Controversias reconstructivas en trauma panfacial complejo
Palabras clave:
Traumatismos Faciales. Fracturas Maxilofaciales. Fijación Interna de Fracturas. Oclusión DentalResumen
DOI: https://doi.org/10.46296/gt.v9i17.0373
Resumen
El trauma panfacial reúne fracturas de múltiples subunidades faciales y suele carecer de referencias anatómicas confiables para la reducción. La controversia actual no radica en una dirección quirúrgica única, sino en cuál referencia ósea permite reconstruir con mayor precisión la oclusión, la anchura facial y la posición orbitaria. Se realizó una revisión crítica narrativa con búsqueda en PubMed de estudios publicados entre 2008 y abril de 2026. Se compararon secuencias de abajo hacia arriba, de arriba hacia abajo, de afuera hacia adentro, de adentro hacia afuera, oclusión primero y estrategias basadas en contrafuertes o fragmentos mayores. La evidencia es heterogénea y predominantemente retrospectiva. La secuencia de abajo hacia arriba y de afuera hacia adentro es la más reportada, pero el único estudio comparativo prospectivo no mostró superioridad clínica clara. La planeación digital y la navegación son más útiles cuando la oclusión es poco confiable o existe conminución orbitaria.
Palabras claves: Traumatismos Faciales. Fracturas Maxilofaciales. Fijación Interna de Fracturas. Oclusión Dental.
Abstract
Panfacial trauma involves fractures of multiple facial subunits and often lacks reliable anatomic landmarks for reduction. The current controversy is not whether one surgical direction is universally superior, but which bony reference allows more accurate restoration of occlusion, facial width, and orbital position. A critical narrative review was performed using a PubMed search for studies published from 2008 to April 2026. Bottom-up, top-down, outside-in, inside-out, occlusion-first, and individualized buttress- or major-fragment-based strategies were compared. The available evidence is heterogeneous and predominantly retrospective. Bottom-up and outside-in remains the most frequently reported sequence, but the only prospective comparative study did not demonstrate clear clinical superiority over a top-down alternative. Digital planning and navigation appear most useful when occlusion is unreliable or when marked orbital comminution is present.
Keywords: Facial Injuries. Maxillofacial Injuries. Fracture Fixation, Internal. Dental Occlusion.
Información del manuscrito:
Fecha de recepción: 09 de febrero de 2026.
Fecha de aceptación: 20 de abril de 2026.
Fecha de publicación: 28 de mayo de 2026.
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Derechos de autor 2026 Revista Científica Arbitrada en Investigaciones de la Salud GESTAR. ISSN: 2737-6273.
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