Executive Editor: Edward Ellis III, Kazuo Shimozato General Editor: Daniel Buchbinder

Authors: Carl-Peter Cornelius, Nils Gellrich, Søren Hillerup, Kenji Kusumoto, Warren Schubert

Midface - Le Fort I, unilateral comminution

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Glossary

Closed treatment
Main indication Skill Equipment
Unilateral fractures in patients with minor malocclusion correctable with maxillary disimpaction in compliant patients amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only

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.).

Further indications 

  • 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
Main indication Skill Equipment
Unilateral comminuted fractures where vertical restoration of the buttress is required. Some specialized surgical experience Simple surgical and imaging resources

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.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2009-12-03