Reconstruction of secondary deformities after facial trauma is a major challenge for maxillofacial surgeons. A surgeon with experience in orbitopalpebral surgery, rhinoplasty, and orthognathic surgery in combination with orthodontics, pre-prosthetic surgery, and implants are required. The management of avulsions of the alveolar process with implants is essential.
The combination of aesthetic and reconstructive surgery technique produces the best results, except in small deformities, the approach requires multiple surgeries due to its complexity. After pan facial fractures, sequelae are frequent, especially if orbitozygomatic and nasoethmoidal are combined. In complex fractures with dental and alveolar process losses, it is difficult to achieve intermaxillary immobilization and perfect fracture reduction.
If the sequelae of fractures are complex and affect several areas, the best results are obtained if an organized approach is performed with exposure of the fracture areas, reduction of these after maxillary and orbital osteotomies, rigid fixation and autologous bone grafts are mainly taken from the shell.
The 32-year-old patient was referred for facial and maxillary reconstruction after suffering a traffic accident with a facial pan fracture that affected both orbits, nasoethmoidal, and maxillary.
The patient had previously undergone surgery by non-maxillofacial surgeons and had various sequelae. The frontal view shows a significant orbital malposition with enophthalmos of the left orbit, vertical orbital dystopia, and telecanthus; the nose is deviated and lateralized, shifting to the left. The septum is deviated to the left with a C deformity, resulting in nasal respiratory failure. The maxilla is retroposition and displaced to the left with missing teeth, coronary fractures, and left crossbite. The profile view highlights the sinking of the nasal root and the lack of lip support due to edentulism and fracture of the maxilla. The chin is rearranged.