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Study Design: A retrospective cohort study was conducted using the Kids' Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective: The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population. Methods: The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures. Results: Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (P < .01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (P < .01) to result in panfacial fractures while car accidents were over two times more likely (P < .01) to result in panfacial fractures. Falls were less likely (OR, .39; P < .01) to result in panfacial fractures. Conclusions: Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle.

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Panfacial fractures are challenging for craniofacial surgeons. Aside from involving multiple subunits, they also lack the reliability of a useful landmark of the facial skeleton. Properly, reducing and fixing palatal fracture to re-establish the premorbid maxillary dental arch is important. This was a retrospective study conducted from 2015 to 2020. All patients underwent computed tomography (CT) scan for surgical planning of orthognathic surgery due to either esthetic or occlusion concerns. The classification of occlusion was recorded as class I, II, and III. The parameters measured on CT were the distance between the midpoint of the supra-orbital foramen/notch (IS), mesio-buccal cusp tips (IB), central fossa (IC), palatal cusp tips (IP), and the midpoint of the palatal marginal gingiva (IM) of the bilateral maxillary first molars. The IS was compared with the IB, IC, IP, and IM. The results were analyzed by using one-way repeated measurement analysis of variance. Eighty-seven patients (36 men and 51 women) were included in the study. There were 13 patients of class I malocclusion, 8 of class II malocclusion, and 66 of class III malocclusion. The IS was comparable to the IC in all three groups. The IS can predict the IC, regardless of the patient's occlusion, and can be subsequently used to decide the width of maxillary dental arch in panfacial fracture management. Further studies are necessary to obtain more definite results.

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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.

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OBJECTIVE: In panfacial fracture management, the controversy still exists in the sequencing of fixation. The purpose of this systematic review is to establish the best sequence pattern which assists in achieving definite facial width, vertical height and anteroposterior projection. METHODS: The review was conducted according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Two independent authors performed a comprehensive search of the PUBMED, EBSCO, J-Gate, SCOPUS and NDH for articles published up until December 2018. Sequence of fixation, timing of intervention, outcome, follow-up period and complications were evaluated for patients with panfacial fracture. RESULTS: In total, 202 articles were identified from the databases. After screening and full text analysis, 25 studies were included in this systematic review. Nineteen studies reported bottom-to-top sequence and two studies reported top-to-bottom approach. However, four studies reported both the approaches. The follow-up period ranges from 3 weeks to 4 years. CONCLUSION: Based on the literature support and evidence, good and satisfactory outcome achieved in "Bottom-top and outside-in" sequence when compared with other sequence pattern. Early repair of panfacial fracture is advised for proper reduction and fixation, but can be delayed in accompanying life-threatening injuries. Complications are perceptible in all the sequences; it can be avoided by definitive treatment planning and stepwise management.

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RESUMEN: Las fracturas panfaciales son aquellas que afectan de forma simultánea al tejido óseo de dos o más tercios del rostro. El manejo inicial de estos pacientes es resolver o estabilizar las urgencias médico - quirúrgicas que puedan presentar, debido a que la gran mayoría de estas fracturas están asociadas a traumatismos de alta energía cinética, las que determinan la presencia de lesiones concomitantes que pueden comprometer la vida del paciente. El tratamiento quirúrgico de las fracturas panfaciales puede abarcar desde la intervención quirúrgica inicial de control de daños, estabilización, reducción y fijación quirúrgica de los segmentos fracturados mediante osteosíntesis hasta intervenciones mediatas para la reconstrucción de los tejidos afectados por el traumatismo. Para el tratamiento de las fracturas panfaciales existe una sistemática quirúrgica que tiene por objeto contener y/o minimizar daños agudos y permitir una reducción morfológica y funcional. Reportamos un caso clínico de fractura panfacial cuyo tratamiento siguió esta sistemática terapeútica.

ABSTRACT: Panfacial fractures affect bone tissue in two or more thirds of the face simultaneously. The initial management of these patients is to resolve or stabilize the medical-surgical emergencies that they may present. Most of these fractures are associated to trauma of high kinetic energy, which determine the presence of concomitant inju- ries that can compromise the life of the patient. The surgical treatment of panfacial fractures may include from the initial surgical intervention of damage control, stabilization, reduction and surgical fixation of fractured segments through osteosynthesis, to mediate the reconstruction of tissues affected by the trauma. For the treatment of panfacial fractures there is a surgical approach that aims to contain and/or minimize acute damage and allow for morphological and functional reduction. We report a clinical case of panfacial fracture whose treatment followed this therapeutic approach.

