Salvage reconstruction of orbitomaxillary defects remains exceptionally difficult, particularly following prior free-flap failure, radiotherapy, and chronic infection. Successful restoration requires reliable vascularised bone for maxillary support, biologic reconstruction of the orbital floor, and well-vascularised soft tissue to re-establish oral–nasal separation and intraoral lining within a scarred and contaminated operative field. Virtual surgical planning was used to facilitate reconstruction with a fibula osteomyocutaneous free flap, allowing restoration of maxillary buttresses and alveolar architecture while providing soft tissue for palatal closure, intraoral lining, and midfacial contour. In this case, the fibula was harvested as a straight segment and osteotomised into a complex Z-shaped construct, a configuration that increases inset difficulty and places the vascular pedicle at risk of kinking, thereby challenging flap perfusion and survival. The osseous construct additionally provided stable inferior orbital rim support, enabling reconstruction of the orbital floor using an autologous iliac crest graft and avoiding reintroduction of alloplastic material into an infected field. This case highlights the feasibility of a single-stage salvage orbitomaxillary reconstruction using a multi-segment Z-shaped fibula osteomyocutaneous flap, emphasising the technical considerations required to maintain vascular integrity in complex osseous geometry. The approach is illustrated through a detailed case presentation and discussion of relevant technical considerations and existing literature.

Purpose Morphea en coup de sabre, or French for “blow from a sword”, is a rare form of localised scleroderma characterised by progressive linear atrophy and frontocranial vertical depression, classically presenting in childhood. In this report, we present a rare case of adult-onset en coup de sabre successfully treated with single-stage autologous fat grafting. Methodology A 64-year-old man presented with a 7-year history of spontaneous right paramedian forehead linear depression, soft tissue atrophy, bony concavity, and alopecia. He was treated with single-stage autologous fat grafting using Coleman's technique, with retrograde injection of 20cc of fat and deliberate overcorrection to allow for fat resorption. Results At 6 weeks post-operatively, we achieved a satisfactory aesthetic outcome with the correction of contour deformity, volume stabilisation and minimal fat resorption. The patient reported high satisfaction with the aesthetic outcome and experienced no complications. Conclusion This case highlights that autologous fat grafting is a safe, effective and minimally invasive single-stage reconstructive treatment for stable craniofrontal linear scleroderma, including adult-onset presentations. Fat grafting provides both volumetric correction and potential regenerative benefits that address disease processes, making it a valuable option for residual deformity after disease quiescence.

Background Thread rhinoplasty is a non-surgical method of altering the appearance of the nose by insertion of typically barbed threads to suspend cartilage or add volume. Due to its minimally invasive nature and lower cost than open rhinoplasty, it has gained popularity in recent decades, particularly in Asia. However, complications can arise from this procedure, such as infection, thread extrusion and loss of suspension. Methods We present a series of Australian patients who developed complications after thread rhinoplasty and performed a literature review using the keywords “nose threading”, “non-surgical rhinoplasty” and “thread rhinoplasty” using Ovid MEDLINE. 189 relevant articles were found and after abstract review 16 were included for full text review by two authors. Results Between April 2020 and April 2024, 11 patients presented with complications relating to thread rhinoplasty which subsequently required surgical management, presenting at a mean of 5.8 months after the initial procedure. 10 out of 11 patients had the threads inserted in Asia, with the remaining patient having the procedure performed by an unregistered nurse in Australia. 4 presented with infections and 7 had thread extrusion, and all resolved following surgical removal of thread material. Conclusions Non-surgical cosmetic procedures such as thread rhinoplasty are becoming more prevalent and as such, their complications may also become more frequently seen. It is important for healthcare professionals to be aware of the risks associated with nasal thread insertion and recognise and manage complications promptly in order to reduce associated morbidity in a cosmetically sensitive area of the face.

Introduction Mandible fractures are common in young adults and have a functional impact. This study evaluates a cohort of patients with mandibular fractures in Western Australia to ascertain factors determining operative management. Methods A cohort of 104 patients with 139 mandible fractures were referred to Sir Charles Gairdner Hospital, Plastics and Reconstructive Services from July 2022 to November 2025. Patient factors and referral source were obtained; alongside fracture characteristics such as displacement, malocclusion, fracture favourability and dental instability. Univariable associations were assessed and multivariable logistic regression was used to identify independent predictors of operative management. Results 68.3% of patients were aged between 18 and 39 years with 75% being male. The most common mechanism of injury was assault (42.3%). In the cohort, 78 fractures (56.1%) were managed operatively. Fracture displacement (adjusted OR 5.79, 95% CI 1.48–22.62), malocclusion (adjusted OR 11.97, CI 1.20–119.37), multiple fractures (adjusted OR 8.46, 95% CI 2.70-26.51) and unfavourable fracture pattern (adjusted OR 6.07, 95% CI 1.25-29.56) remained independent predictors of operative management. Angle fractures were more likely to be managed operatively (OR 5.54, 95% CI 1.98–15.50) as well as parasymphysis fractures (OR 2.69, 95% CI 1.01–7.16). Whereas condylar fractures (OR 0.09, 95% CI 0.03–0.24) and ramus fractures (OR 0.20, 95% CI 0.06–0.64) were less likely to be managed operatively. Patient factors such as gender and referral source were not independently associated with operative management. Conclusion Operative management of mandibular fractures was driven primarily by fracture instability and unfavourable biomechanics rather than patient factors. Future prospective studies incorporating patient-reported outcomes may further refine thresholds for operative intervention in mandible trauma.

Purpose The CLEFT-Q survey has traditionally been administered in paper format. Given that many craniofacial surgery patients are aged 16–30 years, we implemented a QR-code–based delivery method to improve accessibility and optimise data capture for our craniofacial database. Methodology The CLEFT-Q survey was transcribed into Microsoft Forms and distributed to eligible patients via a QR code that could be scanned on personal devices (see Diagrams 1–2). Survey uptake and data completeness were evaluated over the first six months of implementation (August 2025–January 2026) and compared with the preceding six-month periods using the paper-based approach. Outcomes included response rate and the proportion of missing data points. Results Compared with the preceding six-month periods, the QR-code method was associated with improved survey uptake over August 2025–January 2026. A total of 47 initial and follow up surveys were obtained. The average time for completion for the survey was 12 minutes and 28 seconds. A reduction in missing data points was also observed. Results are summarised in the tables below. Conclusion Transitioning from paper to QR-code survey delivery is a feasible, low-cost intervention that aligns with the demographics of a craniofacial population and may improve both participation and data completeness within clinical databases.