Pearls and Pitfalls for Surgical Management of Panfacial Fractures - Chapter 15

Panfacial fracture are facial fractures simultaneously involving the upper, middle, and lower thirds of the face. Fractures of the frontal sinus, maxilla, zygomatic complex, nasoethmoid-orbital (NEO), and mandible are the most common. Management of panfacial fracture requires an understanding of the interrelationship between the horizontal and vertical buttresses of the face. Panfacial fractures result in loss of anterior projection and increased horizontal and decreased vertical dimensions of the face. Panfacial fracture complexity is based on the number of fractures, the degree of fracture comminution and displacement, and the stability of fractured segments. A systematic approach to evaluation, planning, and execution is necessary to achieve the most optimal results. Inadequate early treatment leads to secondary deformities that are challenging to treat. The purpose of this chapter is to review pearls and pitfalls for surgical management of panfacial fractures

Surgical management of maxillofacial fractures

Includes bibliographical references and index

What Is the Most Stable Fixation Technique for Mandibular Condyle Fracture?

Mandibular condylar fractures are relatively common fractures, accounting for 29 to 52% of all mandibular fractures. Recently, the debate between closed versus open treatment of the condylar fracture has shifted toward more specific surgical questions concerning the number and pattern of the fixation method for the condylar region. We have attempted to resolve the controversy with the systematic review and meta-analysis. The purpose of the present study was to compare the outcomes of different methods of fixation for mandibular condylar fractures. We conducted an electronic database search for clinical studies evaluating the stability of internal fixation of condylar fractures. The search was restricted to studies reported in the English language from January 2000 to July 2018. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines. The initial search returned 285 studies reported from January 2000 through July 2018. After reviewing the full-text reports, only 16 studies were deemed eligible for the review. The total sample size was 831 patients with mandibular subcondylar fractures. The patients were classified into 25 groups according to the fixation method, follow-up period, use of intermaxillary fixation, and the presence of associated fractures. The results of our systematic review and meta-analysis showed that single plate fixation has been associated with more complications with poor outcomes, including hardware failure, screw loosening, and postoperative malocclusion

Management of gunshot wounds to the mandible

The gunshot wound to the mandible is a unique traumatic injury. The resultant injury from the gunshot wound is diverse because of the variability of the projectile, motion, velocity, and tissue characteristics. When a high-velocity projectile strikes the mandible, often times the wound will consist of a severely comminuted mandible surrounded by nonvital soft tissues and the implantation of multiple foreign bodies. This represents a challenge for the treating surgeon. The anatomy and function of the mandible make it such that the care of the gunshot wound requires a combination of trauma and reconstructive surgeries. There are varying techniques advocated for the management of gunshot wound to the face. However, for the comminuted mandible fracture sustained from a gunshot wound, an approach involving the fabrication of an occlusal splint, intermaxillary fixation, aggressive debridement of hard and soft tissues, and immediate reconstruction with a titanium plate is a comprehensive approach that can restore the appropriate function and contour of the patient. At the Division of Oral and Maxillofacial Surgery, University of Miami, this approach to the comminuted mandible fracture secondary to the gunshot wound has led to the effective management of this specific subset of injury. The complication rate is comparable with the current literature and provides an advantage as a 1-stage management to restore appropriate function and cosmesis to the patient