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 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.

2 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.

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.

3 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.

4 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