Russell R. Reid

Background: Robin Sequence (RS) is a congenital condition marked by micrognathia, glossoptosis, and airway obstruction. Patients with RS exhibit anatomical differences in the hyoid bone, a key mediator of swallowing and respiration. Severe RS is treated with mandibular distraction osteogenesis (MDO) to lengthen the mandible and increase oropharyngeal space, the latter thought to be caused by changes in hyoid position. Here, we test this hypothesis by quantitatively evaluating 3D hyoid position and morphology in patients with RS and comparing them to pediatric controls. Methods: Computed tomography (CT) scans were obtained for 38 patients with RS pre- and post-MDO and 15 control patients. Hyoid position relative to craniomandibular landmarks and hyoid morphology were compared between pre- and post-MDO RS patients and controls. Results: Pre-MDO patients have shorter relative hyoid-menton distances than post-MDOs and controls (p<0.01). Relative hyoid-basion and hyoid-vertebral column distances are comparable between groups. Controls have smaller relative hyoid-temporomandibular joint distances than RS patients (p<0.05). RS patients have a higher prevalence of abnormal hyoid ossification (control: 13.3%; pre-MDO: 36.8%) and demonstrate dimensional differences in hyoid width and angle related to both RS and MDO. Conclusions: MDO does not enlarge the oropharyngeal space by moving the hyoid anteriorly. Instead, we hypothesize MDO improves airway patency by 1) changing tongue shape and the geometry of the anterior pharyngeal wall, and 2) increasing suprahyoid muscle passive tension. Our results provide new insights into the mechanisms of mandibular distraction and highlight importance of the hyoid and its attachments in the pathologic presentation of RS.

Introduction: Ballistic mandibular fractures represent a complex subset of maxillofacial trauma, producing wider zones of injury, tissue loss, and greater bony comminution than blunt mechanisms. Despite advances in surgical technique, data on the presentation, management, and complications of these injuries in a civilian urban setting remain limited. This study characterizes management and complications of ballistic mandibular fractures at a single urban Level I trauma center. Methods: An IRB-approved retrospective review was conducted of patients evaluated for ballistic mandibular fractures between July 2018 and August 2023. Demographic data, injury characteristics, treatment modality, and postoperative complications were recorded. Univariate and multivariate logistic regressions were performed to identify predictors of any complication and infection. Results: Ninety patients met inclusion criteria. The cohort was predominantly young (mean age 29.3 ± 13.2 years) and male (82.2%), with the majority of injuries resulting from assault (91.1%). Nearly all patients required admission (95.6%), with a mean length of stay of 17.6 days. Upon presentation, 75.6% required urgent intubation and 44.4% had significant facial hemorrhage. Forty percent had concurrent ballistic injuries to other craniofacial structures, and 52.2% sustained injuries to non-head-and-neck structures. Surgical management was required in 74.4% of patients, with a median time to definitive fixation of 8 days (IQR 3-12). Post-operative complications occurred in 20.9% of operative patients, most commonly infection (42.9% of complications), plate exposure (21.4%), and malunion or nonunion (21.4%). No independent predictors of complication or infection were identified on Firth’s regression analysis. Conclusions: Ballistic mandibular fractures in the civilian setting frequently present in the context of multiple concurrent injuries, requiring urgent multidisciplinary intervention. Despite complex injury profiles, timely definitive fixation was achievable, and concurrent injuries did not independently delay surgical management. No modifiable risk factors for postoperative infection or complication were identified.

Sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) in particular, are common conditions with significant implications for perioperative and anesthesia risk, neurocognitive development, cardiovascular health, and long-term quality of life. Craniofacial anomalies and skeletal dysplasias that alter upper airway geometry, for example, micrognathia, maxillary/midface hypoplasias, significantly contribute to, or cause SDB and can be effectively addressed with maxillomandibular surgery. To provide customized and excellent care to the SDB patient, a craniofacial surgeon should be fluent in sleep medicine terminology, diagnostic and treatment options, and perioperative management strategies. This review synthesizes current clinical definitions, physiologic mechanisms relevant to craniofacial anatomy, age-appropriate diagnostic thresholds, and practical guidance on test selection and interpretation (polysomnography vs oximetry). Special emphasis is placed on infants and formerly preterm neonates, non-syndromic and syndromic Robin sequence patients, and perioperative safety planning. This review offers a clinic-ready algorithm for screening and testing, summarizes surgical and non-surgical management options, highlights long-term follow-up priorities, and identifies gaps for future research.

