Surgical Management Of Post-Traumatic Facial Asymmetry: Systematic Overview Of Techniques, Outcomes, And Patient Satisfaction
Keywords:
Post-traumatic facial asymmetry, surgical management, reconstructive techniques, patient satisfaction, clinical outcomesAbstract
Facial asymmetry that occurs post-trauma is a serious aesthetic and functional issue and can be caused by either the fractures, the injuries in the soft tissues, or malunion. This systematic review examines surgical management methods, clinical outcomes, and patient satisfaction to provide evidence-based information for optimizing treatment. In line with the PRISMA recommendations, we identified peer-reviewed studies on the surgical treatment of post-traumatic facial asymmetry by searching PubMed, Scopus, Web of Science, and the Cochrane Library (2010-2025). Information was retrieved regarding methods (e.g., osteotomies, bone grafting, tissue reconstruction), objective outcome measures (e.g., symmetry indices, functional outcomes), complications, and subjective outcome measures (e.g., FACE-Q scores). The quality was evaluated using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tools. The results showed that bony reconstruction, which also includes computer-assisted osteotomies and 3D-printed guides, is associated with a high degree of symmetry restoration but also carries risks such as infection or implant failure. The soft tissue techniques, including fat grafting and flaps, aimed at enhancing beauty, however, often show unpredictable long-term results. Functional restoration and aesthetic perfection have a high interrelation with patient satisfaction, although standardized outcomes are hardly used. Significant gaps exist in the scant long-term follow-up and the lack of data on the pediatric and geriatric populations. More novel technologies, such as surgical planning and regenerative procedures, are exciting, even more so. The review contributes to specifying the need for patient-centered, evidence-based measures and identifies areas of research that could be examined in the future. The results of such findings are expected to inform clinicians in the process of personalizing interventions, aid in conducting high-impact studies, and enhance the effectiveness of facial asymmetry management outcomes in post-traumatic stress.
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Al-Rudainy, D., Ju, X., Stanton, S., & Mehdi Ayoub, A. (2018). Assessment of facial asymmetry before and after the surgical repair of cleft lip in unilateral cleft lip and palate cases. International Journal of Oral & Maxillofacial Surgery, 47(3), 411–419. https://doi.org/10.1016/j.ijom.2017.10.002
Andrade, N.N., Mathai, P., Aggarwal, N. (2021). Facial Asymmetry. In: Bonanthaya, K., Panneerselvam, E., Manuel, S., Kumar, V.V., Rai, A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. https://doi.org/10.1007/978-981-15-1346-6_70
Bagheri, S. C., Meyer, R. A., & Cho, S. H. (2016). Management of orbital fractures: Current techniques. Atlas of the Oral and Maxillofacial Surgery Clinics of North America, 24(2), 103-108. https://doi.org/10.1016/j.cxom.2016.05.008
Bisson, J. I., Shepherd, J. P., & Dhutia, M. (1997). Psychological sequelae of facial trauma. British Journal of Oral and Maxillofacial Surgery, 35(2), 92-95. https://doi.org/10.1016/S0266-4356(97)90683-0
Bohluli, B., & Bagheri, S. C. (2012). Revision rhinoplasty. In Current Therapy in Oral and Maxillofacial Surgery (pp. 104). Elsevier Saunders.
Carruthers, J., & Carruthers, A. (2010). Botulinum toxin in facial rejuvenation: An update. Dermatologic Clinics, 28(4), 571-582.
Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., ... & Hays, R. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63(11), 1179-1194. https://doi.org/10.1016/j.jclinepi.2010.04.011
Coleman, S. R. (2006). Structural fat grafting: More than a permanent filler. Plastic and Reconstructive Surgery, 118(3S), 108S-120S. https://doi.org/10.1097/01.prs.0000234610.81672.e1
Eppley, B. L. (1999). Alloplastic implantation. Plastic and Reconstructive Surgery, 104(6), 1761-1774. https://doi.org/10.1097/00006534-199911000-00029
Gassner, R. (2020). Complications in Cranio-Maxillofacial and Oral Surgery. Springer.
