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 - ORIF

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1 Approach top

Principles enlarge

For this procedure, standard approaches to the maxilla are used. However, if present, lacerations can be used to directly access fracture site for fracture managment.

2 Reduction top


Apply MMF

Arch bars are applied and occlusion is checked. The occlusion is then secured by mandibulomaxillary fixation (MMF). Click here for a detailed description of the MMF technique.


Pearl: securing the reduction

It may be beneficial to use forceps to maintain the reduction while securing the MMF.

3 Fixation top


This technique in the management of a complex (comminuted) palatal fracture is commonly referred to as a closed technique. It is common to perform ORIF with the placement of a longer plate or individual smaller plates to span the alveolar fractures that are in continuity with the palatal fractures. We refer to this as a closed technique because an open reduction of the palate has not been performed, even though ORIF may be applied to the anterior alveolar ridge.

More information on CMF implants can be found here.

Note: In placing the second plate on the anterior alveolar fracture, consider the position of additional plates to be placed for the fixation of the Le Fort I fracture.

4 Addressing the Le Fort I fracture top


In the illustrated case, the Le Fort I fracture needs to be addressed after the palatal unit has been repaired. Please refer to the section on Le Fort fractures for further details.

5 Severely damaged or comminuted tooth-bone units top


In this patient the tooth–bone units are severely damaged or comminuted. Use of a palatal splint alone may not be feasible.

v1.0 2009-12-03