APPROACH TO PANFACIAL FRACTURE IN EMERGENCY (Atena Editora)

Abstract

Introduction: Panfacial fractures are known to be complex and affect at least two-thirds of the face, with multiple bone fractures in both. They are the result of intense trauma, and therefore these victims usually present with multiple trauma, compromising other organs and tissue structures. Due to their complex and emergency nature, the treatment of this level of fracture requires a thorough approach by the Oral and Maxillofacial Surgery and Traumatology team. Among the protocols described in the literature, the most commonly used are “top to bottom and outside to inside” or “bottom to top and inside to outside”. Objective: To report a clinical case of panfacial fracture and address its complexity and difficulty in the facial reconstruction process. Methodology/Case report: A 46-year-old male patient attended the emergency department of ``Hospital Geral do Estado da Bahia`` (HGE-BA) 2 days after the motorcycle accident in which he was a victim. The patient was clinically stable and the Oral and Maxillofacial Surgery and Traumatology team requested a computed tomography scan, which showed signs of fractures of the bilateral orbitozygomatic-maxillary complex, naso-orbito-ethmoidal complex, right mandibular body, Le Fort I and Le Fort II on the left side of the face, and Le Fort III on the right side. Under general anesthesia and orotracheal intubation, the patient underwent surgery using the “top-down” protocol, starting with the orbitozygomatic-maxillary complex, followed by the maxillomandibular block in the transsurgical setting and finishing with the mandible. He was referred to the Intensive Care Unit (ICU) for the immediate postoperative period, where he remained for 3 days. After that, a maxillomandibular block was performed for 60 days using steel wires. Result: A satisfactory alignment of the fractures and bone fixation materials in the appropriate position were observed by means of tomography. No postoperative functional or aesthetic complaints were reported. Conclusion: It can be concluded, then, with the aforementioned case, that the treatment of panfacial fractures is quite challenging and aims to restore the patient's functionality and aesthetics, through the reconstructed facial projection in its proportion, height and width. In addition to there being no ideal protocol or sequence for performing surgeries in these cases, the importance of the emergency approach that the hospital offers are notorious, enabling significant results with regard to complications and sequelae, which were drastically reduced.