Objectives: The goal of treatment of panfacial fractures is to restore both the function and the preinjury three-dimensional facial contours by accurate buttress reconstruction. However, because most patients with panfacial fractures are medically unstable because of associated neurologic or systemic injuries, treatment of panfacial fractures may have to be delayed. Although there have been some case reports on the treatment of panfacial fractures, these fractures have not been clinically evaluated in Japan. The aim of this study was to investigate the frequency of concurrent trauma, treatment sequence of open reduction and internal fixation （ORIF）, and complications in patients with panfacial fractures.
Methods: Between April 2011 and March 2017, we examined 13 patients （11 males and 2 females; average age, 29.5±14.7 years） who were treated for panfacial fractures at the Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital.
Results: In 7 patients （53.8％）, intracranial trauma occurred with the panfacial fracture. Ten patients （76.9％） were treated with the “bottom-up and outside-in” procedure and 3 patients （23.1％） with the “top-down and inside-out” procedure. In addition, 2 patients required secondary ORIF because liquorrhea treatment necessitated a delay in fracture repair. Seven patients （53.8％） had postoperative complications.
Discussion and Conclusion: Surgeons need to consider the areas of fracture, fracture complexity, severity of facial injury, and the condition of the midfacial buttresses when choosing an adequate period of surgery and treatment sequence of ORIF for individual patients. Because of the frequent co-occurrence of cranial trauma and panfacial fractures, ORIF cannot be adequately performed as a first-stage surgery in some cases. Therefore, in such cases, ORIF must be included as a second-stage surgery in the treatment sequence. Surgeons must also recognize and try to minimize or prevent the frequent postoperative complications of panfacial fractures.