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Treatment of Panfacial Fractures and Three-Dimensional Outcome Analysis

The Occlusion First Approach

Choi, Jong Woo, MD, PhD; Kim, Min Ji, MD, PhD

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1255–1258
doi: 10.1097/SCS.0000000000005528
Clinical Studies

Successful management of panfacial fractures requires an understanding of the component fracture patterns and the ability to relate them anatomically to the stable elements of the skull. However, there is no widespread agreement on the ideal approach to treatment of panfacial fractures and several techniques have been proposed. Here, the authors suggest the “occlusion first” approach, a technique that involves larger segment reduction as the initial step to provide an appropriate occlusal plane.

This retrospective study included data from patients undergoing open reduction and internal fixation of panfacial fractures between March 2005 and November 2017 by the occlusion first technique. The degree of reduction in the mid and lower face was evaluated using 3D CT. The causes of injury, combined fracture, and multidisciplinary consultation during postoperative management were reviewed.

The study population comprised 61 patients (47 male, 14 female) with a mean age of 47.6 years (range, 9–76 years). Analysis of 3D CT scans obtained from 42 patients showed no significant difference in hemifacial volume in the postoperative period (left hemifacial volume: 206.48 ± 68.35 cm3, right: 205.17 ± 66.27 cm3, P = 0.436).

The occlusion first approach, with initial reduction of larger segments, enables effective reconstruction of the multiple segments involved in panfacial fractures. The authors have demonstrated that this technique successfully restores the entire face, improves surgical reduction, acts as an orientation aid during surgery, and provides a template for the smaller segments. Therefore, this approach can facilitate the accurate and efficient reduction and fixation of panfacial fractures.

Department of Plastic and Reconstructive Surgery, College of Medicine, Ulsan University, Seoul, Korea.

Address correspondence and reprint requests to Jong Woo Choi, MD, PhD, Department of Plastic and Reconstructive Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; E-mail:

Received 16 November, 2018

Accepted 5 March, 2019

The authors report no conflicts of interest

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© 2019 by Mutaz B. Habal, MD.