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As fraturas panfaciais acometem concomitantemente os terços superior, médio e inferior da face, decorrentes de acidentes automobilísticos, arma de fogo, atropelamento, agressão física, entre outros. Essas fraturas geralmente envolvem osso frontal, zigomático, maxila, mandíbula e ossos nasais, necessitando assim, fixação interna rígida através do uso de miniplacas e parafusos com o propósito de estabilizar as estruturas fraturadas, dar suporte aos tecidos moles e evitar deformidades estéticas da face. O objetivo deste trabalho é relatar o manejo cirúrgico de um caso clinico atendido em um hospital público de Salvador/BA, no qual a vítima apresenta ampla laceração na face e fratura exposta do terço médio da face. O tratamento executado sob anestesia geral foi redução dos cotos ósseos fraturados, fixação com miniplacas e parafusos, reconstrução imediata dos tecidos moles acometidos(AU)

Panfacial fractures affect concomitantly the upper, middle, lower third of the face, resulting from automobile accidents, firearms, hit-and-run, physical aggression, among others. These fractures usually involve frontal bone, zygomatic, maxilla, jaw and nasal bones, thus requiring rigid internal fixation through the use of miniplates and screws in order to stabilize fractured structures, support soft tissues avoiding aesthetic face deformities. The objective of this work is to report the surgical management of a clinical case attended in a public hospital in Salvador/BA, in which the victim has wide laceration of the face and exposed fracture of the middle third of the face. Treatment performed under general anesthesia was reduction of fractured bone stumps, fixation with miniplates and screws, immediate reconstruction of the affected soft tissues(AU)

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Submental or submandibular intubation has been reported to cause fewer complications than tracheostomy. However, the risk of infection is always inherent because oral wounds are exposed to microbial flora and bacteria in the oral cavity. A novel technique of submandibular intubation was devised to reduce infection and injury to the soft tissues. We would like to report a novel safe technique that can be performed in patients requiring submental or submandibular intubation. This is the first report of submandibular intubation using a sterile disposable camera cable drape. This novel technique of submandibular intubation is safer, more sterile, easier, and less invasive than conventional submandibular intubation.

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PURPOSE: The purpose of this study was to investigate concomitant injuries and complications in patients with panfacial fracture (PF) according to patterns of PF. MATERIALS AND METHODS: PF is defined as fractures involving at least three of the four facial parts (frontal, upper midface, lower midface, and mandible). The data for this study were retrospectively analysed. A simple regression analysis, Cramer's V analysis, and Pearson's correlation analysis were used for verifying significance and correlation between the investigated factors and patterns of PF. Short-term postoperative surgical complications were classified according to the Clavien-Dindo classification (CDC). RESULTS: There was a statistically significant association between age and PF pattern (ULM: 44.9 ± 19.2; FUL: 42.0 ± 16.8; FULM: 33.6 ± 15.3; FUM: 65; p = 0.024), between the cause of injury and PF pattern (p = 0.047), and between operative time and fracture pattern (ULM: 4h 45min ± 2h 21min; FUL: 5h 19min ± 2h 54min; FULM: 7h 19min ± 4h 13min; FUM: 2h 15min ± 0; p = 0.008). 89% of patients had concomitant injuries in other body parts. In the CDC grade groups, rade IVa cases (n = 4) showed statistically significant differences with PF patterns (p = 0.006). Of all the patients, 58.6% (n = 58) complained of postoperative complications. CONCLUSION: PF patients can have different fracture patterns, depending on age and cause of trauma. Consequently, different PF patterns have different types of concomitant injuries and complications. PF patients with frontal area fracture have higher CDC grades, and may need ICU care. Therefore, classifying PFs will be a first step towards a systemic approach for treating and reducing complications.

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INTRODUCTION: Airway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management. METHODS: The descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally. RESULTS: The submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (±0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (±1.49) days. DISCUSSION: Submental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.

