Classifying and standardizing panfacial trauma according to anatomic categories and Facial Injury Severity Scale: a 10-year retrospective study

Background The purpose of this study was to identify the epidemiologic factors of panfacial fractures (PFs), and to evaluate the significance of anatomic PF categories and the Facial Injury Severity Scale (FISS) in classifying and standardizing panfacial injuries. Methods A retrospective review of all patients treated with PFs at our institution between June 2010 and April 2021 was performed. PF was defined as a concurrent fracture in at least 3 of 4 facial subunits (frontal, upper midface, lower midface, and mandible). Data regarding patient demographics, causes of injury, location of fractures, major concomitant injuries, and postinjury complications were collected, and the FISS score was collected from each patient. Statistical analysis was performed using IBM SPSS Statistics version 22.0. Results A total of 227 patients were enrolled. The most commonly fractured bones were the maxillary sinus wall (92.1%), mandible (82.8%), and zygomatic arch (75.3%), and the most common fracture sites in PFs were graphically presented. Four PF patterns were defined: FULM (n = 60), FUL (n = 39), ULM (n = 127), and FUM (n = 1). There was a significant association between PF patterns and sex (p = 0.018), the number of concomitant injuries (p = 0.014), and early surgical airway management (p = 0.003). Different PF patterns were significantly correlated with different types of concomitant injuries and complications. The FISS score showed a significant difference with PF patterns (p = 0.000) and sex (p = 0.007), and a FISS value of 11 or more is the appropriate cutoff for the prediction of multiple concomitant injuries and complications. Conclusions Both the anatomic PF categories and FISS were significantly correlated with various concomitant injuries and complications. The combination of PF categories and FISS provided a better positive and negative prediction of concomitant injuries and complications for PF patients. Patients with FULM and FISS > 11 had an obviously higher proportion of the need for multiprofessional treatment.

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.

Management of Panfacial Trauma: Sequencing and Pitfalls

Panfacial trauma refers to high-energy mechanism injuries involving two or more areas of the craniofacial skeleton, the frontal bone, the midface, and the occlusal unit. These can be distracting injuries in an unstable patient and, as in any trauma, Advanced Trauma Life Support (ATLS) protocols should be followed. The airway should be secured, bleeding controlled, and sequential examinations should take place to avoid overlooking injuries. When indicated, neurosurgery and ophthalmology should be consulted as preservation of brain, vision, and hearing function should be prioritized. Once the patient is stabilized, reconstruction aims to reduce panfacial fractures, restore the horizontal and vertical facial buttresses, and resuspend the soft tissue to avoid the appearance of premature aging. Lost or comminuted bone can be replaced with bone grafts, although adequate reduction should be ensured prior to any grafting. Operative sequencing can be performed from top-down and outside-in or from bottom-up and inside-out depending on patient presentation. All protocols can successfully manage panfacial injuries, and the emphasis should be placed on a systematic approach that works from known areas to unknown areas.

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.

Treatment of multiple facial fractures in air crash survivor

Panfacial fractures are due to high-energy trauma, making the treatment of patients since the first visit is challenging. Generally, these involve soft tissue injuries, comminuted fractures and even fragment loss. In addition to this, the surgical approach to facial reconstruction through the fixation of bone fragments can be postponed due to the patient's clinical conditions, which can lead the treatment to a more complex condition due to the possibility of infection, poor union of bone fragments and tissue contraction. The aim of this study is to discuss the clinical case of high-energy trauma caused by an air accident, leading to multiple facial and body fractures. And in this way contribute to the extremely limited scientific literature on the subject, with such etiology and significant facial trauma.

Six-year analysis of traumatic injuries of the craniomaxillofacial area: relation between maxillofacial and traumatic brain injuries

Summary. Craniofacial trauma is one of the most difficult types of injuries. There is disagreement among various authors about the relationship between maxillofacial trauma (MFT) and traumatic brain injury (TBI). Purpose. Retrospectively evaluate the epidemiology of traumatic injuries of the craniomaxillofacial area and determine whether there is a relationship between different isolated or combined fractures of the facial bones and brain damage. Materials and methods. The case histories of three groups of patients with isolated fractures of the mandible (I group), isolated fractures of the midface zone (II group) and combined fractures of all areas of the face (III group), who were hospitalized in the period from 2012 to 2017, were analyzed. The main epidemiological indicators were determined. The analysis of indicators of severity of MFT and TBI is carried out. Correlation analysis of indicators, analysis using the Kruskal- Wallis test and Steel-Dwass test for pairwise comparisons was performed. Results. Were treated519 patients. 457 men (88 %) and 62 women (12 %). The main causes of injuries were assaults (40 %). Correlation analysis did not reveal the dependence of MFT and TBI. The difference in severity of isolated fractures of the mandible and midface bones was statistically significant, and there is a statistical significance between the severity of TBI in case of isolated fractures of midface bones and panfacial fractures (p < 0.05). Conclusions. The severity of maxillofacial trauma in the case of panfacial fractures is on average 3 times higher than in the case of isolated fractures of the lower jaw or midface bones. The severity of TBI is largely consistent with concussion in all groups, but in the group with panfacial fractures, the median rate is lower comparing to other groups. Key words: Glasgow coma scale, fracture, Le Fort, traumatic brain injury

Panfacial Fractures

Most panfacial fractures occur with concomitant injuries to other organs. Management of panfacial fractures is challenging and requires proper planning and sequencing along with adequate knowledge of its anatomy and management.. Airway, breathing, circulation, disability and exposure (ABCDE) always remain the primary care in any trauma setting. Maxillofacial surgeons play a key role in initial stabilisation of fractures, control of local hemorrharage to facial areas and estlabishment of definitive airway in special situations. Definitive treatment is usually done after stabilisation of the patient and systematic evaluation of all systemic injuries. Panfacial fractures demand a lot more planning towards their management. The understanding of same is described in this chapter, in a methododical manner starting from the philosophy, indications, clinical findings to its management in adults and children including the commonly seen complications. This should give the reader adequate knowledge to learn from the authors experiences and comprehensively be able to manage these injuries after having achieved a level of experience and excellence in maxillofacial surgery.