Panfacial trauma is defined as high-energy mechanism injuries involving two or more areas of the craniofacial skeleton, the frontal bone, the midface, and the occlusal unit. These can be distracting injuries in an unstable patient and, as in any trauma, advanced trauma life support (ATLS) protocols should be followed.
To avoid overlooking injuries, the airway should be secured, bleeding controlled, and sequential examinations should take place. In some cases, neurosurgery and ophthalmology consultations are recommended for the preservation of brain, vision, and hearing function should be prioritized. Once the patient is stabilized, reconstruction aims to reduce panfacial fractures, restore the horizontal and vertical facial buttresses, and resuspend the soft tissue to avoid the appearance of premature aging.
Bone grafts can be used to replace lost or comminuted bone, but proper reduction must be achieved first. Depending on the patient's appearance, operational sequencing can be performed from the top-down, outside-in, or bottom-up, inside-out. All techniques can successfully address panfacial injuries, but the emphasis should be on a systematic approach that moves from known to unknown areas.
