúrgica no período entre 2010 e 2019. Resultados: Dentre os 529 prontuários incluídos no estudo e analisados, 71,08% tratava-se de cirurgias eletivas e o restante, 28,92%, de cirurgias de urgência. O trauma foi mais frequente em indivíduos de 20 a 29 anos, o que corresponde a 31,76% do total de casos. Também foi mais frequente em indivíduos do sexo masculino, correspondendo a 78,45% do total de casos. Acidentes automobilísticos foram a causa mais comum, descrita em 22,31% dos prontuários, e a principal fratura, presente em 85,83% dos casos, foi dos ossos próprios do nariz. Conclusão: As vítimas de traumatismo bucomaxilofacial atendidas no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro são predominantemente homens na terceira década de vida, envolvidos em acidentes automobilísticos, com lesões em ossos do nariz que foram abordadas de forma eletiva.

Introduction: Facial trauma represents significant incapacitation for the victim, as well as a challenge for healthcare teams due to its complexity and involvement of important structures. Analyzing its epidemiology allows us to coordinate public health measures to improve care and prevention. Method: Observational, descriptive, longitudinal study with a retrospective approach based on the medical records of patients who suffered facial trauma treated by the surgical clinic between 2010 and 2019. Results: Among in individuals aged 20 to 29 years, which corresponds to 31.76% of total cases. It was also more common in males, corresponding to 78.45% of total cases. Car accidents were the most common cause, described in 22.31% of medical records, and the main fracture, present in 85.83% of cases, was of the bones of the nose. Conclusion: Victims of oral and maxillofacial trauma treated at the Hospital de Clínicas da Universidade Federal do Triângulo Mineiro are predominantly men in their third decade of life, involved in automobile accidents, with injuries to the bones of the nose that were treated electively.

Biotipo facial y clasificación esquelética maxilomandibular en pacientes angolanos con anomalías dentomaxilofaciales

Fundamento las mediciones cefalométricas son un instrumento útil en la atención ortodóncica, pues junto a otras mediciones cefalométricas completan y guían el plan de tratamiento que el especialista puede trazar en función de la resolución de las anomalías dentomaxilofaciales. Objetivo determinar la comorbilidad entre el biotipo facial y la clasificación esquelética maxilomandibular en pacientes angolanos con anomalías dentomaxilofaciales. Métodos se realizó un estudio descriptivo transversal, en la Clínica Meditex, en Luanda, Angola, en el período agosto/2021-julio/2023. La población de estudio fue de 123 telerradiografías del perfil de pacientes con anomalías dentomaxilofaciales, ingresados en la consulta de Ortodoncia. Para el análisis de la telerradiografía de perfil se realizaron mediciones del cefalograma de Ricketts y de Steiner, y se utilizó el software Facad versión 3403. Se estudió la clasificación esquelética maxilomandibular (clase I, clase II, clase III) y el biotipo facial (dolicofacial, mesofacial, braquifacial). Resultados el 46,34 % de los pacientes presentó una clase II esquelética maxilomandibular. Mediante el índice VERT de Ricketts, el 49,59 % de los casos fue clasificado como dolicofacial, seguido del 42,27 % como braquifacial. El 83,60 % de los pacientes con biotipo dolicofacial se caracterizó por presentar una clase II esquelética maxilomandibular, y el 76,92 % de aquellos con biotipo braquifacial clasificó como clase III. Se encontró una asociación significativa entre el biotipo facial y la clasificación esquelética maxilomandibular (p= 0,000). Conclusiones en la mayoría de los pacientes con anomalías dentomaxilofaciales se evidenció una relación entre el biotipo dolicofacial y la clase II esquelética maxilomandibular, por lo que existe una comorbilidad entre ambas características esqueléticofaciales.

