Management of Panfacial Fractures Workup
- Author: Kris S Moe, MD, FACS; Chief Editor: Deepak Narayan, MD, FRCS more...
Order plain films as dictated by the physical examination findings.
Because of the complexity of these injuries, computed tomography (CT) imaging studies yield more accurate information related to the bony architecture and its disruption by injury than plain films.
CT imaging is an integral component of the diagnosis of midfacial fractures. These patients often have a concomitant head injury and require a head CT scan to examine intracranial structures and exclude hemorrhage. Often, if the results are positive for injury, the CT scan needs to be repeated to look for worsening or resolution of an intracranial process.
Axial CT scans through the maxillofacial region can almost always be obtained while performing the initial head CT scan. See the image below.
Coronal CT scans are often difficult to obtain initially in patients who are still intubated and require cervical spine immobilization. Coronal and sagittal reconstructions can usually be obtained from the initial axial CT scans. See the images below.
Three-dimensional CT imaging and computer-generated models of the facial skeleton can be useful in complex cases.[11, 12] They can aid in visualization and treatment planning of the bony injuries. See the image below.
One of the keys to repair or reconstruction of the maxillofacial skeleton is occlusion of the teeth. Dental models can be helpful in assessing the exact position of displaced segments of both the maxilla and mandible attached to teeth. Dental models are useful in the reconstruction of acrylic stents and splints for palatal fractures.
Preinjury photographs of the patient obtained from the family can be helpful in determining the patient's preinjury appearance and the presence of any preexisting maxillofacial problems such as congenital telecanthus, hypertelorism, apertognathia, prognathism, retrognathism, and nasal deviation.
Wenig BL. Management of panfacial fractures. Otolaryngol Clin North Am. 1991 Feb. 24(1):93-101. [Medline].
Follmar KE, Debruijn M, Baccarani A, et al. Concomitant injuries in patients with panfacial fractures. J Trauma. 2007 Oct. 63(4):831-5. [Medline].
Erdmann D, Follmar KE, Debruijn M, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. 2008 Apr. 60(4):398-403. [Medline].
Catapano J, Fialkov JA, Binhammer PA, McMillan C, Antonyshyn OM. A new system for severity scoring of facial fractures: development and validation. J Craniofac Surg. 2010 Jul. 21(4):1098-103. [Medline].
Caron G, Paquin R, Lessard MR, et al. Submental endotracheal intubation: an alternative to tracheotomy in patients with midfacial and panfacial fractures. J Trauma. 2000 Feb. 48(2):235-40. [Medline].
Stoll P, Galli C, Wachter R, Bahr W. Submandibular endotracheal intubation in panfacial fractures. J Clin Anesth. 1994 Jan-Feb. 6(1):83-6. [Medline].
Babu I, Sagtani A, Jain N, Bawa SN. Submental tracheal intubation in a case of panfacial trauma. Kathmandu Univ Med J (KUMJ). 2008 Jan-Mar. 6(1):102-4. [Medline].
Garg M, Rastogi B, Jain M, Chauhan H, Bansal V. Submental intubation in panfacial injuries: our experience. Dent Traumatol. 2010 Feb. 26(1):90-3. [Medline].
Berardo N, Leban SG, Williams FA. A comparison of radiographic treatment methods for evaluation of the orbit. J Oral Maxillofac Surg. 1988 Oct. 46(10):844-9. [Medline].
DeMarino DP, Steiner E, Poster RB, et al. Three-dimensional computed tomography in maxillofacial trauma. Arch Otolaryngol Head Neck Surg. 1986 Feb. 112(2):146-50. [Medline].
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 Jul. 3 (7):e463. [Medline].
Gillespie JE, Quayle AA, Barker G, Isherwood I. Three-dimensional CT reformations in the assessment of congenital and traumatic cranio-facial deformities. Br J Oral Maxillofac Surg. 1987 Apr. 25(2):171-7. [Medline].
Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg. 1983 Feb. 41(2):89-98. [Medline].
Kelly KJ, Manson PN, Vander Kolk CA, et al. Sequencing LeFort fracture treatment (Organization of treatment for a panfacial fracture). J Craniofac Surg. 1990 Oct. 1(4):168-78. [Medline].
Tang W, Feng F, Long J, et al. Sequential surgical treatment for panfacial fractures and significance of biological osteosynthesis. Dent Traumatol. 2009 Apr. 25(2):171-5. [Medline].
Bellamy JL, Mundinger GS, Flores JM, et al. Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis. J Craniofac Surg. 2013 Nov. 24 (6):1922-6. [Medline].