(55) Utilizing Autogenous Grafts in Surgical Treatment of Panfacial Trauma: Coronoid Process Harvesting for Nasal Reconstruction

Abstract: Panfacial trauma simultaneously involves fractures of the upper, middle, and lower thirds of the face. The most common fractures are of the frontal bone, maxilla, zygomatic complex, nasoethmoid-orbital (NEO) region, and mandible. Nasal reconstructions are a challenging procedure as external deformities and breathing abnormalities can occur after surgery, especially in the presence of comminuted fractures. Bone grafts can be used to reconstruct the nasal dorsum. Autogenous bone grafting has several advantages over other augmentation techniques including short healing times, favorable bone quality, and predictability in the repair of larger defects. Commonly used bone grafts are split calvarium, iliac crest, and rib. The coronoid process of the mandible can also be used as a donor site as it provides adequate bone quality, utilizes an intraoral harvesting approach, and is associated with fewer morbidities. A descriptive retrospective study was designed utilizing Epic records of a single surgical residency program at the University of Mississippi Medical Center in Jackson. The cases analyzed occurred between November 2023 and March 2024. The following inclusion criteria included: patients with panfacial trauma; the presence of nasal fractures, nasal septal fractures, and/or NOE fractures; and patients who received a coronoidectomy for nasal reconstruction. Three patients met the inclusion criteria. Cone-beam computer tomography (CBCT) and hospital-grade CTs of patients with panfacial fractures were taken preoperatively. Facial fractures were exposed using bicoronal flap and bilateral subciliary incisions. Intraoral bilateral sagittal split osteotomy incision was made for harvest of coronoid process. Coronoidectomy was completed with sagittal saw, osteotomies, and Bovie electrocautery. Panfacial fractures were reduced and fixated from top to bottom. Coronoid process graft was trimmed into a rectangular shape and used to reconstruct the nasal dorsum through pocket created with bicoronal approach. The coronoid process graft was plated with a straight plate and placed in a cantilever fashion, anchored on the frontal bone, and secured with 1.7 mm screws. In both cases, the nasal septum was manually reduced and Doyle splints were placed in bilateral nares and secured with silk sutures. Thermoplastic splint was placed over the dorsum and secured with tape. CBCT and hospital-grade CT imaging were taken postoperatively. The procedures were considered a success when the patient’s deformities were reconstructed. There were no infections at donor sites. The nasal reconstruction restored normal function and symmetry. Using the coronoid process of the mandible as a source for autogenous bone graft can provide sufficient bone in quantity and quality for nasal reconstruction in panfacial trauma. References Ali K, Lettieri SC. Management of Panfacial Fracture. Semin Plast Surg. 2017;31(2):108-117. doi:10.1055/s-0037-1601579 Amrani S, Anastassov GE, Montazem AH. Mandibular ramus/coronoid process grafts in maxillofacial reconstructive surgery. J Oral Maxillofac Surg. 2010;68(3):641-646. doi:10.1016/j.joms.2009.09.100

Figure 1. Pre-operative CT of panfacial trauma.
Figure 2. Post-operative CT of facial reconstruction with harvested coronoid process of mandible.
Figure 3. Post-operative CT of facial reconstruction.