UA Open Access Publishing Fund / Titanium craniofacial hardware has become commonplace for reconstruction and bone flap fixation following craniotomy. Complications of titanium hardware include palpability, visibility, infection, exposure, pain, and hardware malfunction, which can necessitate hardware removal. We describe three patients who underwent craniofacial reconstruction following craniotomies for trauma with post-operative courses complicated by medically intractable facial pain. All three patients subsequently underwent removal of the symptomatic craniofacial titanium hardware and experienced rapid resolution of their painful parasthesias. Symptomatic plates were found in the region of the frontozygomatic suture or MacCarty keyhole, or in close proximity with the supraorbital nerve. Titanium plates, though relatively safe and low profile, can cause local nerve irritation or neuropathy. Surgeons should be cognizant of the potential complications of titanium craniofacial hardware and locations that are at higher risk for becoming symptomatic necessitating a second surgery for removal.

Introduction: As fractures of the supraorbital region are far less common than midfacial or orbital fractures, a study was initiated to investigate whether fist blows could lead to fractures similar to those often seen in the midface. Methods: A detailed skull model and an impactor resembling a fist were created and a fist blow to the supraorbital region was simulated. A transient finite element analysis was carried out to calculate von Mises stresses, peak force, and impact time. Results: Within the contact zone of skull and impactor critical stress values could be seen which lay at the lower yield border for potential fractures. A second much lower stress zone was depicted in the anterior-medial orbital roof. Conclusions: In this simulation a fist punch, which could generate distinct fractures in the midface and naso-ethmoid-orbital region, would only reach the limits of a small fracture in the supraorbital region. The reason is seen in the strong bony architecture. Much higher forces are needed to create severe trauma in the upper face which is supported by clinical findings. Finite element analysis is the method of choice to investigate the impact of trauma on the human skeleton.

Introduction: As fractures of the supraorbital region are far less common than midfacial or orbital fractures, a study was initiated to investigate whether fist blows could lead to fractures similar to those often seen in the midface. Methods: A detailed skull model and an impactor resembling a fist were created and a fist blow to the supraorbital region was simulated. A transient finite element analysis was carried out to calculate von Mises stresses, peak force, and impact time. Results: Within the contact zone of skull and impactor critical stress values could be seen which lay at the lower yield border for potential fractures. A second much lower stress zone was depicted in the anterior-medial orbital roof. Conclusions: In this simulation a fist punch, which could generate distinct fractures in the midface and naso-ethmoid-orbital region, would only reach the limits of a small fracture in the supraorbital region. The reason is seen in the strong bony architecture. Much higher forces are needed to create severe trauma in the upper face which is supported by clinical findings. Finite element analysis is the method of choice to investigate the impact of trauma on the human skeleton.:Background; Methods; Rersults; Discussion; Results; Consent