{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T23:28:09Z","timestamp":1750980489520,"version":"3.40.1"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T00:00:00Z","timestamp":1641168000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Craniomaxillofacial Trauma &amp; Reconstruction"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec><jats:title>Study Design<\/jats:title><jats:p> Observational. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p> To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations \u2013 neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4\u2013C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1\u20132) joints. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries. <\/jats:p><\/jats:sec>","DOI":"10.1177\/19433875211053091","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T07:40:09Z","timestamp":1641282009000},"page":"312-317","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury \u2013 Is It Safe? Radiological Simulation in a Healthy Volunteer"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7871-1337","authenticated-orcid":false,"given":"Thomas","family":"Pepper","sequence":"first","affiliation":[{"name":"Institute of Naval Medicine, Defence Medical Services, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Spiers","sequence":"additional","affiliation":[{"name":"Department of Surgery, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Weller","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Radiology, Northwick Park Hospital, Watford Road, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Schilling","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, University College Hospital, Academic Head and Neck Unit, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,3]]},"reference":[{"key":"bibr1-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000293763.82790"},{"key":"bibr2-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31819e26f2"},{"key":"bibr3-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2016.08.019"},{"key":"bibr4-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1308\/003588414X14055925059633"},{"key":"bibr5-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1097\/scs.0b013e31814e0581"},{"key":"bibr6-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2008.07.010"},{"key":"bibr7-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181ef90e4"},{"key":"bibr8-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2018.07.003"},{"key":"bibr9-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1016\/S0901-5027(05)80852-5"},{"key":"bibr10-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1016\/S0266-4356(97)90041-3"},{"volume-title":"Audit of Time from Admission to Open Reduction and Internal Fixation of Mandibular Fractures","year":"2016","author":"Schilling C","key":"bibr11-19433875211053091"},{"key":"bibr12-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001829"},{"key":"bibr13-19433875211053091","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000162138.36519.2A"},{"volume-title":"Spinal Injury: Assessment and Initial Management. 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