Case 6: Crush Injury Face

Dear Readers I hope this is not too gruesome & blood-soaked for you because I had not seen a real eyeball popping out of its socket in somebody alive. I can still easily recall what happened that day…There was a call from casualty that a Facial trauma patient needs urgent attention and also that it was so bad that one of the casualty nurse had fainted on seeing this patient. On first sight it seemed like a miracle that this man had survived such a grievous injury. I had read and seen images of survivors of severe Faciomaxillary injuries in trauma textbooks, but actually treating one is a different game altogether. This chap was driving a tractor to his field when the tractor toppled and his face got crushed beneath it…pheww!!

I followed the basic ATLS principles (ABCDE) starting with the airway and Tracheostomy was done along with primary intraoral suturing to control bleeding. Patient had already lost lots of blood so two packed cells were transfused while suturing was done. He was then shifted to radiology for CT scan of face so that definite treatment could be planned.CT scan of the face and Head showed Panfacial Fracture that is practically every bone in the face was fractured. 

Patient was shifted to Surgical ICU for stabilising the vitals and preparing for  definitive repair of Facial Injuries. Assisted Ventilation was done through Tracheostomy tube. Open Reduction & Internal Fixation for Panfacial Fractures using AO principles of Osteosynthesis was planned. A bottom to top sequence was followed for repair of Mandible followed by Zygomatic Complexes and lastly the Maxilla. It was just like a Jigsaw puzzle with so many bony pieces to assemble. Subsequent to ORIF, the overlying soft tissue was repaired in a layerwise fashion after abundant irrigation & debridement. 

After completion of a long 8 hours surgery, he was again shifted back to Surgical ICU for monitoring and assisted ventilation. Next day he was weaned off from ventilator and was closely watched for any signs of SIRS. Once he was able to regain consciousness, appropriate psychologic counselling was administered to help him cope with Loss of vision in one eye. He was a very healthy young individual before the unfortunate accident and this helped in postoperative recovery. There were no major systemic or local issues and almost all of the facial wounds healed nicely. I remember him as a very resolute and witty person with immense zest for life…  

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