MAXILLARY

FRACTURES
 SURGICAL ANATOMY
(MIDDLE THIRD)
 Maxillae -2
 Zygomatic -2
 Zygomatic process of Temporal bones - 2
 Palatine bones -2
 Nasal bones -2
 Lacrimal bones -2
 Inferior conchae -2
 Vomer -1
 Ethmoid -1
 Sphenoid -1
 (Pterygoid plates)
 CLASSIFICATION
 LeFort I ( Low level fracture)
 LeFort II ( Pyramidal fracture)
 LeFort III (High transverse fracture)
 SIGNS AND SYMPTOMS
(CLINICAL EXAMINATION)
PALPATION
• Extra oral
• Tenderness
• Abnormal Mobility
• Step deformity (At Sutures)
• FN ,FZ , IO, ZB.
 SIGNS AND SYMPTOMS
(CLINICAL EXAMINATION)
INSPECTION (csf rhinnorrhea pg
31)
• Intra oral
• Gagging of occlusion (Ant open bite)
• Ecchymosis buccal sulcus /palate
• Mid palatal Split
• Palpation
• Cracked pot sound
• mobility teeth
 RADIOGRAPHIC EXAMINATION
LOW
• Water’s view
• Lateral view face
• Occlusal view maxilla
• CT
• 3D
 TREATMENT
• Reduction
• Fixation
• Immobilization
 REDUCTION
• Rowe’s disimpaction forceps pg 97
• Close reduction (lower 1/3rd)-by
eyelets, imf, splints, Suspension
wires.
• Occlusion
• Open reduction-(Mid face)-Direct
osteosynthesis - Mini plates
/Transosseous wiring
• Occlusion
• infra orbital margins-continuity
• fronto zygomatic suture-continuity
 LEFORT II
 If frac is in one piece, it may be reduced in
same way as lefort l. If there is coexisting
lefort l frac, manipulation by row’s will
only reduce the tooth beraing portion. The
rest of the frag can be reduced by
grasping the nasal septum with Asche’s
or Walshman’s septal forcep while at
the same time exrting forw pressure on
the soft palate with finger.
 After this any ass nasoeth frac is treated.
FIXATION AND IMMOBILIZATION
(CLOSE REDUCTION)
• IMF, splints, eyelet (spie)
• Suspension Wires(sandwitch between
mand and frontal bone )
• Fronto-Mandibular suspension - LeFort 3
• Circumzygomatic suspension - LeFort 2
• Infraorital-mandibular susp - LeFort 1
• Pyriform aperature-mandibular Susp- LeFort 1
• Cranio mandibular/craniomaxillary
• POP head cap
• Halo frame
FIXATION AND IMMOBILIZATIOM
(OPEN REDUCTION) internal

fixation
Direct osteosynthesis - Mini plates
/Transosseous wiring
• High level
 Fronto zygomatic

 Fronto nasal

• Mid level
 Infra orbital margin

 Zygomatic buttress

• Low level
 Alveolar

 Mid palatal

 Support
• Antral pack
• Antral balloon
 SEQUENCE OF RX
IN MULTIPLE FRACTUES
 Rule
• Inside to outside & bottom to up
 Rule
• outer ring – to inner ring
• Example- In poly trauma patient
• Extraction
• Arch bars/splints fixed
• oral lacerations Stitched
• Open reduction/rigid fix mand fracture
• max fracture reduced- IMF
• Incisions at FZ suture, ZM suture,
• Zygomatic bone fixed
• Floor of orbit
• Naso ethmoidal injuries
• skin lacerations - stitched
 COMPLICATIONS
(IMMEDIATE )
 AIRWAY
 NASAL HEAEMORRHAGE
 OPTHALMIC
• RETINAL ARTERY SPASM
• RETRO BULBAR HAEMORRHAGE
• INJURY TO OPTIC NERVE
 INACCURATE REDUCTION/FIXATION
• MALOCCLUSION
• SUSPENSION WIRE INACCURATE
 COMPLICATIONS delayed
FINOMN
 INFECTION
• ODONTOGENIC
• SINUSITIS
 NON UNION (RARE)
 FACIAL PROFILE DEFECT
• LONG FACE OR DISH FACE
 MALOCCLUSION
• ANT OPEN BITE
• GAGGING OF MOLARS
 NASAL
• DEVIATION
• OBSTRUCTION (NASAL SEPTUM DEVIATED)
• ANOSMIA
• CSF RHINORRHOEA –DELAYED ONSET
 ORONASAL/OROANTRAL FISTURLA
 COMPLICATIONS