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In general, internal plate fixation is mainly performed in order to reduce multiple facial bone fractures and rarely uses an external fixator. Although it would be ideal to successfully achieve or preserve the occlusal relationship of the upper and lower jaws, it is difficult to successfully manage multiple bone fragments in order to use them to achieve internal fixation, especially when treating a severely comminuted facial fracture. In addition, it is also important to prevent the onset of severe infection after sub-periosteal dissection, due to the presence of avascular bony fragments and an internal fixation implant which thus represents a foreign body. In order to treat extensive comminuted fracture without internal plate fixation, we performed external fixation using an Ilizarov-type external fixator. The Ilizarov-type external fixator is characterized by a few circular external structures and threaded rods. This device can be modified for use in the field of orthopedic surgery to correct three-dimensional deformities caused by fragile complicated fractures and bone defects. The advantages of the Ilizarov-type external fixator for treating panfacial fractures include a low invasiveness, utility in various fracture situations, easy adjustment of threaded rods, and a low potential cost. We herein report the first case of a severe panfacial fracture that was successfully treated using an Ilizarov-type external fixator.

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INTRODUCTION: The treatment of facial fractures is an integral part of the oral and maxillofacial surgical treatment spectrum. In the case of complex fractures that involve multiple levels of the facial skeleton associated with severe concomitant injuries, an individual and interdisciplinary treatment approach is needed, which requires the infrastructure of a national trauma center. OBJECTIVE: The aim of this study was to analyze the incidence and management of patients with complex facial fractures and considering the concomitant injury pattern. MATERIAL AND METHODS: A retrospective analysis of patients with complex facial fractures during the years 2009-2015 admitted to the emergency surgical department of a national trauma center was carried out. The identification of appropriate patient cases was based on the International Statistical Classification of Diseases and Related Health Problems (ICD) coding of electronic patient data. Only patients with at least a combination of mandibular and midfacial fractures (2-level fractures) were considered. Patients with mainly dentoalveolar fractures and simple nasal bone fractures were not included. The evaluation of the electronic medical records included the etiology, fracture pattern, associated severe injuries on the basis of the injury severity score (ISS), treatment regimen as well as the length of the hospital stay. RESULTS: In the 7­year study period, 3382 patients were identified with facial fractures. Of these, 128 patients (3.78%) presented with a complex fracture pattern with a combination of mandibular fractures and fractures of the midface. The majority of these patients (n = 92) had less severe concomitant injuries (ISS ≤ 16), while 36 patients showed severe concomitant injuries (ISS > 16). The incidence of a 3-level fracture involving the mandible, midface and anterior skull base was only 0.47% and could be detected in 16 patients, of which 10 were classified as polytrauma (ISS > 16). CONCLUSION: The incidence of complex fractures of the facial skeleton was comparatively low with almost 4%. More than one in four patients with complex injury patterns of the facial skeleton exhibited severe concomitant life-threatening injuries, necessitating an interdisciplinary management with the specialized infrastructure of a nationwide trauma center.

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AIM: This study was designed to evaluate the efficacy of awake oral to submental conversion over asleep technique. MATERIALS AND METHODS: This randomized clinical study was conducted in maxillofacial department of a tertiary care hospital in patients who had panfacial or mandibular fractures requiring elective surgical correction. The patients were randomly divided into two groups of 12 patients each, asleep fiberoptic-assisted submental intubation (SMI) (Group G; n = 12) and awake fiberoptic-assisted SMI (Group A; n = 12). The primary predictor was mean conversion time of oral to SMI while other predictors were overall success rate, ease of conversion, and complications. Data are presented as mean (±standard deviation) and frequencies (%) as appropriate. Statistical analysis done using unpaired t-test or Chi-square test was performed and P < 0.05 was considered statistically significant. RESULTS: Twenty-four patients (19:5;Male:Female) aged 18-55 years (Group G = 35.96; Group A = 32.43 years) were included in the study. SMI was successful in all except two patients in group G. Overall success rate was similar in both groups. Time to convert orotracheal intubation to SMI was significantly less in group A (Group G = 9.55 ± 1.42, Group A = 5.67 ± 1.73; P < 0.001). Ease of SMI was found Grade I in 30% and 83% of the patients of group G and A, respectively. No serious complications were observed except 2 cases of bleeding, and 1 case of tube damage. CONCLUSION: Awake oral to submental conversion requires lesser time in comparison to asleep technique besides improving the ease (Δ = 53%) of the procedure.

