CURRENT CONCEPTS IN THE MULTIDISCIPLINARY MANAGEMENT OF MAXILLOFACIAL CICATRICIAL DEFORMITIES
DOI:
https://doi.org/10.11603/2311-9624.2026.2.16429Keywords:
scar deformities, maxillofacial region, hypertrophic scars, keloid scars, laser ablation, Er:YAG laser, corticosteroids, multidisciplinary approach, rehabilitationAbstract
The paper provides a systematic review of the etiology, pathogenesis, and current management strategies for facial and cervical scar deformities. Special attention is focused on the molecular pathogenesis of hypertrophic and keloid scarring. The rationale for a multimodal therapeutic strategy, including pharmacotherapy, physical interventions (laser therapy, cryodestruction), and surgical reconstruction, is established. The study also highlights the specifics of rehabilitation for patients with maxillofacial scar contractures regarding the functional restoration of the dentofacial complex.
The aim of the study – to systematize and scientifically substantiate modern multidisciplinary approaches to the diagnosis, prevention, and treatment of scar deformities of the maxillofacial region in order to optimize the aesthetic and functional results of patient rehabilitation, particularly those with combat trauma.
Materials and Methods. An in-depth bibliosemantic and analytical review of modern professional literature for the last 10 years was conducted using PubMed, Scopus, Web of Science, and Google Scholar databases. International clinical guidelines and results of randomized clinical trials regarding the efficacy of conservative, injection, hardware, and surgical scar correction methods were analyzed.
Results and Discussion. It was established that the etiopathogenesis of hypertrophic and keloid scars is based on the dysregulation of the proliferation phase, mediated by the hyperactivity of transforming growth factor (TGF-β) and an imbalance in the ratio of type I/III collagen. Monotherapy of facial scar deformities was found to demonstrate low clinical efficacy. A stepwise therapy algorithm was substantiated: application of silicone materials and compression therapy for hydration of the stratum corneum and regulation of fibroblast activity; intralesional injection of corticosteroids (triamcinolone) and enzymatic preparations (collagenase) to inhibit glycosaminoglycan synthesis; differentiated use of laser technologies based on selective photothermolysis (PDL 585-595 nm) for vascularization correction and ablative systems for skin relief remodeling (the advantages of the Erbium laser (for treating aesthetically significant facial zones due to its high water absorption coefficient are emphasized); surgical stage – indicated for functional impairments (microstomia, scar contractures, ectropion) using local plasty methods and lipofilling.
Conclusions. Effective management of scar deformities in the maxillofacial region requires a shift from empirical treatment to pathogenetically substantiated combined protocols. The integration of efforts by dentists, maxillofacial surgeons, and combustiologists is critical for restoring the functions of the dentofacial system (mastication, articulation) and the psychosocial reintegration of patients.
