Clinical Application of a Multistage Algorithm for Aesthetic and Functional Reconstruction in Post-Traumatic Craniofacial Sequelae.

[BACKGROUND] Craniomaxillofacial trauma is a common occurrence in adults, often resulting from vehicle accidents, assaults, sports injuries, working accidents, and others. The primary goal of craniomaxillofacial trauma surgery is to restore function and aesthetics, while also supporting the patient's social reintegration. However, many patients develop post-traumatic complications and sequelae such as malocclusion, facial asymmetry, unsatisfactory aesthetic outcomes, pseudoarthrosis, airway disturbances, and nasal or ocular dysfunction. A multistage reconstruction approach involves sequential procedures: first-stage hard tissue correction using orthognathic surgery and bone reconstruction, followed by orbital reconstruction and rhinoplasty in the second stage, and concluding with soft tissue facial plastic surgery in a third stage.

[MATERIALS AND METHODS] This case series includes patients treated with a multistage approach between 2004 and 2025. The procedures performed included orthognathic surgery, bone grafting, rhinoplasty, orbital reconstruction, and facial plastic surgery.

[RESULTS] A total of 25 patients with complete records were reviewed. Data collected included age, gender, trauma etiology, diagnosis, functional sequelae, surgical procedures performed, post-surgical complications, treatment of complications, and follow-up duration.

[CONCLUSIONS] Correcting post-traumatic craniofacial anomalies is challenging due to the involvement of both functional and anatomical structures, often leading to issues such as soft and hard tissue loss, fibrosis, bone fragment malunion, infection, malocclusion, facial asymmetry, airway disturbances, and orbito nasal dysfunction. Successful multistage craniofacial reconstruction requires an interdisciplinary team skilled in trauma, orthognathic, reconstructive, and facial plastic surgery. We propose a multistage treatment algorithm based on clinical evidence to guide practitioners in treatment planning and decision-making.

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