Craniomaxillofacial Trauma & Reconstruction最新文献

{"title":"The Burden of Road Traffic Accidents on Facial Fractures: National Trends, Injury Patterns, and Disparities in 154,185 Patients.","authors":"Carol Y Wang, Daniel Y Kwon, Olachi Oleru, Nargiz Seyidova, Peter E Shamamian, Keisha E Montalmant, Alex Sarosi, Peter J Taub","doi":"10.1177/19433875241272440","DOIUrl":"10.1177/19433875241272440","url":null,"abstract":"<p><strong>Study design: </strong>National database study.</p><p><strong>Objective: </strong>Road traffic accidents (RTAs) are a common and challenging cause of facial fractures in the United States. The present study sought to utilize the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) to investigate national trends, injury patterns and disparities in facial fractures secondary to RTAs. To date, this is the first study to do so.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients with primary facial fractures secondary to RTAs using the 2018-2021 HCUP-NIS. Patients were classified into the RTA and non-RTA group. Demographics, injury patterns, and inpatient outcomes were compared.</p><p><strong>Results: </strong>In total, 154,185 primary facial fractures were identified, of which 17% (n = 26,115) were associated with RTAs. RTAs commonly involved cars (41%), followed by motorcycles (15%), pedestrians (11%), and bicyclists (10%). The RTA group was younger (34% vs 24% < 25 years, <i>P</i> < .01) and more frequently Hispanic (18% vs 15%, <i>P</i> < .01). The most common fracture types were mandibular (23%), frontal (14%), and orbital fractures (14%). The RTA group was 50% more likely to have multiple facial fractures (OR = 1.5, <i>P</i> < .01). The RTA group had a longer length of stay (5.3 vs 4.0 days, <i>P</i> < .01), admission charge ($127,932 vs $79,414, <i>P</i> < .01), and mortality rate (1.9% vs 1.4%, <i>P</i> < .01) than the non-RTA group.</p><p><strong>Conclusions: </strong>The present findings provide valuable insights, informing early involvement of craniofacial surgeons for the assessment of combination facial fractures and tailored treatment approaches for RTA patients.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP182-NP191"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma: A Longitudinal Study.","authors":"Khalil Issa, Nicholas A Frisco, Kayla W Kilpatrick, Maragatha Kuchibhatla, Dane M Barrett, David B Powers, Charles R Woodard","doi":"10.1177/19433875241292164","DOIUrl":"10.1177/19433875241292164","url":null,"abstract":"<p><strong>Study design: </strong>Single-institution retrospective financial analysis.</p><p><strong>Objective: </strong>Trauma care is consistently linked to inadequate reimbursement, posing a significant financial burden for large trauma centers. Data show that declining Medicare reimbursement rates have indirectly led to declining payment for all procedures covered by insurance. The goals of this study are to investigate the opportunity cost associated with contemporary surgical management of CMF trauma at our institution and to evaluate longitudinal financial trends.</p><p><strong>Methods: </strong>Patients with operative facial fractures between 2015 and 2022 at Duke University Medical Center were included and compared to patients undergoing general otolaryngology, plastic surgery and oral surgery operations in the same period. Procedural codes, payor type, charges billed, collections, relative value units (RVUs) and other financial data were obtained and analyzed among the 2 patient populations. Comparative analysis was performed to assess the financial trends in data reported previously from 2007-2015.</p><p><strong>Results: </strong>The collection rate at Duke University Medical Center for operatively managed CMF fractures remains significantly lower than non-CMF counterparts. Interestingly, the collection rate gap between CMF and non-CMF surgeries has narrowed when comparing to the data from 2007-2013. This is largely due to a decrease in collection rates for non-CMF procedures from 29.61% (2007-2013) to 26.57% (2015-2022) [<i>P</i> = 0.0001] and an increase in collection rates for CMF procedures from 17.25% (2007-2013) to 18.05% (2015-2022) [<i>P</i> = 0.0001].</p><p><strong>Conclusions: </strong>Despite a slight improvement of the gap in reimbursement rates for CMF and non-CMF surgeries over the last several years, trauma care continues to have a negative financial impact on health care institutions.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP290-NP297"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for Orbital Defect Assessment and Patient-Specific Implant Design: Introducing OA² (Orbital Assessment Algorithm).","authors":"Nils-Claudius Gellrich, Michael Grant, Damir Matic, Philippe Korn","doi":"10.1177/19433875241272436","DOIUrl":"10.1177/19433875241272436","url":null,"abstract":"<p><strong>Study design: </strong>This study presents a review of the evolutionary development in reconstructive orbital surgery over the past 3 decades. Additionally, it proposes the Orbital Assessment Algorithm (OA²) to enhance decision-making for intraorbital reconstruction of post-traumatic orbital deformities.