In patients with comminution of the palatal segments, an open reduction is generally not the procedure of choice. Exposure of these fractures often reveals small fragments that are difficult or impossible to fix adequately. Therefore observation or closed reduction is usually the preferred modality of treatment for complex (comminuted) palatal fractures.
It is common for these patients to present with palatal splaying and significant malocclusion.
|Rarely indicated in complex injuries.|
It is unlikely that a complex palatal fracture presents without displacement, and with stability and normal occlusion. There is a significant risk of fistula formation. For this reason observation alone is unlikely to be a good choice.
|Severely comminuted fractures difficult to fix adequately with plates and screws without compromising the blood supply to the comminuted segments.|
|Open reduction internal fixation|
|When MMF alone is unable to prevent splaying of the segments and a palatal splint is not readily available.|
- Large fragment accessible, reducible and possible to fix without disturbing the blood supply.
Treatment of complex maxillary fractures via open reduction internal fixation (ORIF) is controversial. The surgeon should try to maintain the blood supply to the comminuted fragments to ensure good healing.
|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|