Sequencing of Fixation in Panfacial Fracture: A Systematic Review

Abstract

Objective In panfacial fracture management, the controversy still exists in the sequencing of fixation. The purpose of this systematic review is to establish the best sequence pattern which assists in achieving definite facial width, vertical height and anteroposterior projection. Methods The review was conducted according to the ''Preferred Reporting Items for Systematic Reviews and Meta-Analyses'' (PRISMA) guidelines. Two independent authors performed a comprehensive search of the PUBMED, EBSCO, J-Gate, SCOPUS and NDH for articles published up until December 2018. Sequence of fixation, timing of intervention, outcome, follow-up period and complications were evaluated for patients with panfacial fracture. Results In total, 202 articles were identified from the databases. After screening and full text analysis, 25 studies were included in this systematic review. Nineteen studies reported bottom-to-top sequence and two studies reported top-to-bottom approach. However, four studies reported both the approaches. The follow-up period ranges from 3 weeks to 4 years. Conclusion Based on the literature support and evidence, good and satisfactory outcome achieved in ''Bottom-top and outside-in'' sequence when compared with other sequence pattern. Early repair of panfacial fracture is advised for proper reduction and fixation, but can be delayed in accompanying life-threatening injuries.Complications are perceptible in all the sequences; it can be avoided by definitive treatment planning and stepwise management.

A realidade do serviço público no tratamento de fratura panfacial: Relato de caso

“…Os princípios para a redução foram popularizados na década de 1980 com a proposta de ampla exposição e visualização direta das zonas da fratura. Esses princípios passaram a ser aplicados às fraturas panfaciais influenciando sua ordem de redução, com estratégias de manejo conservador diante de deslocamentos mínimo de ossos ou cirurgia de campo aberto em quadros mais complexos, o que varia entre os casos (Clauser, L et al, 2003;Chaydhry, O et al, 2015;Ramakrishnan, k., 2020). Dos diversos tipos de tratamentos, os conservadores como o BMM, quando bem indicados, podem oferecer aceitáveis resultados (Cascone et al, 2008).…”

“…Os desafios do tratamento requerem a atuação de cirurgiões experientes que pode incluir na equipe o cirurgião plástico, oftalmologista, neurologista e cirurgiões de trauma, para determinar as técnicas anestésicas, abordagens de intubação e realizar o manejo na redução, com objetivo de devolver a arquitetura facial, evitando novas intervenções ou a procedimentos que possam levar a deformidades persistentes (Chaudhry, O., 2018;Follmar, K.E et al, 2007;Kim, J at el., 2016;Ramakrishnan, k et al, 2020;Sharma, S et al, 2015). O desafio ainda é maior quando não se obtém placas e parafusos para a fixação e abordagem adequada do paciente.…”

Panfacial fracture osteosynthesis combined with submental orotracheal intubation: A case report

“…However, in all of them, the need for individual patient evaluation is fundamental. The main therapeutic objectives are to restore facial dimensions, symmetry, anteroposterior projection and function (Pisano & Tiwana, 2019;Ramakrishnan et al, 2021). Rigid internal fixation with miniplates and screws is of great importance in the rehabilitation of this type of patient.…”

Off-Label Treatment for Severe Craniomaxillofacial Fractures in Low-Income Countries—A Novel Operation Method with the External Face Fixator

“…This type of fixation was chosen as an alternative to plate osteosynthesis due to an uncontrollable intraoral bleeding caused by a severe panfacial fracture of a 70-year-old woman [ 8 ]. In high-income countries (HIC) these factures are treated with mini-plates, even in extensive comminuted fractures [ 9 , 10 ].…”