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Li H, Hao J, Liu X. Research progress and perspective of metallic implant biomaterials for craniomaxillofacial surgeries. Biomater Sci 2024; 12:252-269. [PMID: 38170634 DOI: 10.1039/d2bm01414a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Craniomaxillofacial bone serves a variety of functions. However, the increasing number of cases of craniomaxillofacial bone injury and the use of selective rare implants make the treatment difficult, and the cure rate is low. If such a bone injury is not properly treated, it can lead to a slew of complications that can seriously disrupt a patient's daily life. For example, premature closure of cranial sutures or skull fractures can lead to increased intracranial pressure, which can lead to headaches, vomiting, and even brain hernia. At present, implant placement is one of the most common approaches to repair craniomaxillofacial bone injury or abnormal closure, especially with biomedical metallic implants. This review analyzes the research progress in the design and development of degradable and non-degradable metallic implants in craniomaxillofacial surgery. The mechanical properties, corrosion behaviours, as well as in vitro and in vivo performances of these materials are summarized. The challenges and future research directions of metallic biomaterials used in craniomaxillofacial surgery are also identified.
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Affiliation(s)
- Huafang Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
| | - Jiaqi Hao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
| | - Xiwei Liu
- Lepu Medical Technology Co., Ltd, Beijing 102200, China
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Wolfs E, Arzi B, Guerrero Cota J, Kass PH, Verstraete FJM. Craniomaxillofacial trauma in immature dogs–etiology, treatments, and outcomes. Front Vet Sci 2022; 9:932587. [PMID: 36090162 PMCID: PMC9449964 DOI: 10.3389/fvets.2022.932587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Treatment of craniomaxillofacial (CMF) trauma in dogs often requires a multidisciplinary approach and a thorough understanding of the CMF anatomical structures involved. This retrospective study aimed to utilize computed tomography (CT) studies of immature dogs evaluated for CMF trauma and to describe common fracture locations, treatment modalities, and complications, as well as the fracture healing outcomes. The medical records and CT studies of 94 dogs under 1 year of age over a 13-year period were evaluated. The skeletal location of CMF fractures, as well as the severity of displacement and fragmentation of each fracture, was recorded. Case demographic data and trauma etiology were also recorded. Animal bites accounted for the majority of trauma (71.0%). The most likely bone or region to be fractured was the maxillary bones, followed by the molar region of the mandibles. Up to 37 bones or specific regions were fractured in any given patient, with an average of 8.8 ± 3.1 fractured bones or regions per dog. Rostral mandibular trauma was associated with intra-articular fractures of the temporomandibular joint (p = 0.016). Patients sustained concomitant injuries in 32% of the cases. Muzzle therapy was the main treatment performed for most dogs (53.2%), followed by soft tissue closure (47.9%) and selective dental extractions (27.6%). Healing complications were recorded in 71.6% of the dogs, with malocclusion being the most reported complication (55.2%), and associated with dentate mandibular jaw fractures (p = 0.05). The average number of complications per dog was 2.4. No statistically significant association was found between treatment modality and healing outcome. There was a positive correlation between the severity of fracture fragmentation and displacement and a negative healing outcome (all rho >0.7). Further treatment was required in 55.6% of the dogs. Additional dental extractions were performed in 77.7% of patients. Healing complications were common in the immature CMF trauma case. Thus, the need for a comprehensive assessment of the entire CMF region during the initial visit, as well as follow-up, preferably using CT or cone beam CT, is underscored.
