Skip to main content
SpringerLink
Log in

Craniofacial Trauma and Reconstruction

  • Chapter
Plastic and Reconstructive Surgery

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

  • 6300 Accesses

Summary

The concept of treatment of craniofacial injury has evolved from conservative, delayed, multiple-staged surgery into early, aggressive, and one-stage operation. Adequate exposure, accurate anatomic reduction, rigid fixation, primary bone grafting, and soft tissue suspension remain the gold standard to obtain expected results. A variable plating system applied to specific anatomic areas of the facial skeleton produces three-dimensional (3D) reconstructions, enhances bone healing, and decreases infection. Minimal invasive surgery replaces part of conventional wide incision and achieves competitive results. Microvascular free tissue transplantation makes reconstruction of devastating injury on the face possible, with a more pleasing outcome. Alloplastic implants become more popular especially for orbital reconstruction and produce equivalent results compared with conventional bone grafts. Contemporary computed tomography (CT) scans gradually replace conventional plain films to provide more accurate diagnosis and can be used as a preoperative simulation tool. With the advancement of diagnostic imaging, surgical approaches, and instruments, optimal functional outcome and aesthetic facial appearance can be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 259.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

MMF:

Maxillomandibular fixation

NOE:

Naso-orbito-ethmoidal

TMJ:

Temporomandibular joint

References

  1. Abbe R. A new plastic operation for the relief of deformity due to double harelip. Plast Reconstr Surg. 1968;42:481–483.

    PubMed  CAS  Google Scholar 

  2. Al-Shunnar B, Manson PN. Cheek reconstruction with laterally based flaps. Clin Plast Surg. 2001;28:283–296.

    PubMed  CAS  Google Scholar 

  3. Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg. 1967;39:472–477.

    Article  PubMed  CAS  Google Scholar 

  4. Barry CP, Ryan WJ, Stassen LF. Anatomical study of factors contributing to zygomatic complex fracture instability in human cadavers. Plast Reconstr Surg. 2007;120:1743.

    PubMed  CAS  Google Scholar 

  5. Brandt MT, Haug RH. Open versus closed reduction of adult mandibular condyle fractures: a review of the literature regarding the evolution of current thoughts on management. J Oral Maxillofac Surg. 2003;61:1324–1332.

    Article  PubMed  Google Scholar 

  6. Chen CH, Wang TY, Tsay PK, et al. A 162-case review of palatal fracture: Management strategy from our ten-year experience. Plast Reconstr Surg. 2008;121(6):2065–2073.

    Article  PubMed  CAS  Google Scholar 

  7. Chen CT, Chen YR. Endoscopically assisted repair of orbital floor fractures. Plast Reconstr Surg. 2001;108:2011–2018.

    Article  PubMed  CAS  Google Scholar 

  8. Chen CT, Chen YR. Application of endocope in orbital fractures. Semin Plast Surg. 2002;16(3):241–250.

    Article  Google Scholar 

  9. Chen CT, Chen YR, Tung TC, Lai JP, Rohrich RJ. Endoscopically assisted reconstruction of orbital medial wall fractures. Plast Reconstr Surg. 1999;103(2):714–720.

    Article  PubMed  CAS  Google Scholar 

  10. Chen CT, Huang F, Chen YR. Management of posttraumatic enophthalmos. Chang Gung Med J. 2006;29(3):251–261.

    PubMed  Google Scholar 

  11. Chen CT, Huang F, Tsay PK, et al. Endoscopically assisted transconjunctival decompression of traumatic optic neuropathy. J Craniofac Surg. 2007;18(1):19–26.

    Article  PubMed  CAS  Google Scholar 

  12. Chen CT, Lai JP, Chen YR, Tung TC, Chen ZC, Rohrich RJ. Application of endoscope in zygomatic fracture repair. Br J Plast Surg. 2000;53(2):100–105.

    Article  PubMed  CAS  Google Scholar 

  13. Chen CT, Lai JP, Tung TC, Chen YR. Endoscopically assisted mandibular subcondylar fracture repair. Plast Reconstr Surg. 1999;103(1):60–65.

    Article  PubMed  CAS  Google Scholar 

  14. Chen DJ, Chen CT, Chen YR, Feng GM. Endoscopically assisted repair of frontal sinus fracture. J Trauma. 2003;55(2):378–382.

    Article  PubMed  Google Scholar 

  15. Chen KT, Chen CT, Mardini S, Tsay PK, Chen YR. Frontal sinus fractures: a treatment algorithm and assessment of outcomes based on 78 clinical cases. Plast Reconstr Surg. 2006;118(2):457–468.

