There is considerable variation in different cases as to how unstable or comminuted the fractures may be. Another plate can also be applied at the piriform rim.Depending on the fracture pattern an L-, T-, Y-plate or a straight plate may be used. The highest forces of mastication would be in this area. A plate that is placed for the fixation of the fracture at the zygomaticomaxillary buttress is generally a larger plate because it is the point that will provide most stability to the Le Fort I fracture.The following however should be considered: It is difficult to give absolute guidelines as to the strength of the plates that would be used at the bony interfaces for a Le Fort I fracture. If available, dental cast, stereolithographic models, and/or premorbid photographs may be useful guides for treatment.Īs a general principle, all facial fractures should be exposed and reduced before plating. The goal is to achieve an anatomical correct repositioning by means of 3-D reconstruction. In order to properly achieve a passive position of the maxilla, the maxilla requires strong mobilization forces using varied instrumentation: Rowe’s disimpaction forceps, “Stromeyer” hook, Tessier retromaxillary mobilizers, etc. When the MMF is removed, the condyles re-seat themselves into their normal position, bringing the mandibular dentition forward, creating a Class III malocclusion. The reason for this is that when patients are placed into MMF during surgery, soft-tissue tension from the attached musculature distalizes the mandibular condyles in the glenoid fossae. Without passive mobilization, Class III tendency often occurs in the postoperative period. Portions of the pterygoid plates and associated musculature are still attached to the posterior portion of the maxilla, so passive mobilization of the fracture can be difficult.
These pillars can serve an even more important role in patients who lack dentition (partial or completely edentulous patients).Ī principle in all Le Fort fractures is to reestablish the premorbid dental occlusion. The aim of successful reconstruction of midface fractures is reestablishing the midfacial vertical buttresses. Depending on the patient’s general condition, a tracheostomy might also be considered. If that is not feasible, primary submental/submandibular intubation should be considered. Considerations related to dental occlusion render nasotracheal intubation necessary.
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