</p><p><strong>Objective: </strong>The objective of this paper is to provide insights into modern post-traumatic orbital reconstruction from a surgeon's perspective, with a specific focus on adult patients. It aims to highlight the advancements in computer-aided design and manufacturing techniques, particularly in the field of reconstructive orbital surgery, and to introduce the OA² as a tool for improved decision-making in this context.</p><p><strong>Methods: </strong>The study conducts a comprehensive review of the evolution of reconstructive orbital surgery, focusing on the integration of 3D technology into surgical practices. It also outlines the development and rationale behind the proposed OA2, emphasizing its potential to enhance the accuracy and efficacy of intraorbital reconstruction procedures for post-traumatic deformities.</p><p><strong>Results: </strong>The review demonstrates the significant progress made in reconstructive orbital surgery, particularly in leveraging 3D technology for virtual modeling, navigation, and the design and manufacturing of patient-specific implants. The introduction of the OA² provides a structured approach to assessing and addressing post-traumatic orbital deformities, offering potential benefits in decision-making and surgical outcomes.</p><p><strong>Conclusions: </strong>In conclusion, this paper underscores the pivotal role of computer-aided design and manufacturing in advancing reconstructive orbital surgery. It highlights the importance of integrating innovative design concepts into implant manufacturing processes and emphasizes the potential of the OA² to guide surgeons in the management of post-traumatic orbital deformities, ultimately contributing to improved patient outcomes.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP298-NP318"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Factors Associated With the Development of Calvarial Osteoradionecrosis in Patients Treated for Cutaneous Malignancies.","authors":"Dumindu Weerakkody, Kevin Nguyen, Evania Lok, Richard Khor, Sweet P Ng, Ben Starvaggi, Morikatsu Wada, Henry Li, Sally Kiu-Huen Ng","doi":"10.1177/19433875241242940","DOIUrl":"10.1177/19433875241242940","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Calvarial osteoradionecrosis (ORN) is a rare but devastating complication of radiotherapy. The aim of this study was to describe the cumulative incidence of Calvarial ORN in patients in patients treated for cutaneous malignancy of the scalp.</p><p><strong>Methods: </strong>Data was compiled from patient records of a large tertiary hospital Plastic Surgery department and radiotherapy records of an affiliated cancer Center. We included all patients that were treated for cutaneous malignancies of the scalp that received radiotherapy. Patient demographics, cancer stage, treatment modalities, intraoperative details, and patient outcome data were recorded. Patients with incomplete radiotherapy data were excluded.</p><p><strong>Results: </strong>We analyzed 105 radiotherapy treatments to the scalp administered to 84 patients and recorded 7 cases of calvarial ORN resulting in a gross incidence of 6.67% per radiotherapy treatment. The parietal bone was the most frequently targeted site of radiotherapy and accordingly the most common site of ORN (85.7%). Median time from radiotherapy dose to the development of ORN was 846 days. Higher number of radiotherapy fractionation (<i>P</i> = .038), cumulative radiotherapy dose (<i>P</i> = .035), prolonged radiotherapy duration (<i>P</i> = .022) and skin grafting (<i>P</i> = .003) were associated with the development of ORN.</p><p><strong>Conclusions: </strong>Our findings suggest radiotherapy variables, such as prolonged radiotherapy duration, increased cumulative dose and higher radiotherapy fractions were strongly associated with the development of ORN. In addition, skin grafting following surgical resection was associated with the development of ORN. Further studies with larger sample sizes are required to further explore this relationship.