Sequential surgical treatment for panfacial fractures and significance of biological osteosynthesis.

The goal of this retrospective study was to evaluate the efficacy of panfacial fracture repair and to review guidelines for treatment based on AO/Arbeitsgemeinschaft fuer Osteosynthesefragen Association for Study of Internal Fixation theories of biological osteosynthesis. Sixty-eight patients with panfacial fractures were subjected to preoperative X-ray cephalometric analysis and model surgery, followed by open surgical reduction, rigid internal fixation and at least 8 weeks of clinical follow up. A variety of surgical approaches were used, with the 68 patients undergoing a total of 93 surgical procedures. In all but eight patients, the treatment produced satisfactory correction of maxillofacial deformities and restoration of normal function. Among the eight patients whose treatment was not deemed successful, there were two whose facial deformities were not corrected by treatment. In addition, there were five patients with enophthalmos or motor disturbance of the eye that failed to show improvement during the study, and four patients who exhibited signs of limited mouth opening and malocclusion. The systematic and sequential choices of surgical methods were key factors in determining panfacial fracture treatment outcomes. We propose that treatment of bone fractures must take into account the biological characteristics of the damaged bone to facilitate selection of appropriate plate and screw systems and repositioning methods.