Foundation cephalometric measurements are a useful instrument in orthodontic care, since together with other cephalometric measurements they complete and guide the treatment plan that the specialist can draw up based on the resolution of dentomaxillofacial anomalies. Objective to determine the comorbidity between facial biotype and maxillomandibular skeletal classification in Angolan patients with dentomaxillofacial anomalies. Methods a cross-sectional descriptive study was carried out at the Meditex Clinic, in Luanda, Angola, from August/2021 to July/2023. The studied population was 123 patients' profile teleradiographs with dentomaxillofacial anomalies, admitted to the Orthodontic clinic. For the analysis of the profile teleradiography, measurements of the Ricketts and Steiner cephalogram were made, and the Facad software version 3403 was used. The maxillomandibular skeletal classification (class I, class II, class III) and the facial biotype (dolichofacial, mesofacial, brachyfacial) were studied. Results 46.34% of patients presented maxillomandibular skeletal class II. Using the Ricketts VERT index, 49.59% of cases were classified as dolichofacial, followed by 42.27% as brachyfacial. 83.60% of patients with dolichofacial biotype were characterized by having maxillomandibular skeletal class II, and 76.92% of those with brachyfacial biotype were classified as class III. A significant association was found between facial biotype and maxillomandibular skeletal classification (p= 0.000). Conclusions in the majority of patients with dentomaxillofacial anomalies, a relationship was evident between the dolichofacial biotype and the maxillomandibular skeletal class II, so there is a comorbidity between both skeletal-facial characteristics.

The Adelaide Facial Bone Rule: A simple prediction model and clinical guideline for the presence of facial fractures using CT brain scans in victims of minor trauma.

BACKGROUND: Facial fractures bleed, resulting in high-density fluid in the sinuses (haemosinus) on computed tomography (CT) scans. A CT brain scan includes most maxillary sinuses in the scan field, which should allow detection of haemosinus as an indirect indicator of a facial fracture without the need for an additional CT facial bone scan, yet no robust evidence for this exists in the literature. The aim of this study was to determine whether the presence of haemosinus on a CT brain scan, alone or in combination with other clinical information, can predict the presence of facial fractures. METHODS: 1231 adult patients, who had both brain and facial CT scans performed on the same day, were selected from a seven year period. Patients were eligible if scans were requested for trauma. Brain and facial scans were reviewed separately for the presence of facial fractures, haemosinus, emphysema and intra-cranial haemorrhage. Prediction modelling was used to assess whether findings from brain scans could be used to identify patients requiring further CT scanning. FINDINGS: The full prediction model included four predictors and showed excellent discrimination (AUROC 0.982; 95 % CI 0.971 - 0.993). A simplified model, more suitable for clinical implementation, used only facial fractures and haemosinus as predictors. This model showed only marginally poorer discrimination (AUROC 0.964; 95 % CI 0.945 - 0.983) and excellent performance on other measures. CONCLUSION: Based on the excellent performance of the simplified prediction model, we present the Adelaide Facial Bone Rule: The absence of blood in the sinuses or facial fractures on a CT brain scan means a CT facial bone scan does not need to be routinely performed in the setting of clinically-determined minor trauma.

Midface hypoplasia in syndromic craniosynostosis: predicting craniofacial growth via a novel regression model from anatomical morphometric analysis.

Midface hypoplasia in syndromic craniosynostosis (SC) may lead to serious respiratory issues. The aim of this study was to analyse the morphometric correlation between midface and cranial base parameters in paediatric SC patients in order to formulate predictive regression models. The computed tomography scans of 18 SC patients and 20 control were imported into Materialise Mimics Medical version 21.0 software for the measurement of multiple craniofacial landmarks and correlation analysis. The results showed a strong correlation of anterior cranial base (SN), posterior cranial base (SBa), and total cranial base (NBa) (r = 0.935) to maxilla length and width (ZMR-ZML) (r = 0.864). The model of NBa = - 1.554 + 1.021(SN) + 0.753(SBa) with R2 = 0.875 is proposed to demonstrate the development of the cranial base that causes a certain degree of midface hypoplasia in SC patients. The formula is supported using a prediction model of ZMR-ZML = 5.762 + 0.920(NBa), with R2 = 0.746. The mean absolute difference and standard deviation between the predicted and true NBa and ZMR-ZML were 2.08 ± 1.50 mm and 3.11 ± 2.32 mm, respectively. The skeletal growth estimation models provide valuable foundation for further analysis and potential clinical application.

