Status and Management of Nerves in Strategic Locations of Facial Fractures

Aims: 1. Pre-operative evaluation, recognition, avoidance and management of nerve injuries pre-operatively and intra-operatively 2. Effective steps taken to reduce the injury and to release the entrapment if any. Materials and methods: A total of 192 cases have been studied for 10 months period from February 2018 till November 2018.172 patients were male and 20 patients were female. All these cases were been evaluated for head injuries associated injuries and nerve injuries pre-operatively if any and intra-operative corroboration and avoidance of nerve injuries. Patient underwent Open Reduction Internal Fixation (intra oral approach-104, Extra oral approach-88) Following nerves were taken into account In cases of fracture Mandible 1. Marginal mandibular nerve 2. Inferior alveolar nerve 3. Cervical branch of facial nerve 4. Infra orbital nerve and frontal branch of facial nerve in cases of fracture zygoma and maxilla. There is no conflict of interest. Consent was obtained from all patients. Result: A total of 192 patients with cranio-maxillofacial trauma referred to our center from February 2018 till November 2018 with mean age of 36.5610.65 (ranging from 18 to 60). Among the patients 172 (89.6 %) were men and 20 (10.4 %) women. Motor vehicle accidents were the most common mechanism of injury for maxillofacial fractures followed by assault trauma, fall and sport trauma. The demographic and clinical characteristics of the patients are summarized in Table 1. Frequency of nerve injuries was 5.7 % (11patients). Regarding facial nerve the most common involved branch was frontal branch reported in 5 (1 %) patients. Regarding trigeminal nerve the inferior alveolar branch was the most common involved branch reported in 4 patients ( %) followed by infraorbital branch in 3 (27.2 %). The most prevalent fracture occurred in mandible followed by zygomatic bone. The majority of patients with nerve injury were 18-55 years old (Table 3). Open reduction intra-oral approach was performed in 104 (54.17 %) patients and extra-oral approach in 88 patients (22.4 %). Conclusion: 1. Pre-operative and postoperative evaluations of facial and trigeminal nerves are very important especially in the region of face in the era of evidence based medicine and consumer era.2. The avoidance of iatrogenic injuries and management of injuries of these nerves if detected early are important as a part of surgery is stressed in this paper.