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Traumatic panfacial fracture repair is one of the most complex and challenging reconstructive procedures to perform. Several principles permeate throughout literature regarding the repair of panfacial injuries in a stepwise fashion. The primary goal of management in most of these approaches is to restore the occlusal relationship at the beginning of sequential repair so that other structures can fall into alignment. Through proper positioning of the occlusion and the mandibular-maxillary unit with the skull base, the spatial relationships and stability of midface buttresses and pillars can then be re-established. Here, the authors outline the sequencing of panfacial fracture repair for the restoration of anatomical relationships and the optimization of functional and structural outcomes.

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Panfacial fractures represent a challenge, even for experienced maxillofacial surgeons, because all references for reconstructing the facial skeleton are missing. Logical reconstructive sequencing based on a clear understanding of the correlation between projection and the widths and lengths of facial subunits should enable the surgeon to achieve correct realignment of the bony framework of the face and to prevent late deformity and functional impairment. Reconstruction is particularly challenging in patients presenting with concomitant fractures at the Le Fort I level and affecting the palate, condyles, and mandibular symphysis. In cases without bony loss and sufficient dentition, we believe that accurate fixation of the mandibular symphysis can represent the starting point of a reconstructive sequence that allows successful reconstruction at the Le Fort I level. Two patients were treated in our department by reconstruction starting in the occlusal area through repair of the mandibular symphysis. Both patients considered the postoperative facial shape and profile to be satisfactory and comparable to the pre-injury situation.

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Panfacial fractures are defined as fractures involving the lower, middle, and upper face. Treatment can be challenging and requires an individualized treatment plan. A firm understanding of the treatment principles of each individual fracture is necessary before attempting to tackle the patient with panfacial fractures. Advances in rigid fixation, wide exposure, primary bone grafting, and attention to soft tissue reattachment have significantly improved the treatment of the patient with panfacial fractures.

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Two patients, aged 18 and 28 years, with maxillofacial trauma due to motor vehicle accident, were operated upon by a team of plastic surgeons. In this report we aimed to present our experience with submental intubation procedure in these cases, in which orotracheal or nasotracheal intubation was impossible due to panfacial fracture.

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El manejo de las secuelas faciales por fracturas no tratadas ha tenido un crecimiento importante debido al uso de los biomodelos. Estos permiten optimizar la cirugía, disminuir los tiempos quirúrgicos y mejorar los resultados. El presente articulo muestra un caso de secuela de fractura facial tratada con osteotomías con ayuda de guías quirúrgicos fabricados en base a un biomodelo operado; se presenta el resultado postoperatorio de 6 meses con una resolución adecuada.

The management of facial sequel by facial fractures non-treated nowadays presents an important expansion by the use of biomodels. This system can be used for reduce surgical time, optimize surgical protocol and improve outcomes. This paper presents a sequel case for facial fracture treated with bone osteotomy using surgical guide manufactured base on biomodels operated; is showing the postoperative 6 month follow-up with good results.

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Panfacial fracture defines that fractures include all upper face, midface, and lower face. But clinically it means fracture more than two areas including midface. Many panfacial fracture patients have injury of cranium and face. Serious soft tissue damage and bony defect are frequent, normal anatomical reconstruction is difficult. After primary treatment many patients have sequelae of functional and aesthetic deformities, which are difficult to restore by secondary reconstruction. Patients with panfacial fracture are 75 cases among 1138 facial bone fractures who received treatment in department of plastic and reconstructive surgery of our university. We followed up survey from January, 1997 to December, 2001 by retrospective study and came to a conclusion. First, interconnection between skull base and nasal cavity must be seperated perfectly. Second, telecanthus can be prevented by anatomical bone fixation. Third, surgeon reconstruct zygomatic area exactly for facial width and projection. Forth, surgeon restore normal occlusion by anatomic reduction of maxilla and mandible. Fifth, soft tissue must be repaired layer by layer for prevention of secondary contour deformity. In conclusion, surgeon decides operation methods and time after discuss with related departments for with patient's condition. And treatment plans are based on patients mental and physical state. Proper primary treatment can reduce complications and necessity of secondary operation.

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