Background: Craniosynostosis is a relatively common congenital condition requiring early, multidisciplinary surgical management, making clear patient and caregiver understanding essential for optimal outcomes. However, patient education materials (PEMs) for complex conditions often exceed recommended readability levels, potentially limiting comprehension and adherence to care. This study evaluates the readability of online craniosynostosis materials from U.S. academic centers to assess the accessibility of these resources targeted to patients and their families. Methods: Craniosynostosis PEMs published by academic hospital systems that specifically offer an integrated plastic surgery residency program, with or without additional craniofacial surgery fellowship programs, were processed on WebFX to generate scores across a series of commonly used validated readability indexes. Descriptive statistics, including means and standard deviations (SD) were calculated for all readability metrics with comparisons made between materials from institutions with and without craniofacial fellowships. Results: Among 90 academic institutions participating in the integrated plastic surgery residency match, 78.3% provided online patient education materials (PEMs) on craniosynostosis, the majority of which demonstrated poor readability across all metrics, averaging a high school to early college reading level and far exceeding recommended standards. Fewer than 5% of institutions produced materials at or below the American Medical Association’s recommended sixth grade level. Readability did not significantly differ between institutions with and without craniofacial surgery fellowship programs. Conclusion: Online craniosynostosis patient education materials from academic institutions are written above recommended reading levels, limiting accessibility for many families. This gap persists regardless of institutional specialization and may hinder understanding of complex, longitudinal care. Improving readability through simplified language and clearer communication strategies is essential to enhance health literacy and support optimal patient outcomes.

Background: Iatrogenic facial nerve injury is a feared complication of craniomaxillofacial surgery, particularly when the parotid gland is instrumented or the Superficial Musculoaponeurotic System (SMAS) is violated. Facial palsy can have devastating psychosocial consequences for the patient, prompting decades of research to refine techniques of intraoperative facial nerve identification and preservation to avoid this outcome. The objective of this literature review is to trace the evolution of techniques for intraoperative facial nerve identification and describe ongoing advances in the field. Methods: PubMed and Google Scholar were queried to identify publications describing both historical and conventional understandings of facial nerve anatomy and intraoperative facial nerve identification technique. Keywords included “facial nerve identification,” “facial nerve monitoring,” “facial nerve anatomy,” “facial nerve landmarks,” and “iatrogenic facial nerve injury.” Articles were screened for the following exclusion criteria: non-English language, full text unavailable, single-subject case reports, examination of peripheral nerves other than the facial nerve, non-mammalian animal models, and studies focusing on identification of the facial nerve at its pontine origin. Data was extracted and organized by year of publication, study type, study population, surgical context, method of facial nerve identification, key findings, advantages, limitations, and level of evidence. Results: Forty-two publications, published between 1954 and 2025, were included. Our review details both historical and conventional techniques of facial nerve identification including use of anatomic landmarks, electrical nerve stimulation, magnification and microscopy, and enhanced optical techniques including fluorescence-guided surgery. Conclusions: Intraoperative facial nerve identification is crucial to prevent iatrogenic facial nerve injury; however, there is limited consensus on the precise identification technique. Facial nerve identification techniques continue to evolve, with fluorescence-guided surgery likely to be the next frontier in advancement of the safety and efficacy of these techniques.

