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

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

Midface - Palatoalveolar, complex injury

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Glossary

General considerations

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.

Observation
Main indication Skill Equipment
Rarely indicated in complex injuries. Basic surgical experience, no specialized skills Basic equipment only

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.

Closed treatment
Main indication Skill Equipment
Severely comminuted fractures difficult to fix adequately with plates and screws without compromising the blood supply to the comminuted segments. Basic surgical experience, no specialized skills Basic equipment only
Open reduction internal fixation
Main indication Skill Equipment
When MMF alone is unable to prevent splaying of the segments and a palatal splint is not readily available. Some specialized surgical experience Simple surgical and imaging resources

Further indication

  • 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.

*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