Surgical Sequence for Management of Panfacial Fracture A Systematic Review
Keywords:
panfacial fracture, sequencing, maxillofacial fracture, sequence of fixationAbstract
Aim: To evaluate and analyse the various sequencing strategies for the surgical management of panfacial fractures.
Materials and Methods: A comprehensive electronic and manual search of the literature, without date or language restrictions, was performed across several databases, including PubMed, SCOPUS, SpringerLink, EBSCO, and Google Scholar, 2011 to 2023. The search terms used were "panfacial fracture," "sequencing," "maxillofacial fracture," and "sequence of fixation."
Results: A total of 2820 studies were initially identified through database searches, of which 280 studies were shortlisted after title and abstract screening. Following full-text assessment, 13 studies met the inclusion criteria, comprising 676 participants (388 males, 288 females). Among the included studies, 1 study exclusively used the Top-to-Bottom approach, 2 studies focused on the Bottom-to- Top approach with an emphasis on Occlusion First, 4 studies combined the Bottom-to-Top and Outside-In approaches, and 6 studies employed a comprehensive strategy, integrating both the Bottom-to-Top & Outside-In as well as the Top-to-Bottom & Inside Out approaches. The follow-up period varied from 3 weeks to 24 months.
Conclusion: This systematic review highlights the variability in surgical sequencing strategies for panfacial fracture management, with the Bottom-to-Top and Outside-In approach being the most commonly used and demonstrating superior outcomes compared to other sequencing patterns. While Top-to-Bottom, Inside-Out, and Occlusion First approaches also yielded favorable results, evidence suggests that the Bottom-to-Top and Outside-In sequence achieves better functional and aesthetic outcomes. Early repair is recommended for optimal reduction and fixation; however, in cases with life-threatening injuries, delayed intervention may be necessary. Complications are observed across all sequencing methods but can be minimized with definitive treatment planning and a stepwise surgical approach.