Pan facial Fractures: A Retrospective Analysis of 128 Cases Managed By Emphasis on the Occlusion-First Approach

Pan facial Fractures: A Retrospective Analysis of 128 Cases Managed By Emphasis on the Occlusion-First Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pan facial Fractures: A Retrospective Analysis of 128 Cases Managed By Emphasis on the Occlusion-First Approach Chandrashekhar Chattopadhyay, Vikas Deo, Charu Chouhan, Mamta Patel, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7390695/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Pan facial fractures, defined as complex injuries involving multiple facial skeletal regions, present significant challenges due to their severity and associated complications. This retrospective study analyses 128 cases of pan facial fractures treated between January 2023 and June 2025 at the Department of Dental Surgery, Government Medical College of Rajasthan India under a free government medical insurance scheme. The study introduces a novel "Occlusion-First Approach" (OFA), prioritizing the restoration of dental occlusion as the foundational step for facial reconstruction, leveraging maxillomandibular fixation (MMF) to guide subsequent reductions. Demographic data, aetiology, fracture patterns, surgical techniques, complications, and outcomes were evaluated. The cohort, predominantly male (89.1%) with a mean age of 32.4 years, primarily sustained injuries from road traffic accidents (78.9%). The OFA demonstrated a significant reduction in postoperative complications (p=0.028), particularly malocclusion (8.6%) and facial asymmetry (6.3%), compared to traditional sequencing methods. This approach, facilitated by cost-free access to advanced diagnostics and surgical resources under the insurance scheme, highlights the potential for equitable trauma care in resource-constrained settings. The study underscores the efficacy of the OFA and advocates for its adoption in managing complex pan facial trauma, offering insights into optimizing outcomes in public healthcare systems. Dentistry Pan facial fractures occlusion-first approach maxillomandibular fixation government medical insurance facial trauma dental surgery Figures Figure 1 Figure 2 Introduction Pan facial fractures involve multiple facial skeletal components, including the maxilla, mandible, zygoma, orbit, and nasal bones [1]. In low- and middle-income countries (LMICs), these injuries are prevalent due to high rates of road traffic accidents (RTAs), compounded by systemic challenges such as inadequate infrastructure, delayed presentations, and poor hygiene [2,3]. In wester Rajasthan, the tertiary government hospital under study operates under a government-funded insurance scheme, serving primarily lower socioeconomic groups. Treatment protocols rely on 2.0 mm titanium plates (4-hole or 6-hole, straight), but access to CT imaging, trained personnel, and operating rooms is limited [4,5]. This study examines the demographic profile, fracture patterns, surgical management, outcomes, and complications in 128 pan facial fracture cases, providing insights into trauma care adaptations in resource-constrained settings. Methods Study Design and Setting A retrospective cohort study was conducted in a 1500-bed tertiary care center in western Rajsthan, from January 2022 to June 2025. Inclusion Criteria Clinically and/or radiologically confirmed pan facial fractures (involving at least two facial bones). Surgical treatment with open reduction and internal fixation (ORIF). Exclusion Criteria Incomplete documentation. Non-surgical management. Isolated single-bone fractures. Data Collection Data extracted from medical records included: Demographics: Age, gender, socioeconomic status (proxy: insurance coverage). Injury Details: Cause, time to presentation, fracture location. Treatment: Plate type, anaesthesia, surgical delays. Outcomes: Postoperative complications, hospital stay, functional restoration. Statistical Analysis Using SPSS v26: Descriptive statistics for all variables. Chi-square tests to assess associations between complications and independent variables (e.g., hygiene, plate type). Significance level: p48 hrs: 58 (45.3%) Injury Characteristics Road traffic accidents: 88 (68.8%) Assaults: 28 (21.9%) Falls: 12 (9.4%) Fracture Combinations: Maxilla + Mandible: 70 (54.7%) Maxilla + Mandible + Zygoma: 38 (29.7%) Zygoma + Orbit: 20 (15.6%) Imaging: CT scan: 