The surgical treatment for reconstruction of facial defects following trauma depends upon various factors such as wound character, other associated injuries and complexity of the defect.
The reconstruction of injured soft tissues following a trauma is quite challenging. Skilled Maxillofacial surgeons who can reconstruct these deformities are very difficult to get. Good management and proper monitoring is inevitable for achieving superior and durable results
Assault wounds, often create extremely severe soft tissue injuries and pose a big challenge for reconstructive surgeons. A thorough assessment of the defects is crucial in deciding appropriate tissue repair method.
Current microsurgical practices and latest trends like free flap transfers provide comprehensive treatments for patients with least morbidity and improved functional integrity.
A systematic algorithm is imminent in managing different stages of healing in the most ideal way in order to achieve best outcome.
Midface Craniofacial Injuries
Surgical treatments for high mid face craniofacial traumas are really a clinical dilemma because of the complex networking system of orbito- nasal organs.
Midface traumas can result in facial nerve deficits, anosmia, base skull fractures, post-traumatic telecanthus, blood loss and persistent headache. An injury to frontal sinus causes hazardous leakage of Cerebrospinal fluid.
Meticulous planning is required to restore the normal anatomy and desired function in this region.
Exact positioning of the arch (zygoma) helps restore the proper facial width and framing. Reestablishing normal occlusion is essential in the case of trauma with mandibular fracture.
The soft tissue damages produced by midface trauma create defects to naso-orbito-ethmoidal region, which plays an important role in facial expression.
Bone regeneration without devascularizing the underlying bone mass is possible with external fixation while performing soft tissue coverage. Internal platings and miniplates are used depending upon the nature and location of defect. Significant bone loss and presence of tissue fragments may require primary bone grafting to prevent further soft tissue defects and to maintain structural integrity.
Sometimes massive soft tissue injuries require free tissue transfer. The recent free flap transfer methods like fasciocutaneous flaps and anterolateral thigh flap are used in reconstructive surgeries which can produce optimal aesthetic and functional results.