title: Structural biomechanics of the craniomaxillofacial skeleton under maximal masticatory loading: Inferences and critical analysis based on a validated computational model.
abstract: BACKGROUND
  The trend towards optimizing stabilization of the craniomaxillofacial skeleton (CMFS) with the minimum amount of fixation required to achieve union, and away from maximizing rigidity, requires a quantitative understanding of craniomaxillofacial biomechanics. This study uses computational modeling to quantify the structural biomechanics of the CMFS under maximal physiologic masticatory loading.
  
  
  METHODS
  Using an experimentally validated subject-specific finite element (FE) model of the CMFS, the patterns of stress and strain distribution as a result of physiological masticatory loading were calculated. The trajectories of the stresses were plotted to delineate compressive and tensile regimes over the entire CMFS volume.
  
  
  RESULTS
  The lateral maxilla was found to be the primary vertical buttress under maximal bite force loading, with much smaller involvement of the naso-maxillary buttress. There was no evidence that the pterygo-maxillary region is a buttressing structure, counter to classical buttress theory. The stresses at the zygomatic sutures suggest that two-point fixation of zygomatic complex fractures may be sufficient for fixation under bite force loading.
  
  
  CONCLUSIONS
  The current experimentally validated biomechanical FE model of the CMFS is a practical tool for in silico optimization of current practice techniques and may be used as a foundation for the development of design criteria for future technologies for the treatment of CMFS injury and disease.
authors.affiliation: Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Amir R
authors.initials: AR
authors.lastname: Pakdel
authors.affiliation: Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cari M
authors.initials: CM
authors.lastname: Whyne
authors.affiliation: Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Electronic address: jeff.fialkov@sunnybrook.ca.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Fialkov
mesh_terms: D001696:Biomechanical Phenomena; D003198:Computer Simulation; D005147:Facial Bones / Q000502:physiology*; D020342:Finite Element Analysis; D005593:Fracture Fixation, Internal; D006801:Humans; D008409:Mastication / Q000502:physiology; D008437:Maxilla / Q000502:physiology*; D012886:Skull / Q000502:physiology*; D012887:Skull Fractures / Q000601:surgery; D013314:Stress, Mechanical; D015050:Zygoma / Q000502:physiology
keywords: Biomechanical models; Computational model; Computer model validation; Craniofacial reconstructive surgery; Fracture fixation; Zygomatic fracture