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Part II

Management
of
MIDFACE FRACTURES

INDIAN DENTAL ACADEMY

Leader in continuing dental education
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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

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Treatment must be indivisualised
Factors affecting treatment stratigies
Multi-trauma
Concomitant mandibular Injury

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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
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Timing of Operative repair
Initial concept - 5
th
-8
th
day
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Surgical Approaches
Maxillary vestibular incision
Lower eyelid incision
Transconjunctival
Subciliary
Lower lid incision
Coronal Approach
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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
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Special Instruments


Rowes Maxillary
Disimpaction Forceps

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Hayton Williams Forceps
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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.
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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).

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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
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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.
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Lateral frontal wire:
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BOX FRAME
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Central frontal wire:

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2) Circum zygomatic:
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3) Zygomatic buttress and pyriform:








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Infra-orbital wiring.

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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.
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Halo Frame.

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BOX FRAME
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LEVANT FRAME
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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
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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)

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MAXILLOFACIAL INJURIES

ABCDE
Reduction & fixation
Closed v/s Open

MIDFACE FRACTURES
Management
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MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort I fractures ORIF plates

Intra oral approach
Fixation of plates after
reduction
Pyriform rim
Zygomatic buttress

MIDFACE FRACTURES
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MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort II fractures ORIF plates

Nasal #s
Infra orbital rim
Zygomatic buttress

MIDFACE FRACTURES
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MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort III fractures ORIF plates

Fronto-zygomatic
Fronto-nasal
Zygomatic buttress

MIDFACE FRACTURES
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MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort I, II & III fractures CLOSED

Reduction & Fixation
Suspension wires to mandible
Frontal: Central & lateral
Circum zygomatic


MIDFACE FRACTURES
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MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Le-Fort I, II & III fractures CLOSED

External fixation
Cranio-mandibular
Box, Halo frames
POP head cap
MIDFACE FRACTURES
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Thank you

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