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Affiliation(s)
- Elias Wolfs
- School of Veterinary Medicine, William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Jose Guerrero Cota
- School of Veterinary Medicine, William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States
| | - Philip H. Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Frank J. M. Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- *Correspondence: Frank J. M. Verstraete
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Sansgiri T, Prasad K, Kumar V, Ranganath K, Rajanikanth BR, Sejal KM, Sagar P, Prathibha G. Comparative Assessment of Microplates with Miniplates in the Fixation of Midface Fractures: A Prospective Study. J Maxillofac Oral Surg 2022; 21:396-404. [DOI: 10.1007/s12663-020-01453-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022] Open
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Absorbable Plating of Nasoorbitoethmoid Fractures for Adults. J Craniofac Surg 2019; 30:2297-2298. [PMID: 31568161 DOI: 10.1097/scs.0000000000005991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Update on the management of craniomaxillofacial trauma in low-resource settings. Curr Opin Otolaryngol Head Neck Surg 2019; 27:274-279. [PMID: 31274568 DOI: 10.1097/moo.0000000000000545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Craniomaxillofacial (CMF) trauma is a common cause of global morbidity and mortality. Although in high resource settings the management of CMF trauma has improved substantially over the past several decades with internal rigid fixation technology; these advancements have remained economically unviable and have not yet reached low and middle-income countries (LMICs) en masse. The purpose of this review is to discuss the current management of CMF injuries in low-resource settings. RECENT FINDINGS Trauma injuries remain a global epidemic with head and neck injuries among the most common. CMF trauma injuries largely occur in LMICs, with motor vehicle trauma being a common cause. Patients present in a delayed fashion which increases complications. Diagnostic methods are often limited to plain radiographs as computed tomography is not always available. In low-resource settings, CMF trauma continues to be treated primarily by closed reduction, maxillomandibular fixation, and transosseous wiring, yielding acceptable results through affordable methods. With the advent of less expensive plating systems, internal fixation with plates and screws are gradually finding their place in the management of facial trauma in low-resource settings. A shortage of CMF surgeons in LMICs is a recognized problem and is being addressed by targeted curricula. SUMMARY CMF trauma is a major cause of morbidity and mortality globally that remains poorly addressed. Currently, conventional methods of treating CMF trauma in low-resource settings have evolved to meet resource constraints. The education of CMF surgeons remains a key leverage point in improving CMF trauma care globally.
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Abstract
The future of biomaterial design will rely on development of bioresorbable implant materials that completely and safely degrade in vivo after the tissues grow, without generating harmful degradation products at the targeted anatomic site. Permanent biomaterials such as Ti6Al4V alloy, 316L stainless steel, and Co-based alloys currently used in mandibular reconstruction often result in stress shielding effects due to mismatch in the Young’s modulus values between the bone and the implant, resulting in implant loosening. Also, allergic responses due to metal ion releases necessitates revision surgery to prevent long term exposure of the body to toxic implant contents. Bioresorbable metals are perceived as revolutionary biomaterials that have transformed the nature of metallic biomaterials from bioinert to bioactive and multi-bio functional (anti-bacterial, anti-proliferation, and anti-cancer). In this aspect, magnesium (Mg)-based materials have recently been explored by the biomedical community as potential materials for mandibular reconstruction, as they exhibit favorable mechanical properties, adequate biocompatibility, and degradability. This article reviews the recent progress that has led to advances in developing Mg-based materials for mandibular reconstruction; correlating with the biomechanics of mandible and types of mandibular defects. Mg-based materials are discussed regarding their mechanical properties, corrosion characteristics, and in vivo performance. Finally, the paper summarizes findings from this review, together with a proposed scope for advancing the knowledge in Mg-based materials for mandibular reconstruction.
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Schaller B, Matthias Burkhard JP, Chagnon M, Beck S, Imwinkelried T, Assad M. Fracture Healing and Bone Remodeling With Human Standard-Sized Magnesium Versus Polylactide-Co-Glycolide Plate and Screw Systems Using a Mini-Swine Craniomaxillofacial Osteotomy Fixation Model. J Oral Maxillofac Surg 2018; 76:2138-2150. [PMID: 29684308 DOI: 10.1016/j.joms.2018.03.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE This study compared the degradation profile, safety, and efficacy of bioresorbable magnesium alloy and polylactide-co-glycolide (PLGA) polymer osteosynthesis systems for the treatment of fractures in a load-sharing maxillofacial environment using a new mini-swine fracture fixation model. MATERIALS AND METHODS Two types of clinically relevant situations were evaluated in 5 Yucatan miniature pigs. Defined porcine midface osteotomies of the supraorbital rim and zygoma were created and fixed with either a coated magnesium (test animals) or PLGA plate and screw osteosynthesis system (control animals). After surgery, the mini-pigs were able to recover for either 1 or 9 months with continuous in vivo post-implantation monitoring. Standardized computed tomography (CT) imaging was taken immediately postoperatively and at termination for all animals. The 9-month cohort also underwent CT at 2, 4, and 6 months after surgery. At necropsy, osteotomy sites and bone-implant units were harvested, and healing was evaluated by micro-CT, histopathology, and histomorphometry. RESULTS After clinical and radiologic follow-up examination, all fracture sites healed well for both the magnesium and polymer groups regardless of time point. Complete bone union and gradually disappearing osteotomy lines were observed across all implantation sites, with no major consistency change in periprosthetic soft tissue or in soft tissue calcification. Macroscopic and microscopic examination showed no negative influence of gas formation observed with magnesium during the healing process. Histopathologic analysis showed similar fracture healing outcomes for both plating systems with good biocompatibility as evidenced by a minimal or mild tissue reaction. CONCLUSIONS This study confirms that WE43 magnesium alloy exhibited excellent fracture healing properties before its full degradation without causing any substantial inflammatory reactions in a long-term porcine model. Compared with PLGA implants, magnesium represents a promising new biomaterial with reduced implant sizes and improved mechanical properties to support fracture healing in a load-sharing environment.