    Article  PubMed  CAS  Google Scholar 

  16. Chen RF, Lai J P, Liao HT, et al. Fluoroscan assisted reduction of nasal fracture. J. Plast Surg Asso R O C. 2007; 16:318–326.

    Google Scholar 

  17. Chieng HH, Tsai YC, Lin HC, Tseng FY, Yang SJ. Retrobulbar hemorrhage as a rare complication in surgical reduction of blowout fracture — A case report. J Plast Reconstr Surg Asso R O C. 1999;8:316–321.

    Google Scholar 

  18. Choi BH, Yi CK, Yo o JH. MRI examination of the TMJ after surgical treatment of condylar fractures. Int J Oral Maxillofac Surg. 2001;30:296–299.

    Article  PubMed  CAS  Google Scholar 

  19. Conover MA, Kaban LB, Mulliken JB. Antibiotic prophylaxis for major maxillocraniofacial surgery. J Oral Maxillofac Surg. 1985;43:865–869.

    Article  PubMed  CAS  Google Scholar 

  20. Davidoff G, Jakubowski M, Thomas D, Alpert M. The spectrum of closed-head injuries in facial trauma victims: incidence and impact. Ann Emerg Med. 1988; 17:6–9.

    Article  PubMed  CAS  Google Scholar 

  21. Ellis EIII, Simon P, Throckmorton GS. Occlusal results after open or closed treatment of fractures of the mandibular condylar process. J Oral Maxofac Surg. 2000;58(3):260–268.

    Article  Google Scholar 

  22. Forrest CR. Application of endoscope-assisted minimalaccess techniques in orbitozygomatic complex, orbital floor, and frontal sinus fractures. J Craniomaxillofac Trauma. 1999;Winter 5(4):7–12; discussion 13–14.

    PubMed  CAS  Google Scholar 

  23. Gerbino G, Roccia F, Benech A, Caldarelli C. Analysis of 158 frontal sinus fractures: current surgical management and complications. J Craniomaxillofac Surg. 2000;28:133–139.

    Article  PubMed  CAS  Google Scholar 

  24. Griffin JE Jr., Max DP, Frey BS. The use of the C-Arm in reduction of isolated zygomatic arch fractures: a technical overview. J Craniomaxillofac Trauma. 1997;3:27–31.

    PubMed  Google Scholar 

  25. Gruss JS, Van Wyck L, Phillips JH, Antonyshyn O. The importance of the zygomatic arch in complex midfacial fracture repair and correction of posttraumatic orbitozy-gomatic deformities. Plast Reconstr Surg. 1990;85:878–890.

    Article  PubMed  CAS  Google Scholar 

  26. Hackl W, Hausberger K, Sailer R, Ulmer H, Gassner R. Prevalence of cervical spine injuries in patients with facial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:370–376.

    Article  PubMed  CAS  Google Scholar 

  27. Hardy JM, Montgomery WW. Osteoplastic frontal sinuso-tomy: an analysis of 250 operations. Ann Otol Rhinol Laryngol. 1976;85:523–532.

    PubMed  CAS  Google Scholar 

  28. Haug RH, Nuveen E, Bredbenner T. An evaluation of the support provided by common internal orbital reconstruction materials. J Oral Maxillofac Surg.1999;57:564–570.

    Article  PubMed  CAS  Google Scholar 

  29. Helmy ES, Koh ML, Bays RA. Management of frontal sinus fractures. Review of the literature and clinical update. Oral Surg Oral Med Oral Pathol. 1990;69:137–148.

    Article  PubMed  CAS  Google Scholar 

  30. Hendrickson M, Clark N, Manson PN, et al. Palatal fractures: classification, patterns, and treatment with rigid internal fixation. Plast Reconstr Surg. 1998;101:319–332.

    Article  PubMed  CAS  Google Scholar 

  31. Hunts JH, Patrinely JR, Holds JB, Anderson RL. Orbital emphysema. Staging and acute management. Ophthalmology. 1994;101:960–966.

    PubMed  CAS  Google Scholar 

  32. Jones WD III, Whitaker LA, Murtagh F. Applications of reconstructive craniofacial techniques to acute craniofa-cial trauma. J Trauma. 1977;17(5):339–343.

    Article  PubMed  Google Scholar 

  33. Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg. 1974;27:93–97.

    Article  PubMed  CAS  Google Scholar 

  34. Lakhani RS, Shibuya TY, Mathog RH, Marks SC, Burgio DL, Yoo GH. Titanium mesh repair of the severely comminuted frontal sinus fracture. Arch Octaryngol Head Neck Surg. 2001;127(6):665–669.

