Reconstruction of Complex Facial Trauma, what is Reality?

Introduction: The complex facial trauma are produced by high velocity vectors, most of the time as a consequence of road traffic accidents and usually can be found in the context of a patient with multiple body injury. An accurate evaluation of the general status of the patient is done in ER to exclude the vital risk. The increasing number of drugs (polypharmacy) required sometimes with increasing concomitant diseases (cardiovascular, neurological, musculoskeletal) stretch to influence the therapeutic response, delay or modify the surgical treatment, making therapeutic strategies particularly complex and sensitive to manage.

Objectives: To offer a reality based treatment protocol, without compromising the esthetic and functional outcomes and to see how far is ”restitution ad integrum“ from reality.
We considered different variables: time of surgery, the complexity of fracture lines, the proper logistic of the center(armamentarium, a multidisciplinary team).

Methods: patients with multiple body and facial injury, were treated , focusing on the esthetic contouring of the face and function rehabilitation. Outcomes were assessed with the help of pre and post operative photographs, ct scan /CBCT,X-RAYS, multidisciplinary consults (neurosurgical, ophthalmology consult).

Results: We obtained good results following the basic principles of trauma but in the same time, “keeping the things simple”. These objectives were achieved even when it was required a delayed maxillo-facial treatment due to the general issues, or in the cases where the fracture lines did not follow any pattern.
In order to achieve the full rehabilitation of the patient, other variables needed to be solved (dental/implant treatment).

Conclusions: reality based treatment protocols outcomes were good. The real treatment plan should be a sum between the ideal plan, the patient general state of health, the patient will, the logistics of the center.