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP51-NP59"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving Forward: The Last Subscription Issue and the Dawn of Open Access.","authors":"","doi":"10.1177/19433875241296681","DOIUrl":"10.1177/19433875241296681","url":null,"abstract":"","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"269"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In- Versus Out-Fracture: A Novel Concept in Naso-Orbito-Ethmoid Injury.","authors":"Jesse Menville, Luke Soliman, Nidhi Shinde, Carole Spake, Stephanie Francalancia, Josue Marquez-Garcia, Nikhil Sobti, Vinay Rao, Albert S Woo","doi":"10.1177/19433875241280781","DOIUrl":"10.1177/19433875241280781","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly affect symptomatology and management. We hypothesize that NOE fractures will present differently based upon their severity: Type I injuries are likely to present with medial nasal bone displacement (in-fracture), whereas Type III fractures will be more prone to lateral displacement (out-fracture).</p><p><strong>Methods: </strong>A retrospective review was performed for all patients with NOE fractures who were evaluated by the plastic surgery department at a level 1 trauma center over a 6-year period. Computed tomography data were evaluated to assess for directionality of fracture segment displacement. Frequencies of medial, lateral, and non-displacement across NOE types were compared by Chi-Squared Goodness of Fit and Fisher's Exact Tests.</p><p><strong>Results: </strong>111 patients met inclusion criteria. The patient population was 73.9% male and averaged 51.2 years old. When bilateral fractures were counted independently, there were 141 cases in total: 115 Type I, 20 Type II, and 6 Type III. Type I fractures were most commonly in-fractured (48.7%), while Type III injuries were consistently out-fractured (100%) (<i>p</i> < .001).</p><p><strong>Conclusions: </strong>While Type II and III NOE fractures have dominated clinical focus, this study highlights the prevalence of impaction within Type I fractures. These findings advocate for a more comprehensive approach to the evaluation of Type I NOE fractures and their potential risks, including traumatic hypotelorism and nasal airway obstruction.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP249-NP256"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Facial Fractures: A Multi-Institutional Level 1 Trauma Center Analysis of Incidence, Interventions, and Outcomes.","authors":"Madison Hinson, Avery Wright, Amelia Davidson, Samuel Kogan, Christopher Runyan","doi":"10.1177/19433875241272430","DOIUrl":"10.1177/19433875241272430","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Objective: </strong>The management of pediatric facial fractures presents distinctive considerations compared to adults. This study aims to provide a unique perspective on the correlations between the mechanism of injury, types of facial fractures, and fracture interventions and management utilized in 2 North Carolina Level 1 Trauma Centers to determine the optimal management options for this patient population.</p><p><strong>Methods: </strong>An IRB-approved retrospective chart review was performed of pediatric facial trauma patients ages <18 years old between January 2020 and December 2022 at Atrium Health Wake Forest Baptist Medical Center and Atrium Health Charlotte Medical Center. Data on patient demographics, mechanism of injury, facial fractures, interventions, and outcomes were collected.</p><p><strong>Results: </strong>Of 2,977 pediatric facial trauma patients, 582 patients sustained at least 1 facial fracture at the time of injury. Adolescents were significantly less likely to be transferred from outside institutions and to be admitted for further care (<i>P</i> = 0.002). Adolescents experienced higher levels of residual symptoms following initial discharge (<i>P</i> = 0.001) and were less likely to have a symptom resolution within 1 year (<i>P</i> < 0.0001). Neonates and infants were significantly more likely to receive conservative interventions and to sustain calvarium and skull base fractures (<i>P</i> < 0.0001).</p><p><strong>Conclusions: </strong>This study identifies differences in pediatric age groups related to transfers, admittance, fracture type, management, and outcomes. Our data suggests adolescent patients may experience a higher incidence of residual symptoms with lower levels of symptom resolution within 1 year. Further investigation into these differences may elicit optimized methods of fracture management in pediatric age groups and allow for effective, individualized care with improved long-term outcomes.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP192-NP203"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Socioeconomic Status on Pediatric Facial Trauma.","authors":"Avery Wright, Madison Hinson, Amelia Davidson, Caitrin Curtis, Christopher Runyan","doi":"10.1177/19433875241280214","DOIUrl":"10.1177/19433875241280214","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Objective: </strong>Socioeconomic status (SES) greatly impacts one's health status and the type of trauma that a patient experiences due to increased risk of exposure and varying availability of resources to treat emergent conditions. There is a need for large-scale databases of pediatric facial trauma to identify discrepancies in occurrence and identify risk factors.