Mid face fractures#2 /certified fixed orthodontic courses by Indian dental academy

Part –II
Management
of
MIDFACE FRACTURES
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Treatment
Goal is functional & cosmetic
restoration
Reestablish:





Mid-facial height and projection (most
important)
Occlusion
Integrity of nose and orbit

Provide structural support for proper
soft tissue contour

Treatment must be indivisualised
Factors affecting treatment stratigies


Multi-trauma



Concomitant mandibular Injury


Principles of Treatment
(Rodrich & Shewmake,1992)

Early 1 stage repair
Exposure of all # sites
Precise Anatomic reduction & semirigid
fixation
Immediate bone grafting if needed
Definitive soft tissue repair

Timing of Operative repair

Initial concept - 5th -8th day


Surgical Approaches
Maxillary vestibular incision
Lower eyelid incision
Transconjunctival
Subciliary
Lower lid incision
Coronal Approach

Reduction of Midface Fractures
Most imp step.
Universal rule of mechanics
Reduction:


Manual reduction : Fresh #, Non impacted
Hand manipulation
Dental compounds (1951)
Rubber cathaters (1966)
Special instruments


Special Instruments
Rowe’s Maxillary
Disimpaction Forceps


Hayton Williams Forceps


Lefort II & III –
When inadequate alignment results,
individual

segments

are

reduced

separately.
Direct reduction: Elevator, bone hook or
wire inserted through the fragment.
Traction using elastic bands applied to
maxillary and mandibular arch bar can be
used for reducing fraction.

Immobilization of mid-face
fractures:
A) Internal fixation
a..Direct osteosynthesis :
Miniplates
Transosseous wiring.
High level (fronto-zygomatic and fronto-nasal)
Mid level (orbital rim/ zygoma buttress).
Low level (Alveolar / midpalatal).

b..Suspension wires (Skeletal fixation).
A)Frontal :

Central (LeFort II & III ; Unstable

mand.)
Lateral ( LeFort II & III ; Stable mand)
b) Circum-zygomatic
c) Zygomatic-fronto
d) Infra-orbital rim.
e) Pyriform aperture.
f) Buttress, transnasal
g) Perialveolar wire www.indiandentalacademy.com

B) External fixation:
1) Cranio-mandibular
Box frame
Halo frame.
Plaster of paris head cap.
2) Craniomaxillary:
Supra-orbital pins.
Zygomatic pins.
Halo frames.
Levant Frames.


Lateral frontal wire:


BOX FRAME


Central frontal wire:


2) Circum zygomatic:


3) Zygomatic buttress and pyriform:


Infra-orbital wiring.


Various –
Plaster of paris.
Halo frame.
Box frame.
Levant frame.
Indication – Presence of anteroposterior instability
of the facial skeleton (i.e. concomitant B/L
condylar # of mandible).
Disadvantage: Appliances are cumbersome,
conspicuous is lead to lengthen the period of
hospitalization.
Contraindicated : Presence of mental confusion,
cerebral irritation, epilepsy and alcoholism.

Halo Frame.


LEVANT FRAME


Internal Fixation
- Michelet first introduced miniplate in
facial # 1972.
Monocortical semi-rigid fixation with
plates or screws:





Provides three diamenssional stability
resists antero-posterior and rotatory bony
movements.
Allows primary bony healing


Different configuration X,H, L,T and Y
shapes.
Various material like
Stainless steel
Titanium
Vitallium (Cobalt-chromium and
molydenum)
Resorbable bone plates and screws
(Polylactide, polyglycolic copolymer)


MAXILLOFACIAL INJURIES
MIDFACE FRACTURES
Management

ABCDE
Reduction & fixation
Closed v/s Open


MIDFACE FRACTURES
Le-Fort I fractures ORIF plates
Intra oral approach
Fixation of plates after
reduction
Pyriform rim
Zygomatic buttress

GK / MAXFAC
SDM DHARWAD


MIDFACE FRACTURES
Le-Fort II fractures ORIF plates
Nasal #s
Infra orbital rim
Zygomatic buttress

GK / MAXFAC
SDM DHARWAD


MIDFACE FRACTURES
Le-Fort III fractures ORIF plates
Fronto-zygomatic
Fronto-nasal
Zygomatic buttress

GK / MAXFAC
SDM DHARWAD


MIDFACE FRACTURES
Le-Fort I, II & III fractures CLOSED
Reduction & Fixation
Suspension wires to mandible
Frontal: Central & lateral
Circum zygomatic


GK / MAXFAC
SDM DHARWAD

MIDFACE FRACTURES
Le-Fort I, II & III fractures CLOSED
External fixation
Cranio-mandibular
Box, Halo frames
POP head cap


GK / MAXFAC
SDM DHARWAD

Thank you
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Mid face fractures#2 /certified fixed orthodontic courses by Indian dental academy

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