Risk of complications in panfacial bone fracture according to surgeons: A meta-analysis.

BACKGROUND: Panfacial bone fractures pose intricate challenges because of severe fragmentation and the loss of landmarks. Surgeons use a variety of reduction techniques, including bottom-up and top-down approaches. This single proportional meta-analysis explores sequencing differences and complications between oral and maxillofacial surgery surgeons (OMSs) and plastic and reconstructive surgeons (PRSs) in treating panfacial bone fractures. METHODS: The PubMed and Scopus databases were searched systematically, and we compiled 14 studies published between 2007 and 2023 involving 1238 patients. A systematic review of the included studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data on the reduction techniques; total complication rates; and rates of malocclusion, enophthalmos, infection, asymmetry, and esthetic complications were collected. RESULTS: The bottom-up technique was the most prevalent for both types of surgeons (57.1%, 8 out of 14). Malocclusion rates (I2 = 0% for OMSs and 41% for PRSs) were similar between the groups (p = 0.72), but PRSs tended to have a lower enophthalmos rate (I2 = 0% for OMSs and 32% for PRSs) than OMSs (p < 0.01). Infection rates remained consistent across all studies. However, high heterogeneity was observed for the total complication rate (I2 = 94% for OMSs and 85% for PRSs) and asymmetry and esthetic complications (I2 = 88% for OMSs and 92% for PRSs), making direct comparison between the two groups inconclusive. CONCLUSIONS: In this study, the differences in surgical techniques and levels of interest have a greater impact on the outcomes of the panfacial bone fracture than the surgeon's specialty. However, more in-depth studies are needed to accurately pinpoint panfacial bone fracture reduction trends and differences in postoperative complications in the two expert groups.

Tratamiento de las fracturas maxilofaciales en un hospital cubano durante la pandemia de COVID-19

Introducción: La epidemiología de las fracturas maxilofaciales varía en dependencia de los estilos de vida, el nivel cultural y el estatus socioeconómico en diferentes zonas geográficas. Objetivo: Caracterizar epidemiológica y terapéuticamente a los pacientes con fracturas maxilofaciales, atendidos en un hospital universitario cubano durante la pandemia de COVID-19. Métodos: Se realizó un estudio observacional, descriptivo y transversal a los pacientes atendidos en el Servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia Granma, durante el 1 de enero y el 31 de diciembre de 2020. Se estudiaron variables epidemiológicas y terapéuticas. Resultados: Se incluyeron 85 pacientes con 220 fracturas. Los hombres fueron los más afectados (n = 74; 87,06 %) y la proporción hombre/mujer resultó de 6,73:1. El grupo etario de 41-60 años (n = 40; 47,06 %) sobresalió. En el 38,89 % de los casos el trauma se relacionó con violencia interpersonal. Cincuenta y cuatro pacientes (63,52 %) tuvieron fracturas del complejo cigomático. El ángulo mandibular constituyó la localización anatómica más afectada. Las fracturas mandibulares se trataron fundamentalmente mediante reducción cerrada. Conclusiones: El perfil epidemiológico de las fracturas maxilofaciales se destacó en los pacientes adultos masculinos debido, principalmente, a la violencia interpersonal. Las fracturas complejas del tercio medio facial se trataron por método abierto. La distribución temporal de los casos mostró el impacto de la COVID-19 en la epidemiología de estos traumas.

