This patient suffered traumatic brain injury with multiple facial and skull base fractures. The term "panfacial" fracture applies where there are fractures of each third of the face. Correlating with the injuries depicted by CT and CTA, the patient did have clinical evidence of CSF rhinorrhea from the left nares, left vision loss, and left oculomotor palsy, in addition to the expected facial deformities and dental malocclusion. Extensive operative interventions were undertaken.

Regarding the classification of the facial fractures, one variation merits mention. The midfacial/pterygofacial fractures may be classified as bilateral Le Fort I, bilateral Le Fort II, and left Le Fort III fractures. However, some argue that the pterygoid plates cannot be fractured three separate times and from the standpoint of surgical management, it would also be valid to describe these as bilateral Le Fort I, bilateral NOE (naso-orbito-ethmoid), and left ZMC (zygomaticomaxillary complex) fractures ¹.