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Affiliation(s)
- Benoît Schaller
- Senior Physician, Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, Bern, Switzerland.
| | | | | | - Stefan Beck
- Senior Scientist, Materials Group, Synthes Biomaterials, Oberdorf, Switzerland
| | | | - Michel Assad
- Director, Orthopedics and Biomaterials, AccelLAB, Boisbriand, Quebec, Canada
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Peltola EM, Mäkelä T, Haapamäki V, Suomalainen A, Leikola J, Koskinen SK, Kortesniemi M, Koivikko MP. CT of facial fracture fixation: an experimental study of artefact reducing methods. Dentomaxillofac Radiol 2016; 46:20160261. [PMID: 27786546 DOI: 10.1259/dmfr.20160261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to determine the optimal post-operative CT imaging method that enables best visualization of facial bony structures in the vicinity of osteosynthesis material. METHODS Conducted at Töölö Hospital (Helsinki, Finland), this study relied on scanning a phantom with CBCT, 64-slice CT and high-definition multislice CT with dual-energy scan (providing monochromatic images of 70-, 100-, 120- and 140-keV energy levels) and iterative reconstruction (IR) methods. Two radiologists assessed the image quality, and the assessments were analyzed. In addition, a physicist performed a semi-quantitative analysis of the metal-induced artefacts. RESULTS The three subjects most easily assessed were the loose screw and both the bone structure and the fracture further away from the screw and the plate. Soft tissues adjacent to the screw and the plate remained more difficult for assessment. Both image interpreters agreed that the artefacts disturbed their assessments under dual energy. Metal artefacts disturbed the least under multislice CT with IR [adaptive statistical iterative reconstruction (ASiR) and VEO]. Neither interpreter found metal suppression helpful in CBCT. CONCLUSIONS CBCT with or without a metal artefact reduction algorithm was not optimal for post-operative facial imaging compared with multislice CT with IR. Multislice CT with ASiR filtering offered good image quality performance with fast image volume reconstruction, representing the current sweet spot in post-operative maxillofacial imaging.
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Affiliation(s)
- Elina M Peltola
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Mäkelä
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Haapamäki
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anni Suomalainen
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- 2 Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Seppo K Koskinen
- 3 Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Mika Kortesniemi
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika P Koivikko
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Resorbable Mesh as a Containment System in Mandibular Reconstruction. J Craniofac Surg 2016; 27:1795-1798. [PMID: 27548828 DOI: 10.1097/scs.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The recent advances seen in computer technologies and biomaterials have changed the approach to craniomaxillofacial surgery. In this report, the authors describe the technique of using a resorbable containment system for bone graft in a large mandibular reconstruction patient. The authors provide a patient report with a 1-year follow-up.
