Presentation and Management of Facial Fractures: An Experience from a Tertiary-Care Teaching Institute in India

Most tertiary-care teaching institutes in low and middle-income nations lack dedicated oral and maxillofacial surgery (OMFS) units in the emergency trauma centers. Consequently, most facial fractures need to be managed in the otolaryngology and head-neck surgery (ORL-HNS) setup.

To present a study on a series of patients with facial fractures attending the emergency and outpatient departments of ORL-HNS in a tertiary-care teaching institute in India that lacked the facility of OMFS in its emergency trauma center.

For the patients included in the study, a general protocol for managing polytrauma was followed. Patients with concomitant intracavitary and long bone injuries were excluded. Those with facial fractures that essentially required OMFS expertise were referred to dedicated maxillofacial centers. The most common presentation was pain/tenderness, followed by peri-orbital ecchymosis and trismus. Orbital symptoms were associated with orbital floor and zygomatico-maxillary complex fractures. Diagnosis and surgical planning were made following high-resolution computed tomography scan. Except for nasal bones, all the fractures were managed by open reduction and fixation.

The mean age of the 26 patients included in the series was 32.88 years (range 7-55 years) with a male preponderance of 2.7:1. The fractures involved orbital floor (n = 3), frontal bone (n = 2), mandible (n = 4), zygomatico-maxillary complex (n = 14), and nasal bone (n = 3). Road traffic accidents were the commonest etiology. Management of the respective facial bone fractures was done following the standard care of surgical practice.

For their expertise in functionally and esthetically appropriate repair, a dedicated OMFS unit is desirable for managing facial fractures. The present series shares the experience of managing such fractures by the ORL-HNS team in the absence of an OMFS facility in the emergency trauma center, highlighting the importance of a multidisciplinary approach in the care delivery system.