A Comparative Prospective Study of Two Different Treatment Sequences i.e. Bottom Up-Inside Out and Topdown-Outside in, in the Treatment of Panfacial Fractures.

Abstract

To compare the sequence bottom-up inside-out with top-down outside-in, in the treatment of pan facial fractures and to evaluate the outcome of these approaches. The data from 11 patients with panfacial fracture are prospectively analysed. Five cases are treated with bottom-up approach and six patients with top-down approach. There were 11 male patients (six in top-down approach and five in bottom-up approach), ranging in age from 24 to 50years. All injuries were result of RTA (n=11, 100%). Final treatment outcome was excellent in 3 (50%), 1 (16%) good and 2 (32%) cases were fair in topdown approach, 3 (60%) excellent and 2 (40%) fair in bottom up approach with contingency coefficient value (P<.632) which was insignificant. There was no significant deviation from the two groups in the final treatment outcome. Within the limitation of low sample size we found that both bottom-up inside-out and top-down outside-in approaches have similar clinical outcomes. Hence it could be suggestive to start fixation of least disrupted (more stable) facial half as a guide for reconstruction of the remaining. Choice of the bottom-up inside-out or top-down outside-in sequence should be according to the pattern of fractures and preference of the surgeon. However, further controlled clinical trials, comparative studies with a larger sample size would be better to evaluate the final clinical outcome of individual techniques.