</p><p><strong>Methods: </strong>This retrospective examination uses a multi-center database to evaluate pediatric facial trauma patients (n = 644) visiting Atrium Heath Wake Forest Baptist (AHWFB) hospital from 2020 to 2022. Data collected included demographic information, past medical and surgical history, trauma history, interventions, and long-term outcomes such as scarring, deformities, and sensory or motor deficits. The number of incidents for each zip code surrounding AHWFB was compared with SES data including unemployment rate, mean household income, and poverty level.</p><p><strong>Results: </strong>Thirty-five percent of patients sustained a high-energy injury, and 65% sustained a low-energy injury. Within the surrounding counties of AHWFB, there were more incidents of pediatric facial trauma in areas with greater rates of poverty (<i>P</i> = 0.006). Additionally, there were more incidents due to high-energy injuries in areas with lower income (<i>P</i> = 0.044) and more poverty (<i>P</i> = 0.002). Specifically, motor vehicle accidents were more common in areas with lower income (<i>P</i> = 0.017) and more poverty (<i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>These findings in the central Piedmont region of North Carolina are consistent with previous research of SES's effect on health inequalities and serve as evidence of the need to take steps to prevent pediatric facial trauma in areas of low SES.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP242-NP248"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures.","authors":"Samin Rahbin, Ola Sunnergren, Ellen McBride, Hatef Darabi, Babak Alinasab","doi":"10.1177/19433875241286544","DOIUrl":"10.1177/19433875241286544","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective with follow-up.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP271-NP280"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and Esthetic Outcomes of Either Surgically or Conservatively Treated Anterior Frontal Sinus Wall Fractures: A Long-Term Follow-Up.","authors":"Oscar Solmell, Ola Sunnergren, Abdul Rashid Qureshi, Babak Alinasab","doi":"10.1177/19433875241250225","DOIUrl":"10.1177/19433875241250225","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Frontal sinus fractures (FSFs) can lead to a range of clinical challenges, including facial deformity, impaired facial sensation, cerebrospinal fluid (CSF) leakage, sinus drainage impairment, chronic sinus pain and mucocele formation. The optimal management approach, whether surgical or conservative, remains a topic of ongoing discussion. The aim of this study was to evaluate and compare the functional and esthetic outcomes of patients with surgically and conservatively treated FSFs.</p><p><strong>Methods: </strong>In this retrospective study, patients treated for FSFs at the Karolinska university hospital 2004 to 2020 were identified in hospital records and invited to participate in a long-term follow-up. Sequelae and satisfaction with the esthetic result were assessed trough questionnaires and physical examinations.</p><p><strong>Results: </strong>A total of 93 patients were included in the study, with 49 presenting isolated anterior wall fractures and 44 presenting combined anterior and posterior wall fractures. Surgical intervention was performed in 45 cases, while 48 were managed conservatively. Among patients with moderate anterior wall fractures (4-6 mm dislocation), 80% of surgically treated patients compared to 100% of conservatively treated patients expressed satisfaction with their cosmetic outcomes at follow-up (<i>P</i> = .03). In conservatively treated patients with a forehead impression, the anterior wall fracture dislocation ranged from 5.3 to 6.0 mm (<i>P</i> < .0001). Approximately 50% of surgically treated patients vs 15% of conservatively treated patients developed impaired forehead sensation at follow-up (<i>P</i> = .03). Thirty-six percent of surgically treated patients reported dissatisfaction with surgery-related scarring, particularly those who underwent surgery via laceration or bicoronal incision.</p><p><strong>Conclusions: </strong>This study suggests that anterior FSFs with a dislocation of 5 mm or less can be effectively managed conservatively with high patient satisfaction, low risk of long-term forehead sensation impairment and without potential development of forehead impression. Bicoronal incision or incision via a laceration may be associated with esthetic dissatisfaction and late sequelae such as alopecia.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":" ","pages":"NP68-NP76"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}