title: The mandibular symphysis as a starting point for the occlusal-level reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: report of two cases.
abstract: Panfacial fractures represent a challenge, even for experienced maxillofacial surgeons, because all references for reconstructing the facial skeleton are missing. Logical reconstructive sequencing based on a clear understanding of the correlation between projection and the widths and lengths of facial subunits should enable the surgeon to achieve correct realignment of the bony framework of the face and to prevent late deformity and functional impairment. Reconstruction is particularly challenging in patients presenting with concomitant fractures at the Le Fort I level and affecting the palate, condyles, and mandibular symphysis. In cases without bony loss and sufficient dentition, we believe that accurate fixation of the mandibular symphysis can represent the starting point of a reconstructive sequence that allows successful reconstruction at the Le Fort I level. Two patients were treated in our department by reconstruction starting in the occlusal area through repair of the mandibular symphysis. Both patients considered the postoperative facial shape and profile to be satisfactory and comparable to the pre-injury situation.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 7, A-8036 Graz, Austria. Electronic address: pauromau@tiscali.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pau
authors.affiliation: Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 7, A-8036 Graz, Austria.
authors.forename: Knut Ernst
authors.initials: KE
authors.lastname: Reinbacher
authors.affiliation: Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Feichtinger
authors.affiliation: Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria.
authors.forename: Kawe
authors.initials: K
authors.lastname: Navysany
authors.affiliation: Medical University of Graz, Austria.
authors.forename: Hans
authors.initials: H
authors.lastname: Kärcher
mesh_terms: D001265:Athletic Injuries / Q000601:surgery; D001860:Bone Plates; D003724:Dental Arch / Q000293:injuries; D003766:Dental Occlusion; D005147:Facial Bones / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008334:Mandible / Q000601:surgery*; D008335:Mandibular Condyle / Q000293:injuries*; D008337:Mandibular Fractures / Q000601:surgery*; D008440:Maxillary Fractures / Q000601:surgery; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000601:surgery; D021362:Palate, Hard / Q000293:injuries; D019651:Plastic Surgery Procedures / Q000379:methods*; D012887:Skull Fractures / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D015051:Zygomatic Fractures / Q000601:surgery
keywords: Mandibular symphysis; Panfacial fracture; Repair sequence