References
Son D., Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014. Vol. 29(6). P. 751–757. DOI: https://doi.org/10.3346/jkms.2014.29.6.751
Barone S., Bao E., Rothberg S., Palacios J.F., Smith I.T., Tanna N., Bastidas N. Scar Management in Pediatric Patients. Medicina (Kaunas). 2025. Vol. 61(4). P. 553. DOI: https://doi.org/10.3390/medicina61040553
Andrews J.P., Marttala J., Macarak E., Rosenbloom J., Uitto J. Keloids: The paradigm of skin fibrosis – Pathomechanisms and treatment. Matrix Biol. 2016. Vol. 51. P. 37–46. DOI: https://doi.org/10.1016/j.matbio.2016.01.013
Sullivan T., Smith J., Kermode J., McIver E., Courtemanche D.J. Rating the burn scar. J Burn Care Rehabil. 1990. Vol. 11(3). P. 256–260. URL: https://pubmed.ncbi.nlm.nih.gov/2373734/
Draaijers L.J., Tempelman F.R., Botman Y.A.M., et al. The Patient and Observer Scar Assessment Scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004. Vol. 113(7). P. 1960–1965. DOI: https://doi.org/10.1097/01.prs.0000122207.28773.56
Gold M.H., McGuire M., Mustoe T.A., Pusic A., Sachdev M., Waibel J., Murcia C. Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment. Dermatol Surg. 2014. Vol. 40(8). P. 825–831. DOI: https://doi.org/10.1111/dsu.0000000000000050
Monstrey S., Middelkoop E., Vranckx J.J., et al. Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg. 2014. Vol. 67(8). P. 1017–1025. DOI: https://doi.org/10.1016/j.bjps.2014.04.011
Sidgwick G.P., McGeorge D., Bayat A. A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res. 2015. Vol. 307(6). P. 461–477. DOI: https://doi.org/10.1007/s00403-015-1572-0
Arno A.I., Gauglitz G.G., Barret J.P., Jeschke M.G. Up-to-date approach to manage keloids and hypertrophic scars: a useful guide. Burns. 2014. Vol. 40(7). P. 1255–1266. DOI: https://doi.org/10.1016/j.burns.2014.02.011
Hirsch Y., Waterman C.L., Haber R. Pediatric Keloids and Review of the Efficacy of Current Treatment Modalities. Dermatol Surg. 2023. Vol. 49(7). P. 669–674. DOI: https://doi.org/10.1097/DSS.0000000000003815
Khoosal D., Goldman R.D. Vitamin E for treating children's scars. Can Fam Physician. 2006. Vol. 52(7). P. 855–856. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781083/
Morelli Coppola M., Salzillo R., Segreto F., Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018. Vol. 11. P. 387–396. DOI: https://doi.org/10.2147/CCID.S133672
Mustoe T.A., Cooter R.D., Gold M.H., et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002. Vol. 110(2). P. 560–571. DOI: https://doi.org/10.1097/00006534-200208000-00031
Ledon J.A., Savas J., Franca K., et al. Intralesional corticosteroids for keloids and hypertrophic scars: a review. Dermatol Surg. 2013. Vol. 39(12). P. 1745–1757. DOI: https://doi.org/10.1111/dsu.12346
Payapvipapong K., Niumpradit N., Piriyanand C., Buranaphalin S., Nakakes A. The treatment of keloids and hypertrophic scars with intralesional bleomycin in skin of color. J Cosmet Dermatol. 2015. Vol. 14(1). P. 83–90. DOI: https://doi.org/10.1111/jocd.12132
Payapvipapong K., Niumpradit N., Piriyanand C., Buranaphalin S., Nakakes A. The efficacy of intralesional bleomycin in the treatment of keloids and hypertrophic scars: a prospective clinical trial. J Med Assoc Thai. 2015. Vol. 98(2). P. 153–159. URL: https://pubmed.ncbi.nlm.nih.gov/25842795/
Al-Waiz M.M., Al-Sharqi A.I. Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg. 2002. Vol. 28(5). P. 383–387. DOI: https://doi.org/10.1046/j.1524-4725.2002.01081.x
Xiao Z., Zhang F., Cui Z. Treatment of hypertrophic scars with intralesional botulinum toxin type A injections: a preliminary report. Aesthetic Plast Surg. 2009. Vol. 33(3). P. 409–412. DOI: https://doi.org/10.1007/s00266-009-9334-z
Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg. 2010. Vol. 125(2). P. 557–568. DOI: https://doi.org/10.1097/PRS.0b013e3181c82dd5
Jeong H.S., Lee B.H., Sung H.M., et al. Effect of botulinum toxin type A on differentiation of fibroblasts derived from hypertrophic scar. Plast Reconstr Surg. 2015. Vol. 136(2). P. 171e–178e. DOI: https://doi.org/10.1097/PRS.0000000000001438
Bleasdale B., Finnegan S., Murray K., Kelly S., Percival S.L. The use of silicone adhesives for scar reduction. Adv Wound Care (New Rochelle). 2015. Vol. 4(7). P. 422–430. DOI: https://doi.org/10.1089/wound.2015.0625
Puri N., Talwar A. The efficacy of silicone gel for the treatment of hypertrophic scars and keloids. J Cutan Aesthet Surg. 2009. Vol. 2(2). P. 104–106. DOI: https://doi.org/10.4103/0974-2077.58527
Wiseman J., Ware R.S., Simons M., McPhail S., Kimble R., Dotta A., Tyack Z. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children: a randomized controlled trial. Clin Rehabil. 2020. Vol. 34(1). P. 120–131. DOI: https://doi.org/10.1177/0269215519877516
Viera M.H., Amini S., Valins W., Berman B. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol. 2010. Vol. 3(5). P. 20–26.
