Analysis And The Secondary Treatment Of The Primary Treatment Failure Of Maxillofacial Fractures

Objective: To analyze the reasons and the characteristics of postoperative complications for the treatment failure of maxillofacial fracturesprimarily treated in the other hospitals, investigate the principle and right methods for the secondary treatment.Methods:Fifty one cases of jaw fracture with primary failure treatment in other hospitals were included from 2010 to June 2015 in our hospital,and the reasons for failure treatment were analyzed. 39 cases got rid of the old pates, including 21 cases were taken rigid internal fixation with new plate,12 cases with serious malposition healing of fracture orthognathic surgical correction.After the operation the intermaxillary elastics were maintained for 2 weeks,combined orthodontic treatment or occlusal adjustment,and patients were told to make training in opening and closing mouth regularly.Results:In these cases, there were 20 cases with postoperative infection, 14 cases with occlusion disorders, 11 cases with limitation of mouth opening, 6 cases with facial deformity, 7 cases with nerve injury.The main reasons for the failure of treatment included:(1)First diagnosis doctorwas not a maxillofacial surgeon, insufficient preoperative evaluation, inadequate operation, inaccurate reduction;(2)Improper internal fixation materials, methods and sites,inappropriate stress concentration;(3)The short-term intermaxillary fixation was neglected;(4) The poor compliance of patients;(5) Postoperative infection, improper nursing. All the51 patients had good healing of osteotomy segments without serious complications.47 cases had satisfied occlusal relationship and facial figure after the operations.4 cases with occlusion disorders required postoperativeorthodontic treatment or occlusal adjustment.4cases had good occlusal relationship but asymmetrical face and further more plastic reconstruction was necessary.49 patients were followed-up, 5 cases had moderate limitation of mouth opening 3 months after surgery.Conclusion:It is important to master the principle and right methods of jaw fracture treatment. Internal fixation materials,methods and sites should be appropriate. The short-term intermaxillary fixation is essential.The postoperative complications can be corrected after removal plate or rigid internal fixation with new plate.The cases with serious malposition healing of fracture can be satisfactorily corrected by orthodontic techniques. The complications of complicated upper and lower maxillofacial fractures require multiple surgeries to achieve satisfactory results.