Pan facial Fractures: A Retrospective Analysis of 128 Cases Managed By Emphasis on the Occlusion-First Approach

Pan facial fractures, defined as complex injuries involving multiple facial skeletal regions, present significant challenges due to their severity and associated complications. This retrospective study analyses 128 cases of pan facial fractures treated between January 2023 and June 2025 at the Department of Dental Surgery, Government Medical College of Rajasthan India under a free government medical insurance scheme. The study introduces a novel "Occlusion-First Approach" (OFA), prioritizing the restoration of dental occlusion as the foundational step for facial reconstruction, leveraging maxillomandibular fixation (MMF) to guide subsequent reductions. Demographic data, aetiology, fracture patterns, surgical techniques, complications, and outcomes were evaluated. The cohort, predominantly male (89.1%) with a mean age of 32.4 years, primarily sustained injuries from road traffic accidents (78.9%). The OFA demonstrated a significant reduction in postoperative complications (p=0.028), particularly malocclusion (8.6%) and facial asymmetry (6.3%), compared to traditional sequencing methods. This approach, facilitated by cost-free access to advanced diagnostics and surgical resources under the insurance scheme, highlights the potential for equitable trauma care in resource-constrained settings. The study underscores the efficacy of the OFA and advocates for its adoption in managing complex pan facial trauma, offering insights into optimizing outcomes in public healthcare systems.