We evaluated the accuracy of computer-assisted mandibular reconstructions. Patients and methods: We retrospectively reviewed data for 26 patients who had mandibular reconstruction with a microvascular free fibula flap, January 2015 to June 2018. Postoperative mandible models were obtained from computed tomography scans. After registering the models to the corresponding preoperative plan, we performed comparative measurements. Patients were grouped by condylar involvement and subdivided based on number of fibular segments used for reconstruction. For each segment, we measured length and osteotomy angles. For the final postoperative outcome, we compared intercoronoid, intergonial, and anteroposterior distances and intersegmental plane shift. Results: Means (SD) for deviation of each osteotomy angle and fibular segment length were 1.98°(2.98) and 1.78 mm (2.69), respectively, remaining constant across subgroups. Other mean values were as follows: intercoronoid distance deviation, 3.86 mm (range, 0.20-11.21 mm); intergonial distance deviation, 3.14 mm (range, 0.05-8.28 mm); anteroposterior distance deviation, 2.92 mm (range, 0.03-8.49 mm); and intersegmental plane shift, 11.00°(range, 2.76-24.15°). Where the condyle was preserved, the intercoronoid and intergonial deviation means differed significantly (respectively 5.02 mm and 4.88 mm, both P < 0.05) for one-segmented and threesegmented fibular reconstructions. Furthermore, reconstructions involving the condylar region compared with condyle preservation showed significantly different intersegmental plane shifts (7.18°; P < 0.05). Conclusion: Computer-assisted surgery provides cutting guides for obtaining accurate fibular segments, but current fixation methods lead to inaccuracies and reproducibility errors. In multisegmental transfer with condylar involvement, computer-assisted fixation is recommended to ensure accuracy of the preoperative plan.

Abstract. As the surgical treatment of clavicular fractures is increasingly utilized in orthopedics, the number of related complications rises as well. We present a case of segmental bone loss of the clavicle due to fracture-related infection. Treatment was based on a multidisciplinary team approach, which was important for a successful outcome.

Infection after maxillofacial trauma remains an important complication, with a significant socio-economic impact. While consensus exists that systemic antibiotic prophylaxis reduces the risk of infection in the management of maxillofacial fractures, the type, and duration remain controversial. Therefore, the purpose of this scoping review was to provide an overview of the current evidence that supports the use of prophylactic antibiotics in the treatment of maxillofacial fractures. A comprehensive literature search on 1 January 2022, in PubMed, Web of Science, Embase, and Cochrane, revealed 16 articles. Most studies focused on the duration of systemic antibiotic prophylaxis and compared a one-day to a five-day regimen. Included studies showed considerable variability in design and research aims, which rendered them difficult to compare. Furthermore, a variety of antibiotic regimens were used, and most studies had a short follow-up period and unclear outcome parameters. This scoping review demonstrates the lack of well-constructed studies investigating the type and duration of systemic antibiotic prophylaxis in the treatment of maxillofacial trauma. Based on the included articles, prolonging antibiotic prophylaxis over 24 h for surgically treated fractures does not appear to be beneficial. Furthermore, there is no evidence for its use in conservatively treated fractures. These results should be interpreted with caution since all included studies had limitations.

No abstract