Management of Zygomatic Arch Fracture in Polycythemia Vera Patient-A Case Report

Abstract

Polycythemia vera (PV) is a myeloproliferative neoplastic condition characterized by an unregulated synthesis of red blood cells (RBCs). There is often simultaneous stimulation of the megakaryocytic and myeloid lineages; this causes an increase in the synthesis of white blood cells and platelets2. As a result, there is an increased risk of thrombosis and bleeding. Due to the extensive vascular network of the face and jaw7 and limited surgical access to perform hemostasis, traumatic injuries and surgical procedures are among the most common causes of increased blood loss. Zygomatic bone fracture is one of the most frequent fractures of the facial skeleton. The zygomatic bone is a strong bone that supports the maxilla and the skull base. However, its prominence makes it highly susceptible, mainly when impact occurs on both sides of the face4. Facial bone fractures are associated with 1–11% excess blood loss. These complications have the potential to increase perioperative morbidity and mortality significantly. Adequate precautions must be taken in treating these patients for successful outcomes. The management of patients with PV includes therapeutic preoperative phlebotomy, increased fluid intake, and antiplatelet therapy. This report demonstrates the management of a complex procedure such as maxillofacial trauma in a PV patient with a normal coagulation profile.