Surgical Treatment of Complex Facial Fracture with Stabilization of Alveolar Segments by Cerclage and Rigid Internal Fixation: A Case Report

Abstract

Complex facial fractures represent a diagnostic and therapeutic challenge due to the simultaneous involvement of different bony segments and the need to restore facial function and stability. The aim of this study is to report a clinical case of complex facial fractures, emphasizing the diagnostic aspects and therapeutic management. A 39-year-old female patient, victim of a motorcycle accident, presented to the emergency department of a trauma hospital with facial trauma. On oral and maxillofacial physical examination, impaired bony contours were observed in the middle and lower thirds of the face, associated with significant edema, atypical mobility on maxillary and mandibular manipulation, limited mouth opening, and dystopic occlusion. Computed tomography of the face revealed fractures of the alveolar processes of the anterior maxilla and mandible, bilateral fractures of the zygomaticomaxillary-orbital complex (ZMOC), bilateral parasymphyseal mandibular fractures, and a parasagittal fracture of the maxilla. The initial surgical treatment consisted of reduction and fixation of the maxillomandibular fractures using maxillomandibular fixation, auxiliary cerclage, and multiple osteosynthesis plates. On the tenth postoperative day, the patient developed wound dehiscence in the anterior mandibular vestibular sulcus on the left side, associated with signs of infection related to the fixation hardware, and underwent a second surgical procedure for removal of the alveolar segment. In the present case, the combination of different fixation systems reflected the need to adapt the osteosynthesis to the biomechanical characteristics of fractures. Furthermore, the occurrence of wound dehiscence and infection associated with the fixation hardware demonstrates that achieving stability during surgery does not completely eliminate the risk of complications. Thus, this case highlights the complexity of the treatment of maxillomandibular fractures and the need for rigorous postoperative follow-up, with adaptation of the therapeutic approach in the presence of potential complications.