Reference point and confirming points two important guides in treatment of panfacial fractures of panfacial Fx: A case report

A therapeutic challenge to maxillofacial surgeons is management of panfacial fractures, especially when treating multiple comminuted bone fractures. One of the most important goals in these fractures is achieve and stablish a correct occlusal relationship of the mandibular-maxillary unit in parallel with the proper positioning of the jaws with the skull base and other facial units. Also, it is important to prevent long-term sequelae such as facial asymmetry, enophthalmos, and mal- occlusion that could be caused by inadequate correction. To achieve all these goals some usual guides of management are proposed as follow: “Bottom to up”, “Top to down”, “outside to inside,” or “inside to outside”. We present 3 cases of Panfacial fracture and the proposed methods were based on different sequences of management with introducing “reference point” as the most intact area to determine the management concept & “confirming point” as the areas that should be reduced and fixed completely. These points act as an orientation aid during surgery and aid to successfully restore the entire face contour and maxillomandibular occlusion and also to improves surgical procedure.

Tatalaksana Trauma Wajah dengan Panfasial Fraktur

AbstrakFraktur pada wajah dapat menyebabkan defisit fungsional dan estetika jika tidak ditangani dengan baik. Tatalaksana akut yang tepat dari fraktur wajah harus didasarkan pada evaluasi cepat dan menyeluruh. Keberhasilan rekontruksi wajah merupakan keadaan darurat yang perlu dievaluasi dalam waktu 24 jam dari trauma. Berbagai jenis reduksi dan fiksasi tergantung pada fungsi, lokasi, jenis fraktur, dan usia pasien. Kasus ini diajukan untuk memperlihatkan keberhasilan tatalaksana trauma akut maksilofasial. Dilaporkan seorang laki-laki 37 tahun dengan panfasial fraktur yang dilakukan reduksi dan fiksasi 3 hari setelah trauma dengan pemasangan plat dan sekrup, serta fiksasi mukoginggival kombinasi antara arch bardan quickfix. Reduksi, reposisi dan fiksasi dilakukan setelah edema mukosa hebat disertai kombinasi antara arch bar dan quickfix pada mukoginggival merupakan salah satu alternatif untuk mengurangi risiko perdarahan dan memudahkan reposisi.Kata kunci: fraktur wajah, panfasial fraktur,edema mukosa.Management of Maxillofacial Traumawith Panfacial FractureAbstractFacial fractures can cause functional and aesthetic deficits if not treated properly. Appropriate acute management of facial fractures should be based on a rapid and thorough evaluation. Successful facial reconstruction is an emergency that needs to be evaluated within 24 hours of trauma. Different types of reduction and fixation depend on the function, location, type of fracture, and the age of the patient. This case is presented to demonstrate the success of acute maxillofacial trauma management. Reported a 37-year-old man with a facial fracture who underwent reduction and fixation 3 days after trauma with plate and screw installation, and combination mucogingival fixation between arch bar and quickfix. Reduction, reposition and fixation performed after severe mucosal edema accompanied by a combination of arch bar and quickfix on the mucogingival is an alternative to reduce the risk of bleeding and facilitate repositioning.Keywords: facial fracture, panfacial fracture, mucosal edema.

Sequencing of panfacial fracture repair

Panfacial fractures involve multiple fractures of the upper, middle, and lower thirds of the face. In management of panfacial fractures, the individual fracture techniques and approaches described in the previous chapters in Section 7 are combined to restore bony continuity of the facial skeleton and provide an aesthetic and functional drape of the overlying soft tissues. The aim in treatment of panfacial fractures is to restore the anatomical buttresses of the face in three dimensions, thus restoring vertical face height, horizontal width, and anteroposterior projection.

Palatal Fracture Fixation on Severe Panfacial Fracture: Is There Any Clinical Significance?

Background: Fractures of the hard palate are infrequent. They are found in less then 10% of patients with midfacial fractures. They practically never occur in isolation and are usually part of alveolar process fractures or more complex midfacial fractures of the Le Fort type. Treatment of palatal fractures is planned and performed with the goal of restoring the transverse width of the palate, the anteroposterior projection of the maxillary arch, and the patient’s pretraumatic occlusal plane, as well as maintaining horizontal stability of the midface.Case Presentation: Reporting patient female 17 years old with panfacial fracture due to traffic accident. There was slight epidural haemorrhage on frontal area. The fractures are on upper face, midface, and lower face including the hard palate. We performed open reduction internal fixation on palate to correct the arch of the upper jaw. The other fracture site can be corrected easier. The approaches that we done are bicoronal, subsilier, and intraoral. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and aesthetic outcomes.Conclusion: Palate fractures are relatively uncommon and are associated with significant rates of malocclusion and wound complications. These injuries are typically managed with plate fixation of the alveolar ridge with variable approaches to the palatal vault

Dual support technique for pediatric palatal fracture: 1.5 mm transmucosal titanium plates along with acrylic splint backing

Surgeons are always in a dilemma for the management of paediatric facial fractures due to distinctive nature of growing facial skeleton. The ultimate treatment goal for paediatric fractures should be as conservative as possible with least invasive surgical approach that will access the fracture and least invasive surgical fixation that will allow stable reduction and will prevent any growth disturbances. We are presenting a case of 4- year old with panfacial fracture managed according to this principle using transmucosal titanium plates with acylic splint for sagittal split of palate.