Panfacial trauma: management of a traumatic hemifacial avulsion and degloving injury with multiple maxillofacial fractures

Background: Cases of avulsion and degloving injuries of solitary areas of the face have been reported in the literature. However, complex traumatic degloving hemifacial injury with compound panfacial fractures is very rare. Rehabilitation of extensive degloving facial injuries poses a great challenge for surgeons. Surgery becomes more challenging if these types of soft tissue injuries are associated with multiple bony fractures of the maxillofacial skeleton. Such traumatic injuries require prompt careful treatment; inadequate treatment may lead to loss of normal anatomical framework and a deformed unaesthetic appearance, with adverse physical and psychological effects. It requires adequate fixation of hard tissues, meticulous anatomic repositioning of soft tissues and proper care post-operatively to achieve excellent esthetics as well as functional results.Case presentation: Here, we present a case of a 24-year-old male patient presenting with avulsive degloving injuries of the face and pan-facial fractures. Debridement of wounds, fixation of maxillofacial fractures, primary reconstruction and repair of the soft tissues were performed in a single stage. Arch bars were placed in the maxilla and mandible. The maxillofacial fractures were anatomically reduced and fixed with titanium miniplate and screws. The degloved flaps were anatomically repositioned and multiple-layered suturing was performed. At the six-month follow-up, minimal-to-no functional or esthetic deficit was present.Discussion: Facial degloving injuries combined with panfacial fractures present a significant reconstructive challenge. A carefully planned, staged treatment approach is essential for achieving optimal functional recovery and aesthetic outcomes. Maintaining tissue viability and ensuring meticulous postoperative care are crucial in preventing complications.