Abstract
Purpose: The aim of this retrospective study was to analyze the characteristics of panfacial fractures and evaluate treatment results at the Maxillofacial, Stomatology and plastic surgery department at the AVICENNE military hospital over a period of 5 years. Patients and Methods: Forty eight patients with panfacial fractures were treated in Maxillofacial, stomatology and plastic surgery department of the AVICENNE Military Teaching Hospital between 2012 and 2017. The criteria for inclusion in the study were patients who had fractures of at least three of the four axial segments of the facial skeleton: frontal, upper midface, lower midface, and mandible. Results: 48 patients with panfacial fractures had a total of 116 subtypes of facial bone fractures. A total of seventeen (14.6%) LeFort II fractures in 16 (33.4%) patients were recorded, fifteen LeFort I fractures were recorded in 3 (6.2%) cases; seven (6%) LeFort III fractures were recorded in 5 (10.4%) cases, thirteen (11.2%) fractures of the NOF complex were recorded in 6 (12.5%) patients; sixteen (33.4%) patients had thirty eight (32.7%) fractures involving the mandible. Ten (8.6%) NOM (naso-orbito-maxilla) complex fractures occurred in 9 (18.7%) cases. 5 (10.4%) patients had a total of five (4.3%) CNEMFO (naso-ethmoido-maxillo-fronto-orbital) complex fractures. Our case series included five Comminuted premaxillary fractures and six Intermaxillary disjunctions. All 48 cases had facial deformities and thirty six had malocclusions. The treatment plan to reduce and fix the facial bone fractures was sequenced “Bottom up, Outside in”. Postoperative complications were reported, there were 5 cases whose malocclusions, 4 cases of zygomatic non-union or partial defects, 13 had enophthalmos and hypoglobus. Seven had scars from the trauma, 2 had lower eyelid ectropion, and 2 had temporal muscle atrophy. Conclusion: Panfacial fractures seem to be complex and difficult to treat, but with an organized and flexible approach, appropriate reduction of fractures is accomplishable, yet post-surgical complications mainly caused by soft tissue problems, including lacerations and asymmetries, can’t be easily avoided.
Highlights
Panfacial fractures are defined as those that simultaneously involve the upper, mid and lower face [1] [2]
The aim of this retrospective study was to analyze the characteristics of panfacial fractures and evaluate treatment results at the Maxillofacial, Stomatology and plastic surgery department at the AVICENNE military hospital over a period of 5 years
Ten (8.6%) NOM complex fractures occurred in 9 (18.7%) cases. 5 (10.4%) patients had a total of five (4.3%) CNEMFO complex fractures
Summary
Panfacial fractures are defined as those that simultaneously involve the upper, mid and lower face [1] [2]. There is no clear definition and classification for panfacial fractures in the literature. As defined by Follmar et al are fracture patterns that involve at least three of the four axial segments of the facial skeleton: frontal, upper midface, lower midface, and mandible [3] (Figure 1). Panfacial fractures are due to road traffic accidents, interpersonal violence, sports-related accidents, industrial accidents, and gunshot wounds. Panfacial trauma is commonly associated with Multisystem injury; treatment is often multidisciplinary. When the patient is stabilized, early and total restoration of facial form and function should be the goal. The management of panfacial trauma went from a conservative, delayed, multiple-staged surgery to early, aggressive, and one-stage process. High resolution computed tomography (CT), sufficient surgical exposure, proper anatomic reduction, rigid fixation, primary bone grafting, and soft tissue suspension are the basics for optimum results [4] [5]
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