Management of Pan Facial Fractures: Operative Staging and Overall Complications

Abstract

Background:

Pan facial fractures (PFF), which involve the upper, midface, and lower facial skeleton, are a severe and complex subset of maxillofacial trauma. While the optimal management of PFFs often emphasizes strategic operative sequencing (eg, top-down vs bottom-up approaches), the clinical implications of surgical staging (single-stage vs multi-staged repair) remain less thoroughly investigated. This study aims to evaluate and compare outcomes associated with single-stage versus multi-staged operative repair of PFF.

Methods:

A retrospective cohort review was conducted at a Level I trauma center from 2018 to 2019. Adult patients with fractures involving at least 3 facial subunits were included. Data on fracture patterns, surgical timing, duration of initial surgery and postoperative complications were collected. Outcomes were stratified by operative strategy (single-stage vs staged).

Results:

Of the 50 patients who met the inclusion criteria, 78% (n = 39) necessitated operative intervention. 64% (n = 33) underwent single-stage repair, while 12% (n = 6) received planned, multi-staged reconstruction. Staged procedures were predominantly indicated for PFF patients presenting with highly complex fracture patterns, specifically mixed-pattern Le Fort fractures, extensive zygomaticomaxillary complex injuries, and concomitant orbital floor and medial wall defects. Overall, 28% (n = 14) of the total patient cohort experienced major postoperative complications. No mortalities were reported. Multi-staged repairs were associated with a higher incidence of infection, enophthalmos, and hematoma. However, these patients exhibited greater injury severity at presentation, suggesting a potential selection bias.

Conclusion:

Single-stage reconstruction remains the preferred approach for Pan facial fractures (PFFs) in most clinical scenario. Nevertheless, staged reconstruction is a valuable alternative, particularly in managing extensive pan facial fracture patterns within the context of a polytrauma patient.