Reconstruction Of Comminuted Maxillary Fracture

Objective: Maxillary locates in the central position of themidfacial skeleton, with complicated shape and not well-distributedthickness. It is a core area where is adjacent to orbit and oral cavityfrom ceiling to roof, also it contains a sinus which connects thenasal cavity and pharyngeal cavity. The integrity of the midfaceskeleton and the proper arrangement are the foundation ofmaintaining facial configuration and processing the normalfunction. To compare the clinical results of conservative treatmentand surgical treatment; also compare the clinical results of wireinternal fixation and the internal fixation using mini-titanium platesduring the treatment of comminuted maxillary fracture. To discussabout the etiologoy, complication, examination, surgery keypoint,incisions, materials and prognosis of comminuted maxillaryfracture.Methods: A retrospective review of 16 patient records is conducted.Among the 16 patients,9 are male with the incidence occurring inthe age group from 16 to 50 years old. 3 patients were simplecomminuted maxillary fracture, others were compound fractures: 7with orbital fracture, 4 with nasal bone fracture, 6 with malarfracture. All patients saw the doctors within one week after injury.4 patients underwent conservative treatment, others were treatedwith wire osteosynthesis or rigid internal fixation(RIF) withmini-titanium plate. 3 patients undertook operation as soon as theyentered the hospital. 6 patients received treatment from 3 to 10days after injury. 10 patients underwent the operation throughgingival-buccal-sulcus incision, 4 through lower eyelid incision, 3through itself wounds, 1 through outboard eyebrow incision.Results: Patients underwent conservative treatment have notsatisfied effect. A good stability can not be obtained with wireosteosynthesis in the treatment of comminuted maxillary fractures.The sustaining bony structure of maxillary can be reconstructedwith mini-titanium plate(RIF), which results in a sufficientthree-dimensional stability of the fractured segments and an idealfacial configuration. Mini-titanium plate RIF are more convenientand reliable than wire osteosynthesis in the difficult operationfields of the infraorbital margin and zygomaticomaxillary suture.Conclusion: Maxillary locates in the central position of themidfacial skeleton, with complicated shape and not well-distributedthickness. It is a core area where is adjacent to orbit and oral cavityfrom ceiling to roof, also it contains a sinus which connects thenasal cavity and pharyngeal cavity. Comminuted maxillaryfractures are very serious, and it often associated with seriouscomplications. For maxillary fracture is complicated, the purposeof surgery is mainly reconstruction midface stanchion. We shouldre-establish midface normal width, height and degree of extrusionat the same time, re-establish occlusion relation and openingdegrees normally. When will we perform the operation should beconsidered as the followings. One is the tissue has strong healingability; the other is whether the injury is more severe. The preferredoperation time is 5 to 10 days after injury. Paranasal sinuses CTscan is preferred method for maxillary fracture, CT imagingdemonstrated high specificity and sensitivity for maxillofacialfractures. The association of axial/MPR/3D-CT images addedimportant information in relationship to other CT protocols.Moreover, because maxillary fracture is complicated, X radiation isstill the indispensability. According to the authors, five incisionspermit access to the entire anterior craniofacial skeleton: thecoronal, lower eyelid, upper and lower gingival-buccal-sulcus, andthe preauricular-retromandibular. Through these incisions, thefacial buttresses can be accessed to allow reconstruction and rigidfixation of facial fractures. Open reduction and rigid fixation arecommonly used to treat displaced fractures of the facial skeleton.