A therapeutic challenge to maxillofacial surgeons is management of panfacial fractures, especially when treating multiple comminuted bone fractures. One of the most important goals in these fractures is achieve and stablish a correct occlusal relationship of the mandibular-maxillary unit in parallel with the proper positioning of the jaws with the skull base and other facial units. Also, it is important to prevent long-term sequelae such as facial asymmetry, enophthalmos, and malocclusion that could be caused by inadequate correction. To achieve all these goals some usual guides of management are proposed as follow: “, Bottom to up”, , “, Top to down”, , “, outside to inside, ”,or “, inside to outside”, . We present 3 cases of Panfacial fracture and the proposed methods were based on different sequences of management with introducing “, reference point”,as the most intact area to determine the management concept & “, confirming point”,as the areas that should be reduced and fixed completely. These points act as an orientation aid during surgery and aid to successfully restore the entire face contour and maxillomandibular occlusion and also to improves surgical procedure.

Background: Cases of avulsion and degloving injuries of solitary areas of the face have been reported in the literature. However, complex traumatic degloving hemifacial injury with compound panfacial fractures is very rare. Rehabilitation of extensive degloving facial injuries poses a great challenge for surgeons. Surgery becomes more challenging if these types of soft tissue injuries are associated with multiple bony fractures of the maxillofacial skeleton. Such traumatic injuries require prompt careful treatment; inadequate treatment may lead to loss of normal anatomical framework and a deformed unaesthetic appearance, with adverse physical and psychological effects. It requires adequate fixation of hard tissues, meticulous anatomic repositioning of soft tissues and proper care post-operatively to achieve excellent esthetics as well as functional results.Case presentation: Here, we present a case of a 24-year-old male patient presenting with avulsive degloving injuries of the face and pan-facial fractures. Debridement of wounds, fixation of maxillofacial fractures, primary reconstruction and repair of the soft tissues were performed in a single stage. Arch bars were placed in the maxilla and mandible. The maxillofacial fractures were anatomically reduced and fixed with titanium miniplate and screws. The degloved flaps were anatomically repositioned and multiple-layered suturing was performed. At the six-month follow-up, minimal-to-no functional or esthetic deficit was present.Discussion: Facial degloving injuries combined with panfacial fractures present a significant reconstructive challenge. A carefully planned, staged treatment approach is essential for achieving optimal functional recovery and aesthetic outcomes. Maintaining tissue viability and ensuring meticulous postoperative care are crucial in preventing complications.

INTRODUCTION: Armored removable connector tubes are not always available in operating rooms for routine Altemir submental intubation (SMI) technique. The present study addresses a fiber-optic glidos copy assisted 2-tubes modification of Green & Moore sequence for submandibular intubation.METHODS: The sample was composed of 11 patients (8 males and 3 females) with panfacial fractures where neither the oral and nasal intubation techniques nor tracheostomy were feasible. The inter-operative procedure duration was recorded and a comparison was made between the present results with those obtained in similar studies. Moreover, postoperative complications were assessed over a duration of 6 months.RESULTS: The average duration of this modified procedure was 8-13 min. (Mean, 10.54 ± 1.75 min). No perioperative or postoperative complications were observed. Based on the findings in this study, it is suggested that this new technique is safe, quick and reliable for submandibular intubation.CONCLUSION: This modification establishes a secure airway for treatment of maxillofacial panfacial fractures, where traditional methods are impossible due to non-detachable connector tubes. No perioperative or postoperative complications were observed. This study suggests that this new technique is safe, quick and reliable for submandibular intubation.

Intubating a patient with panfacial fractures is always a challenge to the anesthesiologist as both the anesthesiologist and the surgeon are essentially competing for the same space. The anesthetic management of a 19-year-old boy who presented with multiple maxillofacial injuries, pneumocephalus, and cerebral edema sustained during a road traffic accident has been described. He was posted for open reduction and internal fixation of the fractures, frontal sinus fracture elevation and basal repair which required access to scalp, mouth and the nose. As all the conventional modalities to secure airway seemed unsuitable, orotracheal intubation was done via submental route. Following intravenous induction the patient was intubated with a cuffed oral flexometallic tracheal tube. This was then modified to the submental route through a submental incision. The surgery proceeded uneventfully and the patient was extubated a day later in the ICU. He made a satisfactory recovery and the submental scar healed without complication or scarring. We briefly review the technique of submental intubation in adults which serves as an excellent alternative to tracheostomy.

Methods: This retrospective cross-sectional study utilized the records of the patients who were treated for maxillofacial fractures in Mashhad Shahid Kamyab Hospital or a Private Trauma Center, from 2016 to 2021. Demographic characteristics of the patients (age and gender), educational backgrounds of surgeons, accident causes, year and location of the fractures, and reasons for referrals were recorded. The data were statistically analyzed using SPSS 20, and the significance level was set at 0.05. Results: We examined the records of 60 patients (44 males, 16 females). Males (73.4%) exhibited a significantly higher prevalence of maxillofacial traumas compared to females (26%) (P Value < 0.05). Falling was identified as the most common cause of fractures (51.7%), followed by impacts from hard objects and motor vehicle accidents (MVA) (P Value = 0.63). Mandible fractures were observed in 48% of patients, followed by zygomaticomaxillary and panfacial fractures, subsequently (P Value < 0.05). Conclusion: The study findings highlight the impact of age, gender, and trauma causes on maxillofacial fractures and treatments among patients with certain insurance. Understanding the origins and patterns of these fractures offers crucial insights for shaping effective health policies, providing valuable guidance for addressing such injuries in this population.