1 Splint application topenlarge
A decision has to be made whether or not the reduction of the palatal fracture is to be performed using a palatal splint. A palatal splint is recommended if the segments of tooth–bone units are relatively intact.
If the tooth–bone units are severely damaged or comminuted then a palatal splint alone may be insufficient.
In complex (comminuted) palatal fractures where the tooth–bone units are relatively intact, most surgeons consider utilization of a palatal splint critical. In these cases, it is necessary to take dental impressions, make dental models, and from these models make a palatal splint. (If dental models are available from previous treatment, this may be helpful.)
In these complex cases, cuts need to be made in the maxillary portion of the dental model to determine the premorbid contour of the maxillary arch. This is achieved by using the mandibular model. Once the maxillary cast model has been adjusted to its premorbid shape, the palatal splint is made using that maxillary model.
The palatal splint is then fixed on the palate, also using arch bars and peridental wires. Depending on the stability of the palatal unit, and of the postoperative airway, as well as any complicating issues of other midface fractures, the surgeon may choose to leave the patient in postoperative MMF.
In this photograph, dental impressions have been taken, models have been made, …
… and a clear plastic palatal splint has been made.
2 Reduction topenlarge
Closed treatment of complex palatoalveolar injuries preserves the blood supply of the comminuted segments.
Perform reduction by applying pressure laterally on the two maxillary halves to reduce the splayed fracture. This maneuver needs to be performed while the palatal splint is in place, as the splint offers the best guide as to whether an adequate reduction has been achieved. It may be necessary to continue this pressure while applying the arch bars. There may be an advantage of applying wires from the splint to the arch bar. It may be necessary in some cases to wire the splint to the teeth, and the arch bars to the teeth independently.
Depending on the degree of dentoalveolar trauma one may not be able to use a palatal splint.
Note: The focus has to be on to reestablishing occlusion and the transverse bony dimension.
In this photograph, the palatal splint has been inserted. Holes have been drilled through the palatal splint. These holes have been used to fix the wires to the arch bar.