Case of Facial Trauma

Diagnosis:

• Condition: Facial Trauma

• Affected Areas: Left parasymphysis, left subcondyle, left zygoma

• Date of Injury: Two weeks ago

Clinical Findings: The patient presented with a history of facial trauma sustained two weeks ago. Upon examination, the following clinical findings were noted:

• Facial Asymmetry: The patient exhibited significant facial asymmetry with increased width on the left side of the face, particularly involving the left parasymphysis, left subcondyle, and left zygoma.

• Subconjunctival Hemorrhage: A subconjunctival hemorrhage was observed in the left eye, indicative of vascular damage due to the facial trauma.

• Occlusion Derangement: The patient's occlusion (bite) was severely deranged, likely due to the fractures in the left parasymphysis and subcondyle.

• Step Deformity: A step deformity was noted in the left zygomaticomaxillary (ZM) buttress region, indicating a fracture or displacement of the left ZM buttress.

Plan: Given the extent of the facial trauma and the clinical findings, it was decided to proceed with Open Reduction and Internal Fixation (ORIF) to restore the patient's facial symmetry and function. 

Procedure: The following procedure was performed: 

1. General Anesthesia (GA) and Throat Pack: The patient was placed under general anesthesia, and a throat pack was inserted to protect the airway during the procedure. 

2. Eyelet Wiring: Prior to the surgery, eyelet wiring was carried out to assist in the stabilization of the fractured areas. 

3. A buccal vestibular incision was given. 

4. Fracture Site Exposure: Under aseptic conditions, the surgical team exposed the fracture sites in the left parasymphysis, left subcondyle, and left zygoma. 

5. Reduction of Fractures: The fractures were carefully reduced, aligning the bone fragments to their anatomical positions. 

6. Achievement of Occlusion: Occlusion (proper bite) was achieved and verified to ensure normal function of the patient's jaw. 

7. Intermaxillary Fixation (IMF): Intermaxillary fixation was performed to maintain the achieved occlusion during the healing process. 

8. Fixation with Mini Plates: Mini plates were utilized to rigidly fixate the fractures in the left parasymphysis, left subcondyle, and left zygoma. These plates provide stability and support for proper healing. 

9. Keen's approach was used to reduce zygoma: Keen's approach, also known as the Keen-Zygomatic Arch Approach, is a surgical technique commonly employed in maxillofacial surgery for the reduction and fixation of zygomatic fractures, particularly in cases of facial trauma. This approach provides excellent access to the zygomatic complex, allowing for precise reduction and fixation, and it is particularly useful when there is a need to address complex fractures involving the zygomatic arch and surrounding structures. 

10. Closure of Incisions: The surgical incisions were meticulously closed using appropriate sutures. 

Prognosis: The prognosis for this patient is favorable, with the expectation of restored facial symmetry and functional occlusion following the successful ORIF procedure. However, the long-term outcome will depend on the patient's adherence to postoperative care instructions and the absence of complications. 

This case was done with Dr. Yaser Ishaq and Dr. Khaqan Azam at Akhtar Saeed Trust Hospital, Lahore.