Introduction: The epidemiology of maxillofacial fractures varies according to lifestyles, cultural level and socioeconomic status in different geographical areas. Objective: To characterize epidemiologically and therapeutically the patients with maxillofacial fractures treated in a Cuban university hospital during the COVID-19 pandemic. Methods: An observational, descriptive and cross-sectional study was carried out on patients attended at the Maxillofacial Surgery Service of the General University Hospital "Carlos Manuel de Céspedes" of Bayamo, Granma province, between January 1 and December 31, 2020. Epidemiological and therapeutic variables were studied. Results: 85 patients with 220 fractures were included. Men were the most affected (n = 74; 87.06 %) and the male/female ratio was 6.73:1. The age group 41-60 years (n = 40; 47.06 %) stood out. In 38.89 % of the cases the trauma was related to interpersonal violence. Fifty-four patients (63.52 %) had fractures of the zygomatic complex. The mandibular angle was the most damaged anatomical location. Fractures were treated primarily by closed reduction. Conclusions: The epidemiological profile of maxillofacial fractures was prominent in adult male patients mainly due to interpersonal violence. Complex fractures of the midfacial third were treated by open method. The temporal distribution of the cases showed the impact of COVID-19 on the epidemiology of these traumas.

The Facial Osteoplasty for Polyostotic Fibrous Dysplasia in a Patient With McCune-Albright Syndrome: A Case Report.

Fibrous dysplasia is a developmental anomaly that affects bone maturation and remodeling, generating replacement of medullary and cortical bone by a disorganized and immature fibro-osseous matrix, which makes the sufferer susceptible to bone pain, skeletal deformities, and pathological fractures. This is a condition that, when associated with cutaneous hyperpigmentation and endocrinological disorders, forms the classic triad of McCune-Albright syndrome, a rare multisystemic pathology formed by postzygotic somatic mutations of the GNAS gene. Fibrous dysplasia can even cause loss of vision, hearing, or difficulty breathing. The severity of these manifestations is associated with the type of treatment, which can be conservative or surgical. The surgical approach is adapted to each particularity and it aims mainly to resolve functional restrictions or correct aesthetic deformities through bone plasty. The present work aims to report the case of a McCune-Albright syndrome patient with deforming craniofacial fibrous dysplasia that triggers respiratory compromise. After clinical and tomographic evaluation, it was decided to remove and reshape the bone affected in the maxilla through the Weber-Ferguson approach and the mandible through the modified Newman approach. The case progressed satisfactorily, with an improvement in the respiratory condition and a reduction in facial asymmetry.

Fratura de mandíbula: análise de 50 casos cirúrgicos em um hospital escola / Jaw fracture: analysis of 50 surgical cases in a teaching hospital

Introdução: A mandíbula é o maior e mais forte dos ossos da face. Em razão de sua topografia, apresenta vulnerabilidade nos traumas. A análise de dados sobre as fraturas de mandíbula se mostram fundamentais para auxiliar no tratamento e em políticas de saúde pública. O objetivo desse estudo é realizar um levantamento epidemiológico de fraturas mandibulares tratadas cirurgicamente. Método: Triagem através do sistema de informação hospitalar, buscando pacientes submetidos a cirurgia para fratura de mandíbula realizadas em um hospital escola pela equipe de cirurgia plástica, em Campinas-SP, de abril de 2015 a abril de 2020. Foram, então, coletados dados por meio da análise de prontuários. Resultados: Foram incluídos 50 pacientes, sendo 90% do sexo masculino. A média de idade foi 30,7 anos. A etiologia predominante foi acidente automotivo e a região mais fraturada na mandíbula foi a parassínfise. A mediana de tempo entre o trauma e cirurgia foi de 19 dias. Onze (22%) pacientes apresentavam alguma comorbidade. Quatorze pacientes (28%) foram internados em Unidade de Terapia Intensiva (UTI) e 42% operaram com outra especialidade além da Cirurgia Plástica. Dez (20%) pacientes apresentaram alguma complicação da cirurgia, sendo a mais comum a deiscência de ferida operatória. Conclusão: Houve predominância entre homens jovens e de acidentes de trânsito como etiologia. As fraturas foram localizadas preferencialmente na região da parassínfise e foram tratadas por meio de fixação interna rígida. Os elevados índices de internação em UTI, lesões associadas e realizações de procedimentos cirúrgicos por outras especialidades evidenciam a gravidade dos pacientes assistidos no serviço.