    CAS  Google Scholar 

  35. Lee R, Manson PN, Robertson B. Evolution of craniomax-illofacial trauma. Semin Plast Surg. 2002;16(3):283–293.

    Article  Google Scholar 

  36. Lee TT, Ratzker PA, Galarza M, Villanueva PA. Early combined management of frontal sinus and orbital and facial fractures. J Trauma. 1998;44(4):665–669.

    Article  PubMed  CAS  Google Scholar 

  37. Lindahl L. Condylar fractures of the mandible. I. Classification and relation to age, occlusion, and concomitant injuries of teeth and teeth-supporting structures, and fractures of the mandibular body. Int J Oral Surg. 1977;6:12–21.

    Article  PubMed  CAS  Google Scholar 

  38. Luce EA. Frontal sinus fractures: guidelines to management. Plast Reconstr Surg. 1987;80(4):500–510.

    Article  PubMed  CAS  Google Scholar 

  39. Manson PN, Hoopes JE, Su CT. Structural pillars of the facial skeleton: an approach to the management of Le Fort fractures. Plast Reconstr Surg. 1980;66:54–62.

    Article  PubMed  CAS  Google Scholar 

  40. Manson PN, Ruas E, Iliff N, Yaremchuk M. Single eyelid incision for exposure of the zygomatic bone and orbital reconstruction. Plast Reconstr Surg. 1987;79:120–126.

    PubMed  CAS  Google Scholar 

  41. Manson PN, Shack RB, Leonard LG, Su CT, Hoopes JE. Sagittal fractures of the maxilla and palate. Plast Reconstr Surg. 1983;72(4):484–489.

    Article  PubMed  CAS  Google Scholar 

  42. Marker P, Nielsen A, Bastian HL. Fractures of the mandibular condyle. Part 2: results of treatment of 348 patients. Br J Oral Maxillofac Surg. 2000;38:422–426.

    Article  PubMed  CAS  Google Scholar 

  43. Markowitz BL, Manson PN, Sargent L, et al. Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central fragment in classification and treatment. Plast Reconstr Surg. 1991;87:843–853.

    Article  PubMed  CAS  Google Scholar 

  44. Mickel TJ, Rohrich RJ, Robinson JB Jr. Frontal sinus obliteration: a comparison of fat, muscle, bone, and spontaneous osteoneogenesis in the cat model. Plast Reconstr Surg. 1995;95(3):586–592.

    Article  PubMed  CAS  Google Scholar 

  45. Mustarde JC. Reconstruction of eyelids. Ann Plast Surg. 1983;11(2):149–169.

    Article  PubMed  CAS  Google Scholar 

  46. Okada J, Tsuda T, Takasugi S, Nishida K, Toth Z, Matsumoto K. Unusually late onset of cerebrospinal fluid rhinorrhea after head trauma. Surg Neurol. 1991;35(3):213–217.

    Article  PubMed  CAS  Google Scholar 

  47. Park S, Ock JJ. A new classification of palatal fracture and an algorithm to establish a treatment plan. Plast Reconstr Surg. 2001;107:1669–1676.

    Article  PubMed  CAS  Google Scholar 

  48. Paskert JP, Manson PN. The bimanual examination for assessing instability in naso-orbitoethmoidal injuries. Plast Reconstr Surg. 1989;83:163–167.

    Google Scholar 

  49. Pfeiffer RL. Traumatic enophthalmos. Trans Am Ophthalmol Soc. 1943;41:293–306.

    PubMed  CAS  Google Scholar 

  50. Rohrich RJ, Hollier LH. Management of frontal sinus fractures. Changing concepts. Clin Plast Surg. 1992;19:219–232.

    PubMed  CAS  Google Scholar 

  51. Rubin JP, Yaremchuk MJ. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 1997;100:1336–1353.

    Article  PubMed  CAS  Google Scholar 

  52. Schon R, Schramm A, Gellrich NC, Schmelzeisen R. Follow-up of condylar fractures of the mandible in 8 patients at 18 months after transoral endoscopic-assisted open treatment. J Oral Maxillofac Surg. 2003;61:49–54.

    PubMed  Google Scholar 

  53. Shen BH, Fang RH, Lin JT. Management of frontal sinus fractures. J Plast Reconstr Surg Asso R O C. 1997;6:25–31.

    Google Scholar 

  54. Spinelli HM, Jelks G W. Periocular reconstruction: a systematic approach. Plast Reconstr Surg. 1993;91:1017–1024.

    Article  PubMed  CAS  Google Scholar 

  55. Stanley RB Jr. Use of intraoperative computed tomography during repair of orbitozygomatic fractures. Arch Facial Plast Surg. 1999;1:19–24.

