A Case Study of Pan-Facial Trauma with Subsequent Chronic Hyponatremia

Pan-facial trauma represents a complex pattern of injuries requiring meticulous surgical planning and comprehensive post-operative care. We present a case of a 51-year-old male smoker who sustained severe pan-facial trauma. Initial evaluation revealed multiple facial fractures, including the zygomatic maxillary complex, coronoid, condylar, and symphysis regions. Computed tomography demonstrated additional linear undisplaced fractures of the left temporal and parietal bones, with associated hemorrhagic contusion in the right temporal region. The patient exhibited circumorbital edema, ecchymosis, and multiple lacerations over the scalp and face. Laboratory investigations revealed anemia with hemoglobin of 8.7 g/dL. Following initial stabilization, the patient underwent open reduction and internal fixation under general anesthesia. During the post-operative period, the patient developed significant hyponatremia with serum sodium levels dropping to 117 mEq/L, manifesting as altered sensorium and drowsiness. The electrolyte imbalance was managed using a combination therapy of normal saline infusion (500mL at 20mL/hr), 3% hypertonic saline (10mL/hr), and oral tolvaptan (15mg twice daily). This intervention successfully normalized serum sodium levels to 135 mEq/L within three days. This case highlights the importance of vigilant post-operative monitoring in pan-facial trauma patients, particularly for electrolyte disturbances, and demonstrates the effectiveness of prompt, targeted intervention in managing complications. The successful outcome emphasizes the value of a multidisciplinary approach in treating complex maxillofacial injuries