Panfacial fracture repair is especially difficult when blunt cerebrovascular injury (BCVI) requires antithrombotic therapy and a preexisting malocclusion obscures the intended occlusal endpoint. A 24-year-old woman sustained unstable panfacial fractures in a motor vehicle collision. Computed tomography showed mandibular, Le Fort, zygomaticomaxillary-orbital, and nasal fractures, and diagnostic catheter angiography showed a right internal carotid artery pseudoaneurysm/dissection, corresponding to a Grade III blunt cerebrovascular injury. Preinjury records documented skeletal Class III malocclusion and transverse maxillary deficiency with a planned approximately 5-mm maxillary advancement. Carotid stenting and three staged facial procedures were coordinated within the first two weeks after injury. Preinjury records guided mandibular width correction, maxillary advancement, buttress and orbital repair, and bilateral subcondylar management while aspirin, clopidogrel, and enoxaparin were maintained without interruption. No transfusion, postoperative hemorrhage, neurological event, or wound complication was documented during the available perioperative follow-up, and final imaging showed stable fixation. A preinjury orthognathic plan can provide a patient-specific occlusal target when vascular risk favours staged reconstruction.
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