Management of Panfacial Fracture

Abstract

Traumatic panfacial fracture repair is one of the most complex and challenging reconstructive procedures to perform. Several principles permeate throughout literature regarding the repair of panfacial injuries in a stepwise fashion. The primary goal of management in most of these approaches is to restore the occlusal relationship at the beginning of sequential repair so that other structures can fall into alignment. Through proper positioning of the occlusion and the mandibular-maxillary unit with the skull base, the spatial relationships and stability of midface buttresses and pillars can then be re-established. Here, the authors outline the sequencing of panfacial fracture repair for the restoration of anatomical relationships and the optimization of functional and structural outcomes.

A novel fixation method for panfacial fracture using an Ilizarov-type external fixator

“…Internal plate fixation in the cranio-maxillofacial field is mainly indicated for various type of facial bone fracture and osteotomy operations. In rare cases, an external fixator is applied for panfacial fractures [1]. Only in cases of mandibular condyle fractures does internal versus external fixation tend to be multifactorial, and patient-specific factors often lead us to select the most appropriate management strategy.…”

Experience with airway management and sequencing of repair of panfacial fractures: A single tertiary healthcare appraisal in Najran, Kingdom of Saudi Arabia - A retrospective study

“…Management of extensive craniofacial injuries such as panfacial fractures has witnessed remarkable improvements with advances in airway management, full exposure of the craniofacial skeleton, and fixation of fractures with rigid internal fixation techniques. [ 1 ] Due to the problem of shared airway, special cooperation is required between a surgeon and an anesthetist for airway management when there are midface and panfacial fractures. Panfacial fractures are defined as fractures of the cranio-maxillofacial complex involving bones in the lower, middle, and upper thirds of the facial skeleton.…”

“…Panfacial fractures are defined as fractures of the cranio-maxillofacial complex involving bones in the lower, middle, and upper thirds of the facial skeleton. [ 1 ] Several methods have been proposed for airway management in these complex facial injuries. [ 2 3 ] Management of fractures in this region of the body involves not only restoration of facial appearance and symmetry to premorbid levels, but also restoration of functions such as vision, olfaction, breathing (i.e., airway management), mastication (i.e., restoration of teeth and occlusion), deglutition, and articulation.…”

“…With respect to restoration of occlusion, which is an important aspect in the management of facial bone fractures, temporary mandibulo-maxillary fixation (MMF) is required to re-establish the occlusion so as to ensure maximum occlusal function after healing of fractures in dentate patients. [ 1 ] The usual orotracheal intubation will prevent achievement of temporary MMF during surgery. The other option is nasotracheal intubation which is contraindicated in panfacial, naso-orbito-ethmoidal, and skull base fractures, because of the possibility of accidental intracranial intubation from the base of the skull and/or cribriform plate.…”

“…[ 15 16 17 ] To achieve functional and esthetic outcome and prevent these psychosocial symptoms, there must be sequencing in the repair of this complex region. [ 1 18 ] Several sequencing approaches have been mentioned in the literature to include “bottom-up,” “inside-out,” “outside-in,” and “top-bottom” approach. [ 1 18 19 ] However, the ideal sequencing of a complex panfacial fracture remains the greatest challenge to every oral and maxillofacial surgeon.…”