Abstract
Pan facial fractures being the most complicated fracture as it involves multiple fractures of lower third of the face, the mid-face and the upper third, and so the management of such multiple fractures is extremely complicated. Proximity of the maxillofacial region with features or senses such as vision (diplopia), olfaction, respiration (airway), mastication (occlusion) or chewing, deglutition and aesthetics; contributing in complexities of fracture management, also creates a dilemma for surgeon itself from operating point of view while keeping vitals in mind. The inaccessibility to the fractured site and its reduction is often iatrogenically left uncorrected leading to deformity.
The establishment of pattern of repairing the pan facial fracture is the most challenging and require great experience as well as knowledge, as it vary with each case. All the vertical and horizontal pillars has to be made to restore and rehabilitate the facial anatomy and aesthetic. After all the aggressive treatment, the residual deformity of facial trauma is not uncommon, which often require a second stage corrective surgery.
This article briefs about the management and simple approaches used to reduce and fix a case of pan facial trauma in a 23-year-old male who underwent a road traffic accident.(1)
Keywords: Pan facial fracture, Upper third fracture, Mid face fracture, Nasal fracture, Open reduction and internal fixation.
References
- Adamo Arthur K. Intraoperative airway management with pan-facial fractures: Alternative approach. J Craniomaxillofac Surg. 1996;2:30-5.
- Dongmei He, Yi Zhang, Edward Ellis III. Pan facial fractures: Analysis of 33 cases treated late. J Oral & Maxillofac Surg. 2007;65:2459-65.
- Louis P. Management of Panfacial fractures. In: Miloro M, editor. Peterson’s principle of Oral and maxillofacial surgery. 2nd B C Decker Inc: Hamilton. 2004.
- Yang R, Zhang C, Liu Y, Li Z, Zubling L .Why should we start from mandibular fractures in the treatment of panfacial fractures?. J Oral Maxillofac Surg. 2012;70:1386-92
- Markowitz BL, Manson PN. Panfacial fractures: Organization of treatment. Clin Plast Surg. 1989;16:105.
- Obuekwe ON, Ojo MA, Akpata O, Etetafia M. Maxillofacial trauma due to road traffic accidents in Benin city, Nigeria: A Prospective study. Annals of African Medicine. 2003;2:58-63.
- Miloro M, Ghalli GE, Larsen PE, Waite PD. Textbook of Peterson’s principle of Oral & Maxillofacial surgery. Second edition. Vol-1:547-59.
- Gruss JS, Phillips JH. Complex facial trauma: The evolving role of rigid fixation and immediate bone graft reconstruction.Clin Plast Surg .1989;16(1): 93-104.
- Kreutziger KL. Surgical management of complex maxillofacial fractures. 1982;92(2):192-98.
- Jiye Kim et al, Panfacial Bone Fracture and Medial to Lateral Approach, Arch Craniofac Surg Vol.17 No.4, 181-185.
- Sourav Sharma, Vandana Dhanasekaran, Surgical Approaches and Management of Panfacial Trauma: A Case Report, Journal of Clinical and Diagnostic Research. 2015 Aug, Vol-9(8)
- Mittal G, Mittal RK, Katyal S, Uppal S, Mittal V. Airway management in maxillofacial trauma: do we really need tracheostomy/ submental intubation. J Clin Diagn Res 2014;8(3):77–79
- Rosenberger E, Kriet JD, Humphrey C. Management of nasoethmoid fractures. Curr Opin Otolaryngol Head Neck Surg 2013; 21(4):410–416
- Grabe HM, McKean EL, Eggenberger ER, Trobe JD. Persistent diplopia and superior oblique muscle dysfunction following dissection of the orbital periosteum in cranial base surgery. Br J Ophthalmol 2013;97(10):1330–1332
- Martou G, Antonyshyn OM. Advances in surgical approaches to the upper facial skeleton. Curr Opin Otolaryngol Head Neck Surg 2011;19(4):242–247
- Pau M, Reinbacher KE, Feichtinger M, Navysany K, Kärcher H. The mandibular symphysis as a starting point for the occlusallevel reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: report of two cases. J Craniomaxillofac Surg 2014;42(4): e51–e56
- Alvi A, Doherty T, Lewen G. Facial fractures and concomitant injuries in trauma patients. Laryngoscope. 2003;113:102–106.
Corresponding Author
Dr Gaurang Thanvi
III Year Resident Department of Oral & Maxillofacial Surgery, MGDC Jaipur