[Delayed pan-facial fractures-injury patterns associated with deficient treatment results and clinical...

To analyze the injury patterns in pan-facial fractures (PFF) which potentially lead to deficient treatment outcomes and then to propose a clinical classification.

Thirty-nine patients, 31 male and 8 female, with an average age of 33, treated from 1998 to 2007 in the Center of Maxillofacial Trauma, Peking University School and Hospital of Stomatology, were included. Zygomatic complex, maxilla and mandible were involved in the extensive fracture concomitant with nasal-orbital-ethmoid (NOE) fracture or not. All cases experienced a delay of over 4 weeks after injury. An analysis was made to display the relationship between facial architecture demolition and disfigurement and disability. Treatment results were assessed with facial appearance, opening range, occlusion and regional deformities. The associated injury patterns most frequently leading to deficient outcomes were summarized as references to scheme a clinical classification.

Facial deformities presented in 90% of the patients and mostly related to condylar fracture/dislocation and zygomatic complex fracture. Limited mouth opening occurred in 59% of patients and were caused most frequently by displacement of zygomatic complex and joint ankylosis. Malocclusion was found in 100% of cases and there were the associated optical signs in 46%. Thirty-nine cases were divided into two types. Zygomatic, maxillary and mandibular fractures all together constituted type I, which accounted for 46% of patients. Type I plus NOE fracture was type II, which accounted for 54% of patients. Furthermore, A, B and C sub-types were recognized in corresponding to involvement of condylar dislocation/fracture and zygomatic complex fracture. In treatment outcomes, a difference between type I and type II fractures remained with NOE fractures. The outcomes of term "moderate" and "worse" in subtype C group were attributed to severe soft tissue injuries and trauma-induced ankylosis.

NOE fracture, condylar fracture and dislocation, and zygomatic complex fracture were closely associated with deficient treatment outcomes. Correspondingly, an clinical classification was proposed for PFF.