Gornitsky, J., Viezel-Mathieu, A., Alnaif, N., Azzi, A. J., & Gilardino, M. S. (2019). A systematic review of the effectiveness and complications of fat grafting in the facial region. JPRAS Open, 19, 87-97. https://doi.org/10.1016/j.jpra.2018.12.004
Kholaki, O., Hammer, D. A., & Schlieve, T. (2019). Management of orbital fractures. Atlas of Oral and Maxillofacial Surgery Clinics of North America, 27(2), 157-165. https://doi.org/10.1016/j.cxom.2019.05.007
Kim, Y. H., Choi, J. H., & Kim, J. E. (2015). Three-dimensional analysis of facial asymmetry after zygomatic fracture reduction with or without additional malarplasty. Journal of Craniofacial Surgery, 26(7), 2091-2095.
Lalloo, R., Lucchesi, L. R., Bisignano, C., Castle, C. D., Dingels, Z. V., Fox, J. T., ... & James, S. L. (2020). Epidemiology of facial fractures: Incidence, prevalence and years lived with disability estimates from the Global Burden of Disease 2017 study. Injury Prevention, 26(Suppl 2), i27-i35. https://doi.org/10.1136/injuryprev-2019-043297
Maroulakos, M., Kamperos, G., Tayebi, L., Halazonetis, D., & Ren, Y. (2019). Applications of 3D printing on craniofacial bone repair: A systematic review. Journal of Dentistry, 80, 1-14.
Menick, F. J. (2008). Nasal Reconstruction: Art and Practice. Saunders Elsevier.
Nik, T. H., Gholamrezaei, E., & Keshvad, M. A. (2019). Facial asymmetry correction: From conventional orthognathic treatment to surgery-first approach. Journal of Dental Research, Dental Clinics, Dental Prospects, 13(4), 311–319
Proffit, W. R., White, R. P., & Sarver, D. M. (2003). Contemporary Treatment of Dentofacial Deformity. Mosby Elsevier.
Pusic, A. L., Klassen, A. F., Scott, A. M., & Cano, S. J. (2013). Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale: A new patient-reported outcome instrument for facial aesthetics patients. Clinics in Plastic Surgery, 40(2), 249-260. https://doi.org/10.1016/j.cps.2012.12.001
Robinson, K., Gatehouse, S., & Browning, G. G. (1996). Measuring patient benefit from otorhinolaryngological surgery and therapy. Annals of Otology, Rhinology & Laryngology, 105(6), 415-422. https://doi.org/10.1177/000348949610500601
Rohrich, R. J., & Pessa, J. E. (2008). The retaining system of the face: Histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plastic and Reconstructive Surgery, 121(5), 1804-1809. https://doi.org/10.1097/PRS.0b013e31816c3c1a
Shanti, R. M., Li, W. J., Nesti, L. J., Wang, X., & Tuan, R. S. (2007). Adult mesenchymal stem cells: Biological properties, characteristics, and applications in maxillofacial surgery. Journal of Oral and Maxillofacial Surgery, 65(8), 1640-1647.
Sukegawa, S., Kanno, T., & Furuki, Y. (2018). Application of computer-assisted navigation systems in oral and maxillofacial surgery. Japanese Dental Science Review, 54(3), 139-149.
Thomas, J. R., & Somenek, M. (2012). Scar revision review. Archives of Facial Plastic Surgery, 14(3), 162-174. https://doi.org/10.1001/archfacial.2012.223
Valentini, V., Agrillo, A., Battisti, A., Gennaro, P., Calabrese, L., & Iannetti, G. (2005). Surgical planning in reconstruction of mandibular defect with fibula free flap: 15 patients. Journal of Craniofacial Surgery, 16(4), 601-607. https://doi.org/10.1097/01.jps.0000157811.06921.c5
Wetterau, M., Szpalski, C., Hazen, A., & Warren, S. M. (2012). Autologous fat grafting and facial reconstruction. Journal of Craniofacial Surgery, 23(1), 315-318. https://doi.org/10.1097/SCS.0b013e318241e1de
World Health Organization. (2020). Injuries and violence: The facts. WHO Press. https://www.who.int/publications/i/item/injuries-and-violence-the-facts-2020
Zuk, P. A. (2008). Tissue engineering craniofacial defects with adult stem cells? Are we ready yet? Pediatric Research, 63(5), 478-486. https://doi.org/10.1203/PDR.0b013e31816c5d3
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