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Lee JH, Kwon JS, Moon SK, Uhm SH, Choi BH, Joo UH, Kim KM, Kim KN. Titanium-Silver Alloy Miniplates for Mandibular Fixation: In Vitro and In Vivo Study. J Oral Maxillofac Surg 2016; 74:1622.e1-1622.e12. [DOI: 10.1016/j.joms.2016.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Henslee AM, Yoon DM, Lu BY, Yu J, Arango AA, Marruffo LP, Seng L, Anver TD, Ather H, Nair MB, Piper SO, Demian N, Wong MEK, Kasper FK, Mikos AG. Characterization of an injectable, degradable polymer for mechanical stabilization of mandibular fractures. J Biomed Mater Res B Appl Biomater 2014; 103:529-38. [DOI: 10.1002/jbm.b.33216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/24/2014] [Accepted: 05/22/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | - Diana M. Yoon
- Department of BioengineeringRice UniversityHouston Texas
| | - Benjamin Y. Lu
- Department of BioengineeringRice UniversityHouston Texas
| | - Joseph Yu
- Department of BioengineeringRice UniversityHouston Texas
| | - Andrew A. Arango
- Department of Oral and Maxillofacial SurgeryThe University of Texas Dental BranchHouston Texas
| | - Liann P. Marruffo
- Department of Oral and Maxillofacial SurgeryThe University of Texas Dental BranchHouston Texas
| | - Luke Seng
- Department of Oral and Maxillofacial SurgeryThe University of Texas Dental BranchHouston Texas
| | - Tamir D. Anver
- Department of Oral and Maxillofacial SurgeryThe University of Texas Dental BranchHouston Texas
| | - Hunaiza Ather
- Department of Oral and Maxillofacial SurgeryThe University of Texas Dental BranchHouston Texas
| | | | - Sean O. Piper
- Department of BioengineeringRice UniversityHouston Texas
| | - Nagi Demian
- Department of Oral and Maxillofacial SurgeryThe University of Texas Dental BranchHouston Texas
| | - Mark E. K. Wong
- Department of Oral and Maxillofacial SurgeryThe University of Texas Dental BranchHouston Texas
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Tribocorrosion and oral and maxillofacial surgical devices. Br J Oral Maxillofac Surg 2014; 52:396-400. [DOI: 10.1016/j.bjoms.2014.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/11/2014] [Indexed: 02/08/2023]
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Henderson SE, Verdelis K, Maiti S, Pal S, Chung WL, Chou DT, Kumta PN, Almarza AJ. Magnesium alloys as a biomaterial for degradable craniofacial screws. Acta Biomater 2014; 10:2323-32. [PMID: 24384125 DOI: 10.1016/j.actbio.2013.12.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/12/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
Recently, magnesium (Mg) alloys have received significant attention as potential biomaterials for degradable implants, and this study was directed at evaluating the suitability of Mg for craniofacial bone screws. The objective was to implant screws fabricated from commercially available pure Mg and alloy AZ31 in vivo in a rabbit mandible. First, Mg and AZ31 screws were compared to stainless steel screws in an in vitro pull-out test and determined to have a similar holding strength (∼40N). A finite-element model of the screw was created using the pull-out test data, and this model can be used for future Mg alloy screw design. Then, Mg and AZ31 screws were implanted for 4, 8 and 12weeks, with two controls of an osteotomy site (hole) with no implant and a stainless steel screw implanted for 12weeks. Microcomputed tomography was used to assess bone remodeling and Mg/AZ31 degradation, both visually and qualitatively through volume fraction measurements for all time points. Histological analysis was also completed for the Mg and AZ31 at 12weeks. The results showed that craniofacial bone remodeling occurred around both Mg and AZ31 screws. Pure Mg had a different degradation profile than AZ31; however, bone growth occurred around both screw types. The degradation rate of both Mg and AZ31 screws in the bone marrow space and the muscle were faster than in the cortical bone space at 12weeks. Furthermore, it was shown that by alloying Mg, the degradation profile could be changed. These results indicate the promise of using Mg alloys for craniofacial applications.
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Abstract
PURPOSE OF REVIEW The management of nasoethmoid or naso-orbito-ethmoid (NOE) fractures requires a thorough knowledge of the central facial anatomy, surgical techniques, available tools and patient factors to obtain optimal restoration of aesthetic form and function. This review article describes the current methods of NOE fracture diagnosis, classification, surgical techniques and complication management, with a review of the current literature published over the past 18 months. RECENT FINDINGS Advanced imaging modalities, bioabsorbable versus titanium rigid fixation, nasolacrimal duct stenting, NOE fracture management in children and the elderly, and novel techniques of medial canthopexy. SUMMARY The treatment of NOE fractures has not changed dramatically in the last 5 years. Advanced surgical techniques, intraoperative computed tomography and absorbable plating hold promise requiring future research prior to broad implementation.
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