A comprehensive rehabilitation in a case and panfacial fracture with extensive oral soft tissue trauma of lip and tongue in a musician: a case report

Authors

  • Dempsy Chengappa M. M. Department of Pediatric Dentistry, INHS Sanjivani, Kochi, Kerala, India
  • Sandeep Mehta Department of Oral and Maxillofacial Surgery, INHS Sanjivani, Kochi, Kerala, India
  • Shanender S. Sambyal Department of Oral and Maxillofacial Surgery, INHS Sanjivani, Kochi, Kerala, India
  • Gaurav Dua Department of Oral and Maxillofacial Surgery, INHS Sanjivani, Kochi, Kerala, India
  • Andrews Navin Kumar Department of Pediatric Dentistry, Department of Oral and Maxillofacial Surgery, INHS Sanjivani, Kochi, Kerala, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20220815

Keywords:

Pan facial fracture, Open reduction, Internal fixation

Abstract

Pan facial fractures as the name suggest it involves multiple fractures of facial bones and so the management of such multiple fractures is also extremely complicated and the patient is generally left with residual deformities, which might leave a deep psychological impact on the individual’s life. Maxillofacial region also harbours organs which are very essential for the normal survival of the Individual such as eyes, organ for olfaction, respiration, mastication, deglutition and aesthetics and phonetics. All these factors put additional pressure in complexities of fracture management, also create a dilemma for surgeon. Another peculiarity of the panfacial fractures is the difficulty in accessing the fracture sites and because of that reduction and fixation are compromised often leading to secondary deformity. Determining the sequence of repairing of the pan facial fracture is the most challenging and requires great experience as well as knowledge of anatomy, as the approach varies with each case. All the vertical and horizontal pillars have to be restored to get the near-normal facial anatomy and aesthetic. Even after all the aggressive treatment, the residual deformity in cases of panfacial trauma is not uncommon, which often requires a second stage corrective surgery. This article briefs about the management and simple approaches used to reduce and fix a case of pan facial trauma in a -year-old male who underwent a road traffic accident.

Author Biography

Dempsy Chengappa M. M., Department of Pediatric Dentistry, INHS Sanjivani, Kochi, Kerala, India

Classified Specialist in Oral and Maxillofacial Dept, Army Dental Corps

References

Manson PN, Clark N, Robertson B, Crawley WA. Comprehensive management of pan-facial fractures. J Craniomaxillofac Trauma. 1995;1:43-56.

Markowitz BL, Manson PN. Panfacial fractures: organization of treatment. Clin Plast Surg. 1989;16:105-14.

Adamo Arthur K. Intraoperative airway management with pan-facial fractures: Alternative approach. J Craniomaxillofac Surg. 1996;2:30-5.

Wenig BL. Management of panfacial fractures. Otolaryngol Clin North Am. 1991;24:93-101.

De Melo WM, Sonoda CK, Shinohara EH, Garcia IR. Using the “bottom-up and outside-in” sequence for panfacial fracture management: does it provide a clinical significance? J Craniofac Surg. 2013;24:479-81.

He D, Zhang Y, Ellis E, 3rd. Panfacial fractures: analysis of 33 cases treated late. J Oral Maxillofac Surg. 2007;65:2459-65.

Degala S, Sundar SS, Mamata KS. 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. J Maxillofac Oral Surg. 2015;14:986-94.

Chandra PM, Ali FM, Singhai A, Mudhol A, Ustad F. Submental orotracheal intubation: A better alternative to tracheostomy in panfacial fractures. Anesth Essays Res. 2013;7:415-7.

Rodrigues WC, de Melo WM, de Almeida RS, Pardo-Kaba SC, Sonoda CK, Shinohara EH. Submental intubation in cases of panfacial fractures: A retrospective study. Anesth Prog Fall. 64:153-61.

Curtis W, Horswell BB. Panfacial fractures: an approach to management. Oral Maxillofac Surg Clin North Am. 2013;25:649-60.

Louis P. Management of Panfacial fractures. In: Miloro M, editor. Peterson’s principle of Oral and maxillofacial surgery. 2nd edition. B C Decker Inc: Hamilton. 2004.

Obuekwe ON, Ojo MA, Akpata O, Etetafia M. Maxillofacial trauma due to road traffic accidents in Benin city, Nigeria: A Prospective study. Ann Afr Med. 2003;2:58-63.

Pau M, Reinbacher KE, Feichtinger M, Navysany K, Kärcher H. The mandibular symphysis as a starting point for the occlusallevel reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: report of two cases. J Craniomaxillofac Surg. 2014;42(4):51-6.

Martou G, Antonyshyn OM. Advances in surgical approaches to the upper facial skeleton. Curr Opin Otolaryngol Head Neck Surg. 2011;19(4):242-7.

Rosenberger E, Kriet JD, Humphrey C. Management of nasoethmoid fractures. Curr Opin Otolaryngol Head Neck Surg. 2013;21(4):410-6.

Rosenberger E, Kriet JD, Humphrey C. Management of nasoeth- moid fractures. Curr Opin Otolaryngol Head Neck Surg. 2013;21:410-6.

Mittal G, Mittal RK, Katyal S, Uppal S, Mittal V. Airway manage- ment in maxillofacial trauma: Do we really need tracheostomy/submental intubation. J Clin Diagn Res. 2014;8:77-9.

Singh M, Ricci JA, Caterson EJ. Use of intraoperative computed tomography for revisional procedures in patients with complex maxillofacial trauma. Plast Reconstr Surg Glob Open. 2015;3:e463.

Gruss JS, Phillips JH. Complex facial trauma: the evolving role of rigid fixation and immediate bone graft reconstruction. Clin Plast Surg. 1989;16:93-104.

Gruss JS, Mackinnon SE. Complex maxillary fractures: role of buttress reconstruction and immediate bone grafts. Plast Reconstr Surg. 1986;78:9-22.

Yang R, Zhang C, Liu Y, Li Z, Li Z. Why should we start from mandibular fractures in the treatment of panfacial fractures? J Oral Maxillofac Surg. 2012;70:1386-92.

Kim J, Choi JH, Chung YK, Kim SW. Panfacial bone fracture and medial to lateral approach. Arch Craniofac Surg. 2016;17:181-5.

Merville L. Multiple dislocations of the facial skeleton. J Maxillofac Surg. 1974;2:187-200.

Imazawa T, Komuro Y, Inoue M, Yanai A. Mandibular fractures treated with maxillomandibular fixation screws (MMFS method). J Craniofac Surg. 2006;17:544-9.

Downloads

Published

2022-03-24

Issue

Section

Case Reports