Introduction
A person’s countenance depends directly on the skeletal architecture and
the overlying soft tissues of the midface (Arora et al., 2017). The
midface has been defined as the area between the zygomaticofrontal
suturesand the maxillary occlusal plane. These planes converge
posteriorly meeting near the foramen magnum. This region encompasses the
entire maxilla, zygomatic bones, and nasal orbital ethmoid (NOE) complex
along with the nasal substructures. This region holds a high density of
vascular, musculoskeletal, and nervous system structures whose injury
will often result in substantial morbidity and mortality in cases of
severe midface traumas. A comprehensive knowledge of head and neck
skeletal and soft tissue anatomy is imperative in understanding how to
manage the patients presenting with these patterns of traumas (Khatib et
al., 2017). These traumas are significantly more challenging to manage
compared to isolated facial or dentoalveolar fractures since there is
limited intact and unharmed framework to guide with anatomic reductions.
Furthermore, oftentimes, due to the high impact of force that caused
these traumas in the first place, these patients present with other
significant concomitant traumas that must be managed concurrently (Wang
L, 2019). The appropriate surgical approach to a maxillofacial trauma
must follow a systematic scheme, necessitating systemic evaluations such
as the hemodynamic evaluation, wound extensions, presence or absence of
foreign bodies, neural or vascular or glandular ducts involvements, and
other requisite evaluations which must be carefully undertaken with
preoperative examinations (Bayat and McGrouther, 2005). Inability to
directly visualize and reduce all the components of a mid-facial injury
along with inadequate stability of the fractured skeletal compartments
leads to postoperative deformity. Each case with this type of fracture
is unique and requires skill and expertise of the surgeon to restore the
pre-traumatic facial anatomy, aesthetics and functions (Sharma and
Dhanasekaran, 2015). In this article, we report the management and
further oral rehabilitation of a case suffering severe midface trauma
following a motor vehicle accident were the patient was hit by a
commercial lorry.