This is a 41-year-old male patient who begins to suffer an accident at home and falls from the 3rd floor, at a height of approximately 10, resulting in multiple fractures of the radius and the right stump.
She was admitted to the intensive care unit of the Hospital de Traumatología "Victorio de la Fuente Narváez" IMSS with a Glasgow index of 8.10; emergency tracheostomy was performed.
Laboratory tests and CT of skull and face are indicated to evaluate the lesions present.
After stabilization of the airway, consultation with the maxillofacial surgery service was requested.
The diagnosis of panfacial fracture is established based on tomographic findings with the following components:
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• Nasoorbital discharge.
• Fracture of the cleft palate complex type 2 non-displaced left, type 3 and type 4 on the right side.10
• Le Fort I maxillary fracture
• Right parasymphyseal fracture
• Fracture of the right mandibular ramus.
Intermaxillary fixation was performed with bar arches and elastic traction.
She was admitted to the intensive care unit due to hydroelectrolytic imbalance. She was programmed for open reduction of facial fractures under balanced general anesthesia 13 days after admission to hospital, using dissection of the middle facial third and incisional approach.
Findings during surgery include fracture at the frontonasal suture level, bilateral fracture of infraorbital ridges without involvement of the floor of the orbit, fracture in ciliated pillars of the orbit, fracture of the anterior wall of the maxilla and mandible.
He also had a right parasymphyseal fracture of the jaw.
Fractures were reduced and fixed with a Synthes 2.0 system for those of the middle third of the face, and mandibular fractures were managed conservatively, since the intermaxillary fixation was stable.
Associated with surgery, the patient was readmitted to the intensive care unit where he remained for 5 days, when he improved his general condition and was admitted to the ward.
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At the follow-up appointments, the patient shows adequate postoperative evolution, progressing with edema that resolves slowly, and healing of the approach areas is adequate, without the presence of nasal hematoma or vestibule stenosis.
Intermaxillary fixation was maintained for 8 weeks, during this immobilization period without complications and with stable occlusion.
After removal of the intermaxillary fixation, occlusion was observed without alterations.
Spatial relationships of the face were restored after surgical treatment.
The control radiographs show the fractured areas with miniplates in adequate position, confirming that the anteroposterior, sagittal and transverse relationships of the middle third of the face were restored.