80 patients (62.5%) Radiographs: 48 patients (37.5%) Treatment Characteristics Plate use: 4-hole straight plates: 78 (60.9%) 6-hole straight plates: 50 (39.1%) Anesthesia: General: 116 (90.6%) Local: 12 (9.4%) Mean time to surgery: 2.3 days (SD 1.4) Outcomes Infection: 28 (21.9%) Malunion: 18 (14.1%) Mean hospital stay: 9.1 days (SD 3.4) Table 1: Patient Characteristics and Outcomes Variable Value Total Patients 128 Male 109 (85.2%) Mean Age 34.1 (SD 9.8) Road Traffic Accidents 88 (68.8%) Poor Hygiene 92 (71.9%) 4-hole Plates Used 78 (60.9%) Infection 28 (21.9%) Malunion 18 (14.1%) Mean Hospital Stay (days) 9.1 (SD 3.4) Figure 1: Bar Chart – Complication Rates by Plate Type Note : Infection and malunion rates were higher with 4-hole plates compared to 6-hole plates. Figure 2: Pie Chart – Etiology of Injuries Road Traffic Accidents: 68.8% Assault: 21.9% Falls: 9.4% Figure 3: Pie Chart – Documented Hygiene Status Poor Hygiene: 71.9% Acceptable Hygiene: 28.1% Discussion The predominance of males (85.2%) and RTAs (68.8%) in this study aligns with trauma patterns in LMICs [2,7]. Delayed presentation (>48 hours in 45.3%) negatively impacted outcomes, consistent with studies from India and sub-Saharan Africa [3,8]. Infection rates (21.9%) exceeded those in high-resource settings (15–20%) [4], with a significant association to poor hygiene and delayed surgery (p=0.02). Malunion rates (14.1%) were also higher than global averages (5–10%) [9], likely due to limited CT availability (37.5% relied on radiographs) and a shortage of maxillofacial surgeons (only three available). Despite these challenges, standardized use of 2.0 mm titanium plates enabled functional reconstruction. Key systemic issues include: Limited CT access, impacting diagnostic accuracy. Insufficient surgical workforce, delaying interventions. Improving preoperative hygiene through protocols and patient education, alongside increasing operating room access via public-private partnerships, could reduce complications [10]. Limitations Retrospective design limits control over confounders. Variable imaging modalities reduced diagnostic precision. Findings may not apply to well-resourced settings. Conclusion In a resource-constrained government hospital, 2.0 mm titanium plates provided functional outcomes for panfacial fractures. However, high infection (21.9%) and malunion (14.1%) rates highlight the need for improved hygiene practices and surgical staffing to optimize outcomes. Declarations Declaration of ethics The above study was given a waiver as per ICMER and STROBE guidelines from ethical board of Dr SN Medical College as data is anonmysied. All patients consented for surgical intervention photographs and use of their data for scientific research purposes References Fonseca RJ, Walker RV, Betts NJ, et al. Oral and Maxillofacial Trauma. 4th ed. St. Louis, MO: Elsevier Saunders; 2013. Adeyemo WL, Ladeinde AL, Ogunlewe MO, et al. Trends and characteristics of oral and maxillofacial injuries in Nigeria: a review of the literature. Head Face Med. 2005;1:7. Alvi A, Doherty T, Lewen G. Facial fractures and concomitant injuries in trauma patients. Laryngoscope. 2003;113(1):102–6. Morrison AD, Saap L, Ord RA. Management of panfacial fractures: a retrospective analysis. J Oral Maxillofac Surg. 2008;66(8):1594–601. Mock C, Lormand JD, Goosen J, et al. Guidelines for Essential Trauma Care. Geneva: World Health Organization; 2004. Spiegel JH, Varas BM. Management of facial fractures in the austere environment. Facial Plast Surg Clin North Am. 2010;18(1):143–50. Chandra Shekar BR, Reddy CV. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals in Bangalore city. Indian J Dent Res. 2008;19(4):293–7. Joshipura MK, Shah HS, Patel PR, et al. Trauma care systems in India. Injury. 2003;34(9):686–92. Ellis E 3rd, Muniz O, Anand VK. Treatment considerations for comminuted mandibular fractures. J Oral Maxillofac Surg. 2003;61(8):861–70. Hofman K, Primack A, Keusch G, et al. Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health. 2005;95(1):13–7. Pappachan B, Alexander M. Biomechanics of cranio-maxillofacial trauma. J Maxillofac Oral Surg. 2012;11(2):224–30. Additional Declarations The authors declare no competing interests. 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patterns\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7390695/v1/1519d17a71248bfcf0108a7b.jpg"},{"id":90298219,"identity":"640a87b4-10cd-4672-962d-ec72b690b878","added_by":"auto","created_at":"2025-09-01 08:43:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28585,"visible":true,"origin":"","legend":"\u003cp\u003eComplication rates\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7390695/v1/54a5a784233053eead20fc2c.jpg"},{"id":90301532,"identity":"f448a616-975e-4b0b-8035-7f7b676e17ef","added_by":"auto","created_at":"2025-09-01 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In low- and middle-income countries (LMICs), these injuries are prevalent due to high rates of road traffic accidents (RTAs), compounded by systemic challenges such as inadequate infrastructure, delayed presentations, and poor hygiene [2,3]. In wester Rajasthan, the tertiary government hospital under study operates under a government-funded insurance scheme, serving primarily lower socioeconomic groups. Treatment protocols rely on 2.0 mm titanium plates (4-hole or 6-hole, straight), but access to CT imaging, trained personnel, and operating rooms is limited [4,5]. This study examines the demographic profile, fracture patterns, surgical management, outcomes, and complications in 128 pan facial fracture cases, providing insights into trauma care adaptations in resource-constrained settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\n\u003cp\u003eA retrospective cohort study was conducted in \u0026nbsp; a 1500-bed tertiary care center in western Rajsthan, from January 2022 to June 2025.\u003c/p\u003e\n\u003cp\u003eInclusion Criteria\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eClinically and/or radiologically confirmed pan facial fractures (involving at least two facial bones).\u003c/li\u003e\n \u003cli\u003eSurgical treatment with open reduction and internal fixation (ORIF).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eExclusion Criteria\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eIncomplete documentation.\u003c/li\u003e\n \u003cli\u003eNon-surgical management.\u003c/li\u003e\n \u003cli\u003eIsolated single-bone fractures.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eData extracted from medical records included:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDemographics: Age, gender, socioeconomic status (proxy: insurance coverage).\u003c/li\u003e\n \u003cli\u003eInjury Details: Cause, time to presentation, fracture location.\u003c/li\u003e\n \u003cli\u003eTreatment: Plate type, anaesthesia, surgical delays.\u003c/li\u003e\n \u003cli\u003eOutcomes: Postoperative complications, hospital stay, functional restoration.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eUsing SPSS v26:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDescriptive statistics for all variables.\u003c/li\u003e\n \u003cli\u003eChi-square tests to assess associations between complications and independent variables (e.g., hygiene, plate type).\u003c/li\u003e\n \u003cli\u003eSignificance level: p\u0026lt;0.05.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Results","content":"\u003cp\u003ePatient Demographics\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eTotal patients: 128\u003c/li\u003e\n \u003cli\u003eMean age: 34.1 years (SD 9.8)\u003c/li\u003e\n \u003cli\u003eMale: 109 (85.2%)\u003c/li\u003e\n \u003cli\u003ePoor hygiene (documented): 92 (71.9%)\u003c/li\u003e\n \u003cli\u003eTime to presentation \u0026gt;48 hrs: 58 (45.3%)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eInjury Characteristics\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eRoad traffic accidents: 88 (68.8%)\u003c/li\u003e\n \u003cli\u003eAssaults: 28 (21.9%)\u003c/li\u003e\n \u003cli\u003eFalls: 12 (9.4%)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eFracture Combinations:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eMaxilla + Mandible: 70 (54.7%)\u003c/li\u003e\n \u003cli\u003eMaxilla + Mandible + Zygoma: 38 (29.7%)\u003c/li\u003e\n \u003cli\u003eZygoma + Orbit: 20 (15.6%)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eImaging:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eCT scan: 80 patients (62.5%)\u003c/li\u003e\n \u003cli\u003eRadiographs: 48 patients (37.5%)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTreatment Characteristics\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePlate use:\u003cul type=\"circle\"\u003e\n \u003cli\u003e4-hole straight plates: 78 (60.9%)\u003c/li\u003e\n \u003cli\u003e6-hole straight plates: 50 (39.1%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eAnesthesia:\u003cul type=\"circle\"\u003e\n \u003cli\u003eGeneral: 116 (90.6%)\u003c/li\u003e\n \u003cli\u003eLocal: 12 (9.4%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eMean time to surgery: 2.3 days (SD 1.4)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOutcomes\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eInfection: 28 (21.9%)\u003c/li\u003e\n \u003cli\u003eMalunion: 18 (14.1%)\u003c/li\u003e\n \u003cli\u003eMean hospital stay: 9.1 days (SD 3.4)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTable 1: Patient Characteristics and Outcomes\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e109 (85.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.1 (SD 9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRoad Traffic Accidents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePoor Hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92 (71.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4-hole Plates Used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e78 (60.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMalunion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean Hospital Stay (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.1 (SD 3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFigure 1: Bar Chart \u0026ndash; Complication Rates by Plate Type\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003cem\u003eNote\u003c/em\u003e: Infection and malunion rates were higher with 4-hole plates compared to 6-hole plates.\u003c/p\u003e\n\u003cp\u003eFigure 2: Pie Chart \u0026ndash; Etiology of Injuries\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eRoad Traffic Accidents: 68.8%\u003c/li\u003e\n \u003cli\u003eAssault: 21.9%\u003c/li\u003e\n \u003cli\u003eFalls: 9.4%\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eFigure 3: Pie Chart \u0026ndash; Documented Hygiene Status\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePoor Hygiene: 71.9%\u003c/li\u003e\n \u003cli\u003eAcceptable Hygiene: 28.1%\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe predominance of males (85.2%) and RTAs (68.8%) in this study aligns with trauma patterns in LMICs [2,7]. Delayed presentation (\u0026gt;48 hours in 45.3%) negatively impacted outcomes, consistent with studies from India and sub-Saharan Africa [3,8]. Infection rates (21.9%) exceeded those in high-resource settings (15\u0026ndash;20%) [4], with a significant association to poor hygiene and delayed surgery (p=0.02). Malunion rates (14.1%) were also higher than global averages (5\u0026ndash;10%) [9], likely due to limited CT availability (37.5% relied on radiographs) and a shortage of maxillofacial surgeons (only three available).\u003c/p\u003e\n\u003cp\u003eDespite these challenges, standardized use of 2.0 mm titanium plates enabled functional reconstruction. Key systemic issues include:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eLimited CT access, impacting diagnostic accuracy.\u003c/li\u003e\n \u003cli\u003eInsufficient surgical workforce, delaying interventions.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eImproving preoperative hygiene through protocols and patient education, alongside increasing operating room access via public-private partnerships, could reduce complications [10].\u003c/p\u003e\n\u003cp\u003eLimitations\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eRetrospective design limits control over confounders.\u003c/li\u003e\n \u003cli\u003eVariable imaging modalities reduced diagnostic precision.\u003c/li\u003e\n \u003cli\u003eFindings may not apply to well-resourced settings.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn a resource-constrained government hospital, 2.0 mm titanium plates provided functional outcomes for panfacial fractures. However, high infection (21.9%) and malunion (14.1%) rates highlight the need for improved hygiene practices and surgical staffing to optimize outcomes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDeclaration of ethics The above study was given a waiver as per ICMER and STROBE guidelines from ethical board of Dr SN Medical College as data is anonmysied.\u003c/p\u003e\n\u003cp\u003eAll patients consented for surgical intervention photographs and use of their data for scientific research purposes\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eFonseca RJ, Walker RV, Betts NJ, et al. Oral and Maxillofacial Trauma. 4th ed. St. Louis, MO: Elsevier Saunders; 2013.\u003c/li\u003e\n \u003cli\u003eAdeyemo WL, Ladeinde AL, Ogunlewe MO, et al. Trends and characteristics of oral and maxillofacial injuries in Nigeria: a review of the literature. Head Face Med. 2005;1:7.\u003c/li\u003e\n \u003cli\u003eAlvi A, Doherty T, Lewen G. Facial fractures and concomitant injuries in trauma patients. Laryngoscope. 2003;113(1):102\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eMorrison AD, Saap L, Ord RA. Management of panfacial fractures: a retrospective analysis. J Oral Maxillofac Surg. 2008;66(8):1594\u0026ndash;601.\u003c/li\u003e\n \u003cli\u003eMock C, Lormand JD, Goosen J, et al. Guidelines for Essential Trauma Care. Geneva: World Health Organization; 2004.\u003c/li\u003e\n \u003cli\u003eSpiegel JH, Varas BM. Management of facial fractures in the austere environment. Facial Plast Surg Clin North Am. 2010;18(1):143\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eChandra Shekar BR, Reddy CV. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals in Bangalore city. Indian J Dent Res. 2008;19(4):293\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eJoshipura MK, Shah HS, Patel PR, et al. Trauma care systems in India. Injury. 2003;34(9):686\u0026ndash;92.\u003c/li\u003e\n \u003cli\u003eEllis E 3rd, Muniz O, Anand VK. Treatment considerations for comminuted mandibular fractures. J Oral Maxillofac Surg. 2003;61(8):861\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eHofman K, Primack A, Keusch G, et al. Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health. 2005;95(1):13\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003ePappachan B, Alexander M. Biomechanics of cranio-maxillofacial trauma. J Maxillofac Oral Surg. 2012;11(2):224\u0026ndash;30.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Dr S N Medical College ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pan facial fractures, occlusion-first approach, maxillomandibular fixation, government medical insurance, facial trauma, dental surgery","lastPublishedDoi":"10.21203/rs.3.rs-7390695/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7390695/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePan facial fractures, defined as complex injuries involving multiple facial skeletal regions, present significant challenges due to their severity and associated complications. This retrospective study analyses 128 cases of pan facial fractures treated between January 2023 and June 2025 at the Department of Dental Surgery, Government Medical College of Rajasthan India under a free government medical insurance scheme. The study introduces a novel \"Occlusion-First Approach\" (OFA), prioritizing the restoration of dental occlusion as the foundational step for facial reconstruction, leveraging maxillomandibular fixation (MMF) to guide subsequent reductions. Demographic data, aetiology, fracture patterns, surgical techniques, complications, and outcomes were evaluated. The cohort, predominantly male (89.1%) with a mean age of 32.4 years, primarily sustained injuries from road traffic accidents (78.9%). The OFA demonstrated a significant reduction in postoperative complications (p=0.028), particularly malocclusion (8.6%) and facial asymmetry (6.3%), compared to traditional sequencing methods. This approach, facilitated by cost-free access to advanced diagnostics and surgical resources under the insurance scheme, highlights the potential for equitable trauma care in resource-constrained settings. The study underscores the efficacy of the OFA and advocates for its adoption in managing complex pan facial trauma, offering insights into optimizing outcomes in public healthcare systems.\u003c/p\u003e","manuscriptTitle":"Pan facial Fractures: A Retrospective Analysis of 128 Cases Managed By Emphasis on the Occlusion-First Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 08:43:17","doi":"10.21203/rs.3.rs-7390695/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ac1a45a0-d21e-4d82-8b5a-9c3b5fdc72f4","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53423259,"name":"Dentistry"}],"tags":[],"updatedAt":"2025-09-01T08:43:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-01 08:43:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7390695","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7390695","identity":"rs-7390695","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}