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All Reductions & Fixations

Le Fort I, linear fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally mobile Le Fort I fractures with unaffected occlusion in compliant patients with good dentition.
Closed treatment	Non- or minimally displaced fractures in a compliant patient amenable to MMF.
Open reduction internal fixation	Mobile maxillae with resulting malocclusion in cases where vertical restoration of one or more of the buttresses are indicated.

Le Fort I, unilateral comminution Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Closed treatment	Unilateral fractures in patients with minor malocclusion correctable with maxillary disimpaction in compliant patients amenable to MMF.
Open reduction internal fixation	Unilateral comminuted fractures where vertical restoration of the buttress is required.

Le Fort I, bilateral comminution Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Open reduction internal fixation	Bilateral comminuted fractures where vertical restoration of the buttress is required.

Le Fort I, edentulous patients Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Standard treatment of edentulous patients with atrophic maxilla.
Open reduction internal fixation	Malposition of the fractured maxilla resulting in inadequate support to wear prosthesis.

Le Fort II Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally mobile Le Fort II fractures with unaffected occlusion in compliant patients with good dentition.
Closed treatment	Non- or minimally displaced fractures in a compliant patient amenable to MMF.
Open reduction internal fixation	Displaced Le Fort II fractures resulting in malocclusion or facial deformity.

Le Fort III Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally mobile Le Fort III fractures with unaffected occlusion in compliant patients with good dentition.
Closed treatment	Non- or minimally displaced fractures in a compliant patient amenable to MMF.
Open reduction internal fixation	Displaced Le Fort III fractures resulting in malocclusion or facial deformity.

Palatoalveolar fracture, simple injury Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally displaced fractures in a compliant patient with good occlusion.
Closed treatment	Non- or minimally displaced fractures in a compliant patient amenable to MMF.
Open reduction internal fixation	When MMF alone is unable to prevent splaying of the segments and a palatal splint is not available.

Palatoalveolar fracture, complex injury Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Rarely indicated in complex injuries.
Closed treatment	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.

Nasal bone Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non-displaced fractures without nasal deformities or airway obstruction.
Closed reduction	Displaced, unilateral or bilateral, nasal bone fractures.
Open reduction	Unstable or dislocated nasal bone fractures.
Septorhinoplasty	Persistent septal deformity leading to external nasal deformity and/or airway obstruction.
Nasal septal hematoma drainage	Emergent procedure to evacuate septal hematoma preventing necrosis of the cartilage.

NOE Type I Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally displaced fractures without telecanthus.
Open reduction internal fixation	Clinically significant displacement of the fracture results in telecanthus or malposition of the medial canthal ligament.

NOE, Type II Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Open reduction internal fixation	Clinically significant displacement of the fracture results in telecanthus or malposition of the medial canthal ligament.

NOE, Type III Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Open reduction internal fixation	Clinically significant displacement of the fracture resulting in telecanthus or malposition of the medial canthal ligament.

Orbit, orbital floor fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally displaced fractures without orbital deformity and intact ocular motility.
Open reduction with or without internal fixation	Indicated for the rare cases where the reduced fracture segment is stable.
Orbital reconstruction	Standard method of treatment for the repair of critical sized orbital wall defects.
Orbital reconstruction, CAS: Intraoperative imaging	Ideal method for control of treatment for the repair of critical sized orbital fractures, when intraoperative imaging is available.
Orbital reconstruction, CAS: Virtual planning and intraoperative navigation	Ideal method for control of treatment for the repair of critical sized orbital fractures, when intraoperative navigation equipment is available.

Orbit, medial orbital wall fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally displaced fractures without orbital deformity and intact ocular motility.
Orbital reconstruction	Standard method of treatment for the repair of critical sized orbital wall defects.

Orbit, combined fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally displaced fractures without orbital deformity and intact ocular motility.
Orbital reconstruction	Standard method of treatment for the repair of critical sized orbital wall defects.

Orbit, orbital roof fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Observation	Non- or minimally displaced fractures without orbital deformity and intact ocular motility.
Open treatment	Critical sized fractures affecting ocular motility or resulting in orbital deformity.

Zygoma, isolated zygomatic arch Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Closed treatment	Displaced fracture amenable for minimally invasive reduction techniques.
Open reduction without fixation	Displaced fractures resulting in impingement of the coronoid process and/or facial deformities.
Open reduction with fixation	Displaced unstable fractures resulting in impingement of the coronoid process and/or facial deformities requiring reduction and fixation.
CAS: Intraoperative imaging in closed treatment	Whenever post reduction control imaging is available.

Zygoma, zygomatic complex fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Closed treatment	Displaced fracture amenable for minimally invasive reduction techniques such as bone hook or a Carroll-Girard type screw.
ORIF, 1-point fixation (without orbital reconstruction)	Displaced simple noncomminuted fracture with minimal separation of zygomaticofrontal suture.
ORIF, 2-point fixation (without orbital reconstruction)	Displaced fracture requiring 2-point exposure to verify reduction.
ORIF, 3-point fixation (without orbital reconstruction)	Displaced and/or comminuted fracture requiring 3-point exposure to verify reduction.
ORIF, 3-point fixation (with orbital reconstruction)	Displaced and/or comminuted fracture requiring 3-point exposure to verify reduction and need for orbital reconstruction.
ORIF, 4-point fixation (with orbital reconstruction)	Complex zygomatic fractures where exposure of the zygomatic arch (4th point) is necessary to ensure proper reduction of the zygomatic complex.
CAS: Intraoperative imaging (ORIF without orbital reconstruction)	Any zygomatic fracture benefits from intraoperative CT scanning to confirm fracture reduction.
CAS: Virtual planning and intraoperative imaging (ORIF without orbital reconstruction)	Zygomatic fractures that have a significant amount of displacement, with or without internal orbital disruption, benefit from virtual planning.
CAS: Virtual planning and intraoperative imaging (ORIF with orbital reconstruction)	Zygomatic fractures that have a significant amount of displacement, with internal orbital disruption benefit from virtual planning.
CAS: Virtual planning and intraoperative navigation (ORIF with orbital reconstruction)	Zygomatic fractures that have a significant amount of displacement, with internal orbital disruption, benefit from virtual planning and intraoperative navigation.

Special considerations
Airway considerations Panfacial fractures (sequencing of repair)
Computer assisted surgery - Zygomatic arch Intraoperative imaging (closed reduction)
Computer assisted surgery - Zygomatic complex Intraoperative imaging Virtual planning and intraoperative imaging
Computer assisted surgery - Orbit Intraoperative imaging Virtual planning and intraoperative navigation
Computer assisted surgery - Zygomatic complex and orbit Virtual planning and intraoperative imaging Virtual planning and intraoperative navigation
Computer assisted surgery - Gunshot Virtual planning and intraoperative navigation

*Skill
	Basic surgical experience, no specialized skills
	Some specialized surgical experience
	Highly experienced and skilled surgeon

*Equipment
	Basic equipment only
	Simple surgical and imaging resources
	Full specialized surgical and imaging resources

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v1.0 2009-12-03