Tratamento cirúrgico das fraturas panfaciais: uma revisão integrativa da literatura

Abstract

Panfacial fractures are defined as fractures involving the lower, middle and upper parts of the face, usually resulting from a high-intensity trauma, which makes its treatment challenging, due to the complexity of this type of trauma. This type of fracture is most often caused by collisions of motor vehicles and injuries by high-caliber firearm projectiles. The objective of this work is to carry out an integrative literature review about the surgical treatment of panfacial fractures. Clinical case report articles were selected between 2005 and 2020, in the PUBMED database, in which the topic of panfacial fractures was the area of interest. The keywords used were panfacial, trauma, treatment and management, being crossed as follows: (panfacial AND trauma; panfacial AND treatment; panfacial AND management). 90 articles were found, and 10 articles were selected following the inclusion and exclusion criteria. In airway management, the main techniques reported were orotracheal, nasotracheal, oral intubation with submental derivation and tracheostomy. Regarding occlusion, studies have shown that it can be preserved, as well as not preserved after trauma. Regarding the segmentation of the arches, a greater occurrence of segmentation of the mandibular arch was found in this study. Following treatment, the most commonly found was the “bottom to top” technique, which consists of a bottom-up approach to the surgical treatment of panfacial fractures. The authors showed that maxillary mandibular fixation optimizes the reestablishment of occlusion, as it helps in sequencing surgical treatment. Complications from panfacial trauma were quite varied, and in some studies they were not reported and in others complications were observed, such as: severe epistaxis, airway obstruction, among others. From this review, we were able to conclude that panfacial traumas do not have a clear definition in the literature, as many of the authors reported multiple fractures of the face as being panfacial, not necessarily affecting the three thirds of the face, but that they are complex due to high intensity forces exerted on the facial region and its surgical treatment becomes challenging. Maxillary mandibular fixation is used on a large scale because it assists the surgeon in open reduction and internal fixation and restoration of occlusion and, consequently, in the sequencing of both approaches (“top to bottom” and “bottom to top”). In addition, the correct management of airways is of vital importance. The treatment sequence is still not consensual in the literature, therefore, there should be more studies so that the benefit to the patient is as great as possible. However, the “bottom to top” sequence was the most reported.