35. MAXILLARY FRACTURES. TREATMENT.

what are the aims of treatment in maxillary fractures?

restore anatomical form, function, aesthetics and symmetry

prevent any complications such as brain injuries, upper airway occlusion and massive blood loss

what is the aims of treating a maxillary fracture?

1. Reposition the fragments

Put the maxilla back where it belongs.

2. Restore occlusion

The teeth must meet correctly.

3. Immobilize the fracture

Prevent movement while healing occurs.

4. Maintain airway and control associated injuries

Especially:

Traumatic brain injury

Airway obstruction

Blood loss

how do you treat an alveolar ridge fracture?

Step 1: Reposition

reduce the fragment back into its normal anatomical position.

Step 2: Immobilize

Use:

Arch bars

Splints

Wiring

to stabilize the teeth and attached alveolar segment.

splinting

wiring

arch bars

how do you treat a sagittal (ombredan) fracture

Closed reduction

Manually reduce the fragment.

Immobilization

Can be performed with:

Occlusal plate (acrylic splint over teeth)

Submental bandage (a sling for the lower jaw)

Antibiotics:

Frequently required because of communication with:

Nasal cavity

Oral cavity

Maxillary sinus

what are the methods of treatment for total maxillary fractures?

1. orthopaedic methods

2. orthopaedic surgical methods

3. surgical methods

what are the orthopaedic methods for treatment?

not commonly used use of special external fixation devices to:

- reduce fracture fragments into correct anatomical position + restore occlusion

- fixate fragments by anchoring device to stable cranial structures

what are the components of the external fixation device?

1. Reducing Part

Repositions fracture fragments.

Restores normal occlusion.

Often uses a mandibular arch bar.

2. Fixation Part

Anchors the reduced maxilla to the cranium.

Consists of:

Cranial fixation elements → attached to skull.

Maxillary fixation elements → attached to maxilla.

Connecting rods and wires → connect cranial and maxillary components.

what are the orthopaedic surgical methods?

1. Adam's approach

2. Klisarov's approach

what is Adam's approach?

general anaesthesia

skin incision

- from the distal part of the eyebrow for access to the supraorbital rim

- drill a hole

- above the zygomaticofrontal suture

place 0.5mm ligature wire through the hole,

- guide it under the zygomatic arch until it reaches the buccal sulcus of the first molar

- both wires on each side tied to same maxillary splint (a modified version as author recognised potential damage to first molar)

what are the fixation points for the le fort fractures?

Le Fort 1:

Zygomaticoalveolar crest

(because this area remains stable.)

Le Fort II:

Infraorbital rim

because it is above the fracture.

Le Fort III:

Supraorbital rim

because almost the entire midface is detached and only structures above the orbit remain stable.

what is the Klisarov approach?

modified approach of Adam

guide the wire around the zygomatic arch and underneath the skin of the forehead

do this on the other side

fasten both wires to the splnt + IMF

what are the main principles of surgical methods?

Open Reduction:

Open the fracture site

↓

Directly visualize fragments

↓

Reposition anatomically

Osteosynthesis:

Fixing bone fragments together.

what are the 3 types of osteosynthesis that can be performed?

A- wire osteosynthesis

= drill holes ~1cm from fracture

= steel wire passed through and tied in x/z/n shape

B- Plate osteosynthesis

= Ti plates + screws

C- Miniplate Osteosynthesis

= miniplate screws to fixate

what are the indications and advantages of Ti plates + screws?

indications:

Fragments are significantly displaced

Fracture passes through pathological bone

Strong stabilization is needed

advantages:

Rigid fixation

Better healing

Better stability

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