Definition & Overview
Open or closed treatment of palatal or maxillary fractures is one of the treatment methods for maxillofacial fractures. Maxillary or midface fractures affect the two maxillae that form the upper jaw and the anterior part of the hard palate. A palatal fracture, on the other hand, affects the hard palate. Maxillofacial fractures can cause complications when not treated properly. These fractures can be treated with open surgery or closed therapy. In an open procedure, the doctor opens up the fracture site and sets the fractured bones manually. In a closed procedure, the bones are simply manipulated without a surgical incision. Doctors use either an open or closed procedure depending on which is more appropriate for each case.
Who Should Undergo and Expected Results
Open or closed treatment of palatal or maxillary fracture is necessary for patients who suffer from a broken bone in the maxillae and hard palate.
Maxillary fractures are classified into three different types, namely:
Le Fort I – This is a horizontal fracture across the maxilla’s inferior aspect. It usually results from a direct downward blow. It causes the alveolar process and the hard palate to become separated from the maxilla. The injury may also affect the palatine bones, the pterygoid plates, and the lower nasal septum.
Le Fort II – This is a pyramid-shaped fracture that often results from a blow to the middle or the lower part of the maxilla. The fracture usually runs from the nasal bridge and travels all the way across the pterygomaxillary fissure and through the pterygoid plates.
Le Fort III – This is a transverse fracture that often results from a blow to the upper maxilla or the nasal bridge. It causes all the facial bones from the cranial base to separate. Thus, all the bones near the cranial base may become mobile following the injury.
Maxillary fractures can cause the following symptoms:
- Loose teeth
- Facial oedema
- Mobile hard palate
- Subconjunctival haemorrhage
- CSF rhinorrhea
- Widened and flattened nasal bridge
- Facial flattening
- Airway obstruction
Palatal fractures, on the other hand, are caused by hard palate trauma. They are less common than maxillary fractures. However, when they do occur, they can cause a number of severe problems. These include severe malocclusion and wound complications. In fact, studies show that malocclusion occurs postoperatively in 8.9% of cases. Other complications also occur in 4.3% of all cases, with more of these wound complications occurring in cases where internal fixation techniques were used.
Both techniques are effective, but open treatment is associated with more risks and complications. However, closed reduction comes with its own limitations. For one thing, it has to be performed as soon as the bone breaks.
How is the Procedure Performed?
Open or closed treatment of palatal or maxillary fracture is used to restore the facial skeleton to its normal contour as much as possible. This means that after the procedure, the patient should be able to move his jaw and be able to chew and speak as normally as possible.
Both open and closed reduction of maxillary fractures are painful. Thus, patients are placed under local or general anaesthesia or a nerve block depending on the severity of the condition and the patient’s unique circumstances.
An open procedure is similar to a traditional open surgery in which an incision is made in the mouth or gums to gain access to the fractured bone. In severe maxillary fractures, the incisions may also be made in the hairline.
Meanwhile, closed reduction works by setting the bones right and allowing them to grow back together. Doctors use different techniques to do so, such as manipulation or traction.
In maxillary fractures that cause airway obstruction, airway management techniques are also used alongside open or closed treatment.
Once the fractured bones are placed back in their original position following a closed or open treatment, the bones will be stabilised and fixed using plates and screws. This way, the bones will not move again.
After suffering from a palatal or maxillary fracture and after receiving treatment, patients should go on a soft diet for several weeks as the fracture heals. They will also undergo maxillofacial x-rays to evaluate the success of the procedure.
Possible Risks and Complications
Between open and closed treatment methods, open techniques are associated with more potential risks and complications. These include:
- Wound infections
- Injury to tooth roots
Nevertheless, both types of treatment still put the patient at risk of some complications generally associated with fractures. These include:
- Total nonunion
- Blood clot
- Soft-tissue complications
- Nerve injury
- Allergic reactions to anaesthesia
In case a closed reduction does not work, the patient may undergo an open treatment instead.
Moss WJ, Kedarisetty S, Jafari A, Schaerer DE, Husseman JW. “A review of hard palate fracture repair techniques.” Journal of Oral and Maxillofacial Surgery. 2016 February. 74(2): 328-336.
http://www.sciencedirect.com/science/article/pii/S0278239115012951 Most SP. “Fractures of the jaw and face.” Merck Manual. http://www.merckmanuals.com/home/injuries-and-poisoning/facial-injuries/fractures-of-the-jaw-and-face
Moe KS. “Maxillary and le fort fractures treatment and management.” Medscape. http://emedicine.medscape.com/article/1283568-treatment#d16