    Article  PubMed  Google Scholar 

  56. Sullivan PK, Rosenstein DA, Holmes RE, Craig D, Manson PN. Bone-graft reconstruction of the monkey orbital floor with iliac grafts and titanium mesh plates: a histo-metric study. Plast Reconstr Surg. 1993;91:769–775.

    Article  PubMed  CAS  Google Scholar 

  57. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975;55:533–544.

    Article  PubMed  CAS  Google Scholar 

  58. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg. 1979;64:595–604.

    PubMed  CAS  Google Scholar 

  59. Tessier P. The definitive plastic surgical treatment of the severe facial deformities of craniofacial dysostosis. Crouzon's and Apert's diseases. Plast Reconstr Surg. 1971;48:419–442.

    Article  PubMed  CAS  Google Scholar 

  60. Wallis A, Donald PJ. Frontal sinus fractures: a review of 72 cases. Laryngoscope. 1988;98:593–598.

    Article  PubMed  CAS  Google Scholar 

  61. Waterhouse N, Lyne J, Urdang M, Garey L. An investigation into the mechanism of orbital blowout fractures. Br J Plast Surg. 1999;52:607–612.

    Article  PubMed  CAS  Google Scholar 

  62. Webster RC, Coffey RJ, Kelleher RE. Total and partial reconstruction of the lower lip with innervated muscle-bearing flaps. Plast Reconstr Surg Transplant Bull. 1960;25:360–371.

    Article  PubMed  CAS  Google Scholar 

  63. Wei FC, Chen HC, Chuang CC, Noordhoff MS. Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg. 1986;78:191–200.

    Article  PubMed  CAS  Google Scholar 

  64. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109:2219–2226.

    Article  PubMed  Google Scholar 

  65. Wei FC, Santamaria E, Chang YM, Chen HC. Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants. J Craniofac Surg. 1997;8:512–521.

    Article  PubMed  CAS  Google Scholar 

  66. Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS. Fibula osteosep-tocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg. 1994;93:294–304.

    Article  PubMed  CAS  Google Scholar 

  67. Wilson IF, Lokeh A, Benjamin CI, et al. Prospective comparison of panoramic tomography (zonography) and helical computed tomography in the diagnosis and operative management of mandibular fractures. Plast Reconstr Surg. 2001;107:1369–1375.

    Article  PubMed  CAS  Google Scholar 

  68. Wolfe SA. Application of craniofacial surgical precepts in orbital reconstruction following trauma and tumour removal. J Maxillofac Surg. 1982;10(4):212–223.

    Article  PubMed  CAS  Google Scholar 

  69. Yang WG, Chen CT, de Villa GH, Lai JP, Chen YR. Blunt internal carotid artery injury associated with facial fractures. Plast Reconstr Surg. 2003;111:789–796.

    Article  PubMed  Google Scholar 

  70. Yang WG, Chen CT, Tsay PK, Chen YR. Functional results of unilateral mandibular condylar process fractures after open and closed treatment. J Trauma. 2002;52(3):498–503.

    Article  PubMed  Google Scholar 

  71. Yang WG, Tsai TR, Hung CC, Tung TC. Life-threatening bleeding in a facial fracture. Ann Plast Surg. 2001;46:159–162.

    Article  PubMed  CAS  Google Scholar 

  72. Zide MF. Discussion. J Oral Maxillofac Surg. 2001;59:375–376.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Chang Gung University, Medical College, Kuei Shan Hsiang, Taoyuan Hsien, Taiwan

    Chien-Tzung Chen

  2. Department of Plastic and Reconstructive Surgery, Chang Gung University, College of Medicine, Kweishan, Taoyuan, Taiwan

    Ruei-Feng Chen

  3. Department of Plastic Surgery, Chang Gung University and Medical College, Taipei, Taiwan

    Fu-Chan Wei

Authors
  1. Chien-Tzung Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ruei-Feng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fu-Chan Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Maria Z. Siemionow (Professor of Surgery, Director of Plastic Surgery Research, Head of Microsurgery Training) (Professor of Surgery, Director of Plastic Surgery Research, Head of Microsurgery Training)

  2. Department of Plastic and Aesthetic, Hand, and Reconstructive Surgery, Caritas-Krankenhaus St. Josef, affiliated with Regensburg University, Regensburg, Germany

    Marita Eisenmann-Klein (Director) (Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London Limited

About this chapter

Cite this chapter

Chen, CT., Chen, RF., Wei, FC. (2010). Craniofacial Trauma and Reconstruction. In: Siemionow, M.Z., Eisenmann-Klein, M. (eds) Plastic and Reconstructive Surgery. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84882-513-0_21

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-513-0_21

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-512-3

  • Online ISBN: 978-1-84882-513-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation