Avascular Necrosis of Maxilla following Midface Trauma - A Case Report

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.