Cleft lip (CL) and cleft palate (CP), collectively referred to as orofacial clefts (OFCs), are among the most common birth defects and can have significant effects on speech, nutrition, and physical and psychosocial development. Manifestation, classification, and treatment plans of OFCs are diverse and not standardized. Recent technological advancements and genetic testing have enabled researchers to propose relationships between certain genes and the development of OFCs. Potential genetic precursors for OFCs have been found to be numerous and diverse. Treatment strategies are also numerous and vary greatly between individuals. In this review article, we summarize the most commonly discussed genetic factors in the literature, variation in classification, and advances in management.

Effective repair of large bone defects through bone tissue engineering (BTE) remains an unmet clinical challenge. Successful BTE requires optimal and synergistic interactions among biocompatible scaffolds, osteogenic factors, and osteoprogenitors to form a highly vascularized microenvironment for bone regeneration and osseointegration. We sought to develop a highly effective BTE system by using 3D printed citrate-based mPOC/hydroxyapatite (HA) composites laden with BMP9-stimulated human urine stem cells (USCs). Specifically, we synthesized and characterized methacrylate poly(1,8 octamethylene citrate) (mPOC), mixed it with 0%, 40% or 60% HA (i.e., mPOC-0HA, mPOC-40HA, or mPOC-60HA), and fabricated composite scaffold via micro-continuous liquid interface production (μCLIP). The 3D-printed mPOC-HA composite scaffolds were compatible with human USCs that exhibited high osteogenic activity in vitro upon BMP9 stimulation. Subcutaneous implantation of mPOC-HA scaffolds laden with BMP9-stimulated USCs revealed effective bone formation in all three types of mPOC-HA composite scaffolds. Histologic evaluation revealed that the mPOC-60HA composite scaffold yielded the most mature bone, resembling native bone tissue with extensive scaffold-osteointegration. Collectively, these findings demonstrate that the citrate-based mPOC-60HA composite, human urine stem cells, and the potent osteogenic factor BMP9 constitute a desirable triad for effective bone tissue engineering.

Approaches to regenerating bone often rely on integrating biomaterials and biological signals in the form of cells or cytokines. However, from a translational point of view, these approaches are challenging due to the sourcing and quality of the biologic, unpredictable immune responses, complex regulatory paths, and high costs. We describe a simple manufacturing process and a material-centric 3D-printed composite scaffold system (CSS) that offers distinct advantages for clinical translation. The CSS comprises a 3D-printed porous polydiolcitrate-hydroxyapatite composite elastomer infused with a polydiolcitrate-graphene oxide hydrogel composite. Using a micro-continuous liquid interface production 3D printer, we fabricate a precise porous ceramic scaffold with 60 wt% hydroxyapatite resembling natural bone. The resulting scaffold integrates with a thermoresponsive hydrogel composite in situ to fit the defect, which is expected to enhance surface contact with surrounding tissue and facilitate biointegration. The antioxidative properties of citrate polymers prevent long-term inflammatory responses. The CSS stimulates osteogenesis in vitro and in vivo. Within 4 weeks in a calvarial critical-sized bone defect model, the CSS accelerated ECM deposition (8-fold) and mineralized osteoid (69-fold) compared to the untreated. Through spatial transcriptomics, we demonstrated the comprehensive biological processes of CSS for prompt osseointegration. Our material-centric approach delivers impressive osteogenic properties and streamlined manufacturing advantages, potentially expediting clinical application for bone reconstruction surgeries.

Ballistic facial trauma can cause complex fractures and overlying soft tissue damage, with a zone of injury that extends beyond the bullet tract. Early skeletal fixation is indicated, and previous large case series describe the use of debrided bone fragments as ‘spare part’ grafts. This series presents the indications and techniques for simultaneous coronoid bone grafting in 2 patients who sustained a gunshot wound to the right midface and required coronoidectomy. The coronoid process was used as (1) an interposition graft in the lateral buttress of the right maxilla for stability, and (2) an onlay graft on the right inferior orbital rim for contour. Both patients did not have graft infection, extrusion, or malposition at the 1-month clinic follow-up. The coronoid process of the mandible is a viable, safe spare-part option, despite the possible location of the coronoid process within the zone of injury in the reconstruction of complex ballistic facial trauma.