Byl N.N., McKenzie A., Wong T., West J., Hunt T.K. Incisional wound healing: a controlled study of low and high dose ultrasound. J Orthop Sports Phys Ther. 1993. Vol. 18(5). P. 619–628. DOI: https://doi.org/10.2519/jospt.1993.18.5.619
Zouboulis C.C., Blume U., Büttner P., Orfanos C.E. Outcomes of cryosurgery in keloids and hypertrophic scars: a prospective consecutive trial of case series. Arch Dermatol. 1993. Vol. 129(9). P. 1146–1151. URL: https://pubmed.ncbi.nlm.nih.gov/8363398/
Kazemeini S., Nadeem-Tariq A., Hajian P., Anil B., Easterly J., Sraa K., Pokharel S., Metellus R., Kazemeini M. Hypertrophic and Keloid Scar Management: Advances in Diagnosis, Perioperative Care, and Anesthetic Modulation. Cureus. 2025. Vol. 17(7). P. e88810. DOI: https://doi.org/10.7759/cureus.88810
Khatri K.A., Mahoney D.L., McCartney M.J. Laser scar revision: A review. J Cosmet Laser Ther. 2011. Vol. 13(2). P. 54–62. DOI: https://doi.org/10.3109/14764172.2011.564625
El-Domyati M., Hosam W., Abdel-Azim E., Abdel-Wahab H., Mohamed E. Microdermabrasion: a clinical, histometric, and histopathologic study. J Cosmet Dermatol. 2016. Vol. 15(4). P. 503–513. DOI: https://doi.org/10.1111/jocd.12252
Moortgat P., Anthonissen M., Meirte J., Van Daele U., Maertens K. The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature. Burns Trauma. 2016. Vol. 4. P. 34. DOI: https://doi.org/10.1186/s41038-016-0053-9
Arndt S., Unger P., Wacker E., et al. Cold atmospheric plasma (CAP) changes gene expression of key molecules of the wound healing machinery and improves wound healing in vitro and in vivo. PLoS One. 2013. Vol. 8(11). P. e79325. DOI: https://doi.org/10.1371/journal.pone.0079325
Harmon C.B. Dermabrasion. Dermatol Clin. 2001. Vol. 19(3). P. 439–452. DOI: https://doi.org/10.1016/s0733-8635(05)70284-9
Orentreich D.S., Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg. 1995. Vol. 21(6). P. 543–549. DOI: https://doi.org/10.1111/j.1524-4725.1995.tb00259.x
Klinger M., Marra A., Vigo D., et al. Fat injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction. Aesthetic Plast Surg. 2008. Vol. 32(3). P. 465–469. DOI: https://doi.org/10.1007/s00266-008-9122-1
Larrabee W.F., East C.A., Jaffe H.S., Stephenson C., Peterson K.E. Intralesional Interferon Gamma Treatment for Keloids and Hypertrophic Scars. Arch Otolaryngol Head Neck Surg. 1990. Vol. 116(10). P.1159–1162. doi:10.1001/archotol.1990.01870100053011
Munavalli G.S., Smith S., Maslowski J.M., Weiss R.A. Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial. Dermatol Surg. 2013. Vol. 39(8). P. 1226-36. doi: 10.1111/dsu.12204
