![]() Options include one or two straight plates, or various configurations of Y- or X-plates.Ĭlick here for a description of implant options.Recently, facial bone fracture is characterized by multiple injuries, and its surgery could be delayed due to the associated morbidity and mortality. A variety of different plates may be used at the nasofrontal area. Generally, a smaller straight plate is adequate at the zygomaticofrontal area. Furthermore, compression plating at this location is not necessary. The soft-tissue coverage over this area is very thin, and patients are likely to complain if the plate is palpable. Older texts often recommended using a larger compression plate at the zygomaticofrontal suture. This has a further impact in deciding whether a larger or smaller plate is adequate. Finally, in many cases of Le Fort III fractures with other panfacial trauma, many surgeons may choose to leave the patient in MMF for a period of time postoperatively. ![]() This has further impact on deciding the size and strength of the plate to be used. Furthermore, the majority of Le Fort III fractures are also associated with a plethora of other midface fractures. There is considerable variability as to how unstable or comminuted the fractures may be. It is difficult to give absolute guidelines as to the strength of the plates to be used at the three key points of fixation for a Le Fort III fracture. If available, dental cast, stereolithographic models, and/or premorbid photographs may be useful guides for treatment.Īs a general principle, all fractures should be exposed and reduced before plating. The goal is to achieve an anatomical correct repositioning by means of 3-D reconstruction. In order to properly achieve a passive position of the maxilla, the maxilla requires strong mobilization forces using various instrumentation: Rowe’s disimpaction forceps, “Stromeyer” hook, Tessier retromaxillary mobilizers, etc. When the MMF is removed, the condyles re-seat themselves into their normal position, bringing the mandibular dentition forward, creating a Class III malocclusion. The reason for this is that when patients are placed into MMF during the surgery, the soft-tissue tension from the attached musculature distalizes the mandibular condyles in the glenoid fossae. Without passive mobilization, Class III tendency occurs often in the postoperative period. Portions of the pterygoid plates and associated musculature are still attached to the posterior portion of the maxilla, so passive mobilization of the fracture can be difficult. These pillars can serve an even more important role in patients who lack dentition (partial or completely edentulous patients).Ī principle in all Le Fort fractures is to reestablish the premorbid dental occlusion. The aim of successful reconstruction of midface fractures is reestablishing the midfacial buttresses. Depending on the patient’s general condition, a tracheostomy might also be considered. If that is not feasible, primary submental/submandibular intubation should be considered. These fractures are also referred to as craniofacial dysjunction.Ĭonsiderations related to dental occlusion render nasotracheal intubation necessary. A Le Fort III fracture includes fracture of the nasofrontal junction, bilateral fractures through the area of the frontozygomatic suture, and probable fractures of the zygomatic arch.
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