A Shift in Conceptual Thinking of Panfacial Fracture Sequencing: The Major Fragment Theory

Study Design: A literature review of relevant publications regarding panfacial fracture sequencing. Objective: To review the current landscape of sequencing of panfacial trauma and propose the utilization of the Major Fragment Theory when conventional sequencing techniques are inadequate. Methods: We conducted a review of existing literature on panfacial fracture management, focusing on sequencing techniques. Additionally, we analyzed unique fracture patterns to identify instances where conventional sequencing may be insufficient. Results: Existing literature emphasizes directional-based sequencing techniques for panfacial fracture reduction. However, unique fracture patterns often necessitate deviation from these sequences. The Major Fragment Theory suggests prioritizing the reduction of larger fragments over conventional sequencing, particularly when dealing with complex fractures. Conclusions: While directional-based sequencing techniques provide a valuable framework for panfacial fracture management and almost any approach can be utilized successfully, the Major Fragment Theory offers a complementary approach for cases where conventional sequencing falls short. Incorporating this theory into practice may enhance outcomes in the treatment of panfacial fractures.