Modern Surgical Treatment of Complex Facial Fractures: A 6-Year Review

Abstract

Open reduction and internal fixation (ORIF) with refined titanium plates and screws have revolutionized the surgical treatment of complex facial fractures, but its outcome remains relatively unknown. The purpose of this study is to review the results of modern surgical treatment of complex facial fractures involving at least two of the three zones of the face. From 1996 to 2002, 54 consecutive patients (41 males, 13 females; age 5-74 years) with complex facial fractures were treated by the plastic surgery service in our institution. All patients had their fractures repaired within 10 days after injury. ORIF of the fractures was performed through standard surgical approaches for the upper, middle, or lower face in a preferred sequence. Multiple rigid fixations were completed with current titanium plates and screws. Postoperative functional problems, residual cosmetic deformities, and reoperations for any complications in each patient were evaluated. All patients have been followed for up to 5 years. Overall, of the 54 consecutive patients in this study, 8 (14.8%) patients had postoperative functional problems, and 7 (13.0%) developed variable postoperative cosmetic deformities. Only nine (16.7%) patients underwent a subsequent reoperation for correction of the functional or cosmetic concern. Thus, we believe that modern surgical treatment of complex facial fractures by way of open treatment and rigid fixation with refined titanium plates and screws has resulted in overall good to excellent outcomes and a relatively low postoperative complication rate.

Fracturas panfaciales. Oportunidad de tratamiento

“…Las órbitas y el tercio medio de la cara son expuestos a través de las incisiones subciliares y vestibular superior, mientras que la mandíbula lo es por abordajes submandibulares o intraorales vestibulares inferiores 13 . De acuerdo con Jack y Vasconez, las complicaciones posoperatorias han disminuido en número y gravedad como también las reoperaciones por secuelas y deformidades secundarias, fundamentalmente por la precocidad en el tratamiento integral y el uso de la fijación rígida interna 14 .…”

Reconstrução da estrutura facial por biomateriais: revisão de literatura

“…O sistema de placas de titânio foi o meio mais efetivo e seguro de fixação óssea para a cirurgia de crânio e maxilofacial até 1996. Tradicionalmente, as placas de titânio são de fácil aplicação e bem toleradas pelos pacientes, e os resultados são considerados entre bom a excelente e com baixos índices de complicação pós-operatória 20 . Na população pediátrica acompanhada por mais de dez, a fixação com placas de titânio interfere no crescimento ósseo, exposição da placa, infecção e migração transcranial 21 .…”

Complications of Rigid Internal Fixation

“…Sixteen percent of patients, however, required reoperation due to errors in anatomic reduction of zygomaticomaxillary complex fracture repair (telecanthus, malar contour abnormalities and enophthalmos), underscoring the need for proper alignment of fragments that are rigidly fixated with microplating systems. 26 From the clinical descriptions of each series, craniofacial reconstruction with the addition of lower profile systems involves the establishment of the integrity of the upper midface with miniplates, followed by midface and periorbital fixation with microplating systems. Within each anatomic subgroup, microplate fixation of local bone fragments minimizes the extent of bone grafting from distant sites.…”