Introduction: The mandible is the largest and strongest of the bones in the face. Due to its topography, it is vulnerable to trauma. Data analysis on mandible fractures is fundamental for treatment and public health policies. This study aims to conduct an epidemiological survey of surgically treated mandibular fractures. Method: Screening through the hospital information system, seeking patients undergoing surgery for jaw fracture performed at a teaching hospital by the plastic surgery team in Campinas-SP from April 2015 to April 2020. Data were then collected through analysis of medical records. Results: 50 patients were included, 90% male. The average age was 30.7 years. The predominant etiology was an automobile accident, and the most fractured region in the mandible was the parasymphysis. The median time between trauma and surgery was 19 days. Eleven (22%) patients had some comorbidity. Fourteen patients (28%) were admitted to the Intensive Care Unit (ICU), and 42% underwent surgery with another specialty besides Plastic Surgery. Ten (20%) patients had some complication of the surgery, the most common being surgical wound dehiscence. Conclusion: There was a predominance among young men and traffic accidents as etiology. Fractures were preferably located in the parasymphysis region and were treated using rigid internal fixation. The high rates of ICU admission, associated injuries, and surgical procedures carried out by other specialties demonstrate the severity of the patients assisted in the service.

E-Scooters and Craniofacial Trauma: A Systematic Review.

Study Design: Systematic review. Objective: Standing electric scooters (e-scooters) provide a cheap and environmentally friendly transport alternative, but also elicit substantial concern regarding their volume of associated injuries especially in the craniofacial region. This review aims to explore the demographics, risk factors, types of injury and surgical management of craniofacial trauma associated with e-scooters. Methods: PubMed and Scopus databases were systematically searched. Inclusion criteria were clinical studies investigating craniofacial trauma associated with e-scooters. Exclusion criteria were duplicates; non-English publications; non-full-text publications; studies with insufficient data. Results: Of the 73 articles identified, 10 eligible articles representing 539 patients were included. The mean age was 31.5 years. Most cases were male (63.7%). Common risk factors were alcohol/drug intoxication, absence of distal extremity injuries and lack of helmet use. The most common mechanism of injury was mechanical falls (72.4%). The most common facial fracture pattern was middle third fractures (58.3%). Surgical management was required for 43.3% of fractures. Other types of injuries reported were traumatic brain injuries (17.6%), soft tissue injuries (58.3%), dental injuries (32.9%) and ophthalmological injuries (20.6%). Conclusions: The findings of this review suggest common presentations for craniofacial trauma associated with e-scooters. Robust longitudinal evaluations with standardised descriptions of types of injuries are required. Gaps in knowledge relate to surgical management, post-operative complications and associated risk factors.

The ideal shape of the female jaw angle: An online survey.

The aim of this study was to determine the characteristics of an attractive white female jaw angle in the three dimensions. An online survey of photographs of celebrities and laypeople was used to rate their attractiveness using 6 questions and a 3-item Likert scale. If ≥ 80% of participants rated a model as having attractive aesthetic features, it was considered attractive. The following features were considered important: a gonial angle in profile of 125.5° and in anterior view of 142°, an intergonial-interzygomatic width ratio of 0.83 and the vertical position of the jaw angles at the level of the stomion or upper lip. Surgeons can use these consensus criteria to help design a jaw angle implant, define orthognathic surgical strategies, or shape the angle using injectables.

A Massive Craniofacial Polyostotic Fibrous Dysplasia of Midface - A Rare Case Report.

