Avascular Necrosis of Maxilla following Midface Trauma - A Case Report
Soniya Sawant Dessai, Archana Sen, Vikas Dhupar, Francis Akkara, S. SakthivelAbstract
The Rationale:
Avascular necrosis (AVN) of the maxilla following facial trauma is an exceptionally rare clinical condition. The risk increases with comminuted fractures, extensive soft-tissue injury, periosteal stripping or surgical disruption of the vascular pedicles.
Patient Concerns:
A 50-year-old male with a comminuted Le Fort I fracture managed with open reduction and internal fixation and primary closure presented 2 weeks postoperatively with progressive loosening of the anterior maxillary segment and features suggestive of ischaemia.
Diagnosis:
Clinical examination revealed discolouration and significant mobility of the left anterior maxillary segment, without evidence of infection, consistent with maxillary AVN.
Treatment:
The necrotic segment was resected under local anaesthesia with provisional obturator rehabilitation.
Outcomes:
Recovery was uneventful, with stabilisation of symptoms and satisfactory interim function.
Take-away Lessons:
This case highlights the importance of maintaining vascular integrity during maxillofacial trauma surgery and the need for early intervention to prevent larger functional and aesthetic defects.