Pan facial trauma – is the trauma that covers a lot of facial area. When there are many simultaneous facial fractures, this is called pan facial fractures. These affect the upper, middle and lower thirds of the face. Since almost the whole of the face is involved, pan facial fractures might also involve many skeletal structures like the mandible, maxilla, zygomatic complex, frontal bone and the NOE complex.
If the pan facial fractures are severe, it can lead to complex facial deformities, decreased facial movements and malocclusion. Pan facial injuries and treatment might also need extra care about soft tissue injuries associated with pan facial fractures and other intracranial, cervical or vascular injuries.
The treatment of pan facial fractures can appear a bit complex because it involves a host of other smaller procedure that are used in maxillofacial injuries. Pan facial fractures are complex to treat because of lack of reliable landmarks. The surgeon performing the surgery must adhere to the treatment protocol and treat each fracture as a unit to obtain best results. The general principles for treating maxillofacial trauma can be used here.
Pan facial trauma treatment before technological advancements, was done differently. The extent of injuries caused by the trauma was analysed with surgical exploration. Plain radiographs provided limited information about bone involvement.
With growing advances, treating pan facial fractures has undergone many changes. Pan facial injuries and fractures are now managed with the plate and screw fixation technique that has revolutionised the sequence. The ‘inside-out, bottom-to-top’ approach has been widely accepted as the guiding principle for managing pan facial trauma. But with rigid fixation method, midface reconstruction might precede fixation of the mandible to ensure proper maxillary positioning.
Preoperative (before surgery) analysis for pan facial factures
Surgeons must take care to follow certain careful procedures before the surgery to effectively treat pan facial fractures. Information regarding the location and extent of all fractures must be obtained by surgeons prior to treatment. The structures that are involved in the fracture site and are directly or indirectly injured must be identified and noted for individual treatment to prevent complications. Surgeons must also note the amount of soft tissue loss (including the skin, mucosa and nerve tissue), and the bone loss.
The presence of any dentoalveolar injury must also be analysed before surgery. Gross loss of teeth may affect the ability to relate the maxilla to the mandible. The pan facial fractures usually present many remarkable challenges for both experienced and inexperienced surgeons because every segment of bone has a precise function in the repair. And the treatment or surgery is individualized for each patient. Certain concomitant injuries might require attention because they may delay early treatment of pan facial fractures.
CT Scan and Pan facial fractures
The computed tomography (CT) scan has been a major gain for surgery and treatment of pan facial fractures because it helps to identify the location and exact fracture patterns in the precise areas. This allowed for better classification of facial injuries. Surgeons could anticipate the injuries and decide on the best treatment course. With more development, CT scan data with computer technology have given surgeons information that can be manipulated and analysed in three dimensions without any invasive procedures (as was the norm earlier).
The repair sequence of pan facial fractures
While a maxillofacial surgeon decides to perform surgery or treatment of pan facial trauma, the various injuries might create many challenges. The goal of pan facial trauma treatment is to restore anatomy in all the three dimensions by plating the maxillofacial buttresses. Pan facial trauma treatment can have two sequencing options – re-establishing the maxilla mandibular unit (bottom up) or starting with reduction and fixation at the calvarium level working in caudal direction (top down).
Pan facial fractures might also include Le Fort type fracture with or without sagittal split of the palate and mandibular fracture. The Le Fort fracture might include or not affect the mandibular area and the treatment methods might vary for each type of pan facial fracture.
Surgeons performing the surgery need sound anatomic knowledge to ensure successful long term outcome for patients. Blunt force injuries to the mid face region might have lot of consequences to orbital region. While other penetrative injuries might cause severe damages to the skull and other bone structures, treatment of pan facial trauma might need to look at the whole picture.
A pan facial fracture might have a few notable potential complications due to the complex area it covers and the many secondary effects that might arise. Pan facial fractures are usually documented with postoperative radiologic documentation. Contour stability must also be noted to make sure pan facial trauma has no long lasting effects.
Dr. Debraj Shome is an expert facial plastic surgeon in analysing and treating pan facial trauma. He also analyses the cosmetic after effects of trauma and manages facial contouring to ensure that the trauma does not have any lasting effects or deformities.