Rationale: Fibrous dysplasia (FD) is a fibro-osseous lesion of the osseous structures of the body. With an incidence of 1:4000-1:10,000, it seems to be a rare disease. Polyostotic craniofacial fibrous dysplasia involves the skull base bones and facial bones. Patient Concerns: The patient complained of a huge swelling over the right side of her face for the past 12 years. Diagnosis: Based on clinical, radiological and histopathological findings, the swelling was diagnosed as polyostotic craniofacial FD. Treatment: Swelling over the right side of the midface around 6 cm × 5 cm involving right maxilla, zygoma, floor of orbit, lateral side of nose (pyriform aperture) and skull base bones. Since the patient had no functional deficit, we opted for surgical recontouring. Outcomes: The patient was satisfied with post-operative results. Take-Away Lessons: In huge asymptomatic facial deformity, rather than going for resection, we can remove bone in a piecemeal manner followed by recontouring.

Relationship between midfacial fractures and maxillary sinus pathology.

BACKGROUND: Midfacial fractures frequently involve the maxillary sinus, leading to maxillary sinus pathology. We aimed to examine the incidence and contributing factors of maxillary sinus pathology in patients who underwent open reduction and internal fixation (ORIF) for midfacial fractures. METHODS: A retrospective analysis was conducted on patients who underwent ORIF for midfacial fractures at our department over the past 10 years. The incidence of maxillary sinus pathology was identified clinically and/or by computed tomography findings. Factors that significantly influenced the groups with and without maxillary sinus pathology were examined. RESULTS: The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was found to be 11.27%, with sinusitis being the most common pathology. Maxillary sinus pathology was significantly associated with the presence of a blowout fracture involving both the medial and the inferior orbital walls. Factors such as sex, age, diabetes mellitus, hypertension, smoking, inflammatory disease, follow-up period, use of absorbable plates, and use of titanium plates did not have a significant impact on the development of maxillary sinus pathology. CONCLUSION: The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was relatively low, and in most cases, it resolved without the need for specific treatment. Consequently, there may not be a significant need for concern regarding postoperative maxillary sinus pathology.

Caracterización clínica y epidemiológica de pacientes con fractura nasal atendidos en un hospital universitario cubano / Clinical and epidemiological characterization of patients with nasal fracture treated in a Cuban university hospital

Introducción: Las fracturas nasales son las más comunes de la región maxilofacial. Sin embargo, la literatura cubana sobre el tema es escasa y desactualizada, por lo que surgió la motivación para realizar esta investigación. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes con fractura nasal atendidos en un hospital universitario cubano. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes atendidos en el Servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia Granma, Cuba, en el período comprendido entre el 1 de enero y el 31 de diciembre del 2020. Se estudiaron variables clínicas, epidemiológicas y terapéuticas. Resultados: Se incluyeron 99 pacientes, de los cuales 74 (74,75 por ciento) fueron masculinos. En el 44,44 por ciento de los casos las edades estuvieron comprendidas entre los 21 y 40 años. Cincuenta pacientes (50,51 por ciento) tuvieron fracturas producto de la violencia interpersonal. Noventa y siete pacientes (97,98 por ciento) presentaron epistaxis. Cincuenta y nueve pacientes (59,60 por ciento) recibieron reducción cerrada asociada con taponamiento nasal y fijación externa con yeso. Conclusiones: Predominó el sexo masculino y el grupo de edades de 21 a 40 años. La principal etiología fue la violencia interpersonal. En la mayoría de los casos la epistaxis estuvo presente. Prevalecieron las fracturas cerradas, así como las que tuvieron el dorso desviado lateralmente(AU)

Introduction: Nasal fractures are the most common fractures of the maxillofacial region. However, Cuban literature on the subject is scarce and outdated, so the motivation for this research arose. Objective: To characterize patients with nasal fractures treated in a Cuban university hospital in a clinical and epidemiological manner. Methods: An observational, descriptive and cross-sectional study was carried out in patients treated at the Maxillofacial Surgery Service of the University General Hospital. "Carlos Manuel de Céspedes" of Bayamo, Granma province, Cuba, from January 1 to December 31, 2020. Clinical, epidemiological and therapeutic variables were studied. Results: 99 patients were included, of whom 74 (74.75 percent) were male. In 44.44 percent of the cases the ages were between 21 and 40 years. Fifty patients (50.51 percent) had fractures resulting from interpersonal violence. Ninety-seven patients (97.98 percent) presented epistaxis. Fifty-nine patients (59.60 percent) received closed reduction associated with nasal packing and external fixation with plaster cast. Conclusions: Male gender and age group 21 to 40 years predominated. The main etiology was interpersonal violence. Epistaxis was present in most cases. Closed fractures prevailed, as well as those with laterally deviated dorsum(AU)

Craniofacial involvement in Langerhans cell histiocytosis: A review of 44 cases at a single medical center.

BACKGROUND: Craniofacial bones are the most commonly involved site of Langerhans cell histiocytosis (LCH). The main purpose of this study was to clarify the relation between subsites of craniofacial bone and clinical presentation, treatment modalities, outcomes, and permanent consequences (PCs) in patients with LCH. METHODS: Forty-four patients diagnosed with LCH involving the craniofacial region presenting at a single medical center during 2001-2019 were collected and divided into four groups: single system with unifocal bone lesion (SS-LCH, UFB); single system with multifocal bone lesions (SS-LCH, MFB); multisystem without risk organ involvement (MS-LCH, RO-); and multisystem with risk organ involvement (MS-LCH, RO+). Data including demographics, clinical presentation, treatments, outcomes, and the development of PC were retrospectively reviewed. RESULTS: Temporal bone (66.7% versus 7.7%, p = 0.001), occipital bone (44.4% versus 7.7%, p = 0.022), and sphenoid bone (33.3% versus 3.8%, p = 0.041) involvement were more common in SS-LCH, MFB than they were in SS-LCH, UFB. No difference of reactivation rate was noted among the four groups. The most common PC is diabetes insipidus (DI), reported in 9 of the 16 (56.25%) patients with PC. The single system group was reported with the lowest incidence of DI (7.7%, p = 0.035). The reactivation rate was also higher in patients with PC (33.3% versus 4.0%, p = 0.021) or DI (62.5% versus 3.1%, p < 0.001). CONCLUSION: An increased risk of multifocal or multisystem lesions was associated with temporal bone, occipital bone, sphenoid bone, maxillary bone, eye, ear, and oral involvement, which may indicate poor outcomes. Longer follow-up may be indicated if there is the presence of PC or DI due to the high risk of reactivation. Therefore, multidisciplinary evaluation and treatment according to risk stratification are vital for patients diagnosed with LCH involving the craniofacial region.

Ewing's Sarcoma of the Zygoma: A Very Rare Location.

Ewing's sarcoma is a rare and aggressive neoplasm that typically affects the long bones. The presence of a primary tumor in the facial bones is extremely uncommon. Here, we present a case of a 21-year-old male with Ewing's sarcoma of the zygoma. To date, only a few such cases have been reported worldwide in the literature.

An analysis of lateralized neural crest marker expression across development in the Mexican tetra, Astyanax mexicanus.

The biological basis of lateralized cranial aberrations can be rooted in early asymmetric patterning of developmental tissues. However, precisely how development impacts natural cranial asymmetries remains incompletely understood. Here, we examined embryonic patterning of the cranial neural crest at two phases of embryonic development in a natural animal system with two morphotypes: cave-dwelling and surface-dwelling fish. Surface fish are highly symmetric with respect to cranial form at adulthood, however adult cavefish harbor diverse cranial asymmetries. To examine if lateralized aberrations of the developing neural crest underpin these asymmetries, we used an automated technique to quantify the area and expression level of cranial neural crest markers on the left and right sides of the embryonic head. We examined the expression of marker genes encoding both structural proteins and transcription factors at two key stages of development: 36 hpf (∼mid-migration of the neural crest) and 72 hpf (∼early differentiation of neural crest derivatives). Interestingly, our results revealed asymmetric biases at both phases of development in both morphotypes, however consistent lateral biases were less common in surface fish as development progressed. Additionally, this work provides the information on neural crest development, based on whole-mount expression patterns of 19 genes, between stage-matched cave and surface morphs. Further, this study revealed 'asymmetric' noise as a likely normative component of early neural crest development in natural Astyanax fish. Mature cranial asymmetries in cave morphs may arise from persistence of asymmetric processes during development, or as a function of asymmetric processes occurring later in the life history.

Treatment with an inhibitor of matrix metalloproteinase 9 or cathepsin K lengthens embryonic lower jaw bone.

OBJECTIVES: Skeletal malocclusions are common, and severe malocclusions are treated by invasive surgeries. Recently, jaw bone length has been shown to be developmentally controlled by osteoclasts. Our objective was to determine the effect of inhibiting osteoclast-secreted proteolytic enzymes on lower jaw bone length of avian embryos by pharmacologically inhibiting matrix metalloproteinase-9 (MMP9) or cathepsin K (CTSK). METHODS: Quail (Coturnix coturnix japonica) embryos were given a single dose of an inhibitor of MMP9 (iMMP9), an inhibitor CTSK (iCTSK), or vehicle at a developmental stage when bone deposition is beginning to occur. At a developmental stage when the viscerocranium is largely calcified, the heads were scanned via micro-computed tomography and reproducible landmarks were placed on 3D-reconstructed skulls; the landmark coordinates were used to quantify facial bone dimensions. RESULTS: Approximately half of the quail given either iMMP9 or iCTSK demonstrated an overt lower jaw phenotype, characterized by longer lower jaw bones and a greater lower to upper jaw ratio than control embryos. Additionally, iMMP9-treated embryos exhibited a significant change in midface length and iCTSK-treated embryos had significant change in nasal bone length. CONCLUSION: MMP9 and CTSK play a role in osteoclast-mediated determination of lower jaw bone length. Pharmacological inhibition of MMP9 or CTSK may be a promising therapeutic alternative to surgery for treating skeletal jaw malocclusions, but more preclinical research is needed prior to clinical translation.

FACE-Q satisfaction following upper third facial gender-affirming surgery using custom bone-section guides.

Postoperative satisfaction after facial gender-affirming surgery (FGAS) has not yet been assessed using a validated questionnaire. There is currently no postoperative satisfaction questionnaire specific to transgender patients concerning facial surgery. The contributions of three-dimensional planning in fronto-orbital surgery in trans women and the use of bone cutting guides for facial feminization surgery have been demonstrated. The primary objective of this study was to evaluate postoperative satisfaction with the upper third of the face in trans women using a validated questionnaire - FACE-Q - after fronto-orbital surgery using custom-made bone cutting guides. The secondary objective was to determine predictive factors of satisfaction. Forty-two patients who underwent frontoplasty with frontal sinus impaction osteotomies using custom bone cutting guides between May 2018 and September 2020 were included. Three-dimensional preoperative computed tomography planning was performed for each patient. Evaluations were performed preoperatively and at 1 year postoperative using FACE-Q items relating to the upper third of the face (fronto-orbital area) and general questionnaire items. At 1 year, the following FACE-Q scales had improved significantly in comparison to the preoperative evaluation: overall facial appearance (33.6 ± 19.4 vs 70.1 ± 21.1; P < 0.001), forehead and eyebrow appearance (38.3 ± 19.7 vs 80.1 ± 15.9; P < 0.001), wrinkles between the eyebrows (54.1 ± 26.7 vs 82.6 ± 19.9; P = 0.001), appearance-related psychological distress (58.1 ± 18.1 vs 24.6 ± 24.5; P < 0.001). No factors predictive of postoperative satisfaction were found for the included frontal FGAS. In the absence of a validated questionnaire specific to facial feminization surgery in transgender patients, the FACE-Q questionnaire showed an improvement in patient satisfaction after FGAS of the upper third using custom-made cutting guides.