Staged reconstruction of panfacial trauma involving a comminuted mandibular fracture: a case report

Comminuted mandibular fractures (CMFs) associated with panfacial trauma are challenging because restoration of skeletal continuity does not necessarily re-establish functional occlusion or facial form. We report a staged multidisciplinary rehabilitation in a 34-year-old man who sustained severe craniofacial injuries in an industrial explosion, including a CMF, multiple midfacial fractures, and extensive anterior maxillary destruction. Initial treatment consisted of hemorrhage control, top-down open reduction and internal fixation, and simultaneous orbital floor reconstruction. Because severe mandibular comminution and fragment interference prevented safe restoration of the mandibular arch and occlusion, stable skeletal fixation was prioritized and the potential need for delayed correction was recognized intraoperatively. After osseous union, persistent mandibular arch discrepancy and malocclusion were reassessed, and definitive corrective surgery was planned using right sagittal split ramus osteotomy and anterior mandibular vertical osteotomy. Subsequent rehabilitation included rhinoplasty, anterior maxillary reconstruction with an autogenous mandibular body block bone graft, implant placement, and prosthetic treatment. The staged approach achieved clinically acceptable occlusion, satisfactory masticatory function, and improved facial symmetry. This case suggests that delayed corrective surgery after skeletal healing can provide a practical pathway when immediate occlusal restoration is unsafe during primary fixation.