Multiple maxillofacial fractures in a patient undergoing orthodontic treatment: a case report

Severe maxillofacial injuries among patients receiving orthodontic treatment are very rare. When they occur, they can be life threatening with several complications which include neurologic deficits, malunion of fracture segments secondary to delay in reduction and immobilization of fracture segments and massive blood loss. Delay in treatment of such maxillofacial injuries in the presence of other life threatening injuries predisposes the patient to residual and minor malocclusion. The interdisciplinary management of injuries sustained by an orthodontic patient and the challenges associated with its management are highlighted in this report. Reduction and immobilization was carried out under general anaesthesia using an arch bar in the mandibular arch. Direct bonded brackets in the maxillary arch with additional eyelet wires were used in the management of the fractures. An acceptable reduction of bilateral parasympseal fractures was obtained with available intermaxillary fixation. There was some residual and minor malocclusion attributed to the delay in treatment and possibly the method used. A multi-disciplinary team approach for the management of maxillofacial fractures in patients undergoing orthodontic treatment with fixed appliances is suggested. Orthodontic treatment with surgical involvement has been found to improve both facial aesthetics and occlusal function. Key words : Maxillofacial, trauma, reduction, immobilization, orthodontic