Splitting and Splaying Apart of the Craniomaxillofacial Skeleton by Medially Directed Disruptive Forces of Unusual Etiologies- A Case Series

Early human evidence such as case series or small samples is exploring possible benefits.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Introduction Extreme forces directed towards the centre of the facial region can produce devastating injuries, with disruption of the mandible, maxilla and naso-orbito-ethmoid complex, with or without frontal bone involvement. The magnitude and trajectory of the force and nature of the impacting object, dictate the degree of displacement and comminution of the craniomaxillofacial skeletal components, as well as the extent of soft tissue loss sustained. Diagnosis & challenges To elucidate various challenges faced in the management of four cases of extreme craniomaxillofacial injuries, caused by centrally directed forces of rather unusual etiologies, namely, a traversing bullet, a bamboo rod, a heavy iron cattle tethering peg and a metal electrical pole. In each of the cases, the force of impact resulted in splitting and splaying apart of the facial skeleton, with a resultant increase in its transverse width, and an ensuing severe facial deformity and functional debility. Rationale & interventions A ߢBottom-up, Outside-in' surgical sequence was employed to carry out reduction, fixation and reconstruction of the deranged maxillofacial skeletal architecture and restoration of the soft tissue morphology. Outcomes & lessons The transverse dimensions of the flared out facial frames could be re-established and restored to their pre-trauma status successfully in all the cases, thereby a

Evidence level

Early human evidence such as case series or small samples is exploring possible benefits.

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