|Unilateral fractures in patients with minor malocclusion correctable with maxillary disimpaction in compliant patients amenable to MMF.|
Fractures with minor malocclusion readily correctable with maxillary manipulation, and not grossly mobile after repositioning may be treated closed. However, closed reduction is more commonly used in conjunction with other stabilization techniques (skeletal suspension, external fixators, etc.).
- Premorbid or unstable medical condition preventing general anesthetic
- Conditions making open reduction and internal fixation difficult
- Patient refusal of operative treatment (eg, for religious/cultural or financial reasons)
- Unavailability of plates and screws
Special consideration: MMF may be contraindicated in patients with psychiatric disorders, seizure disorders, and alcoholics.
|Open reduction internal fixation|
|Unilateral comminuted fractures where vertical restoration of the buttress is required.|
Open reduction internal fixation is usually the method of choice for mobile Le Fort I fractures with unilateral comminution and malocclusion. Bone contact on the noncomminuted side allows the reestablishment of appropriate facial height and maxillary position.
If there are large pieces in the comminuted area that can be attached to the plate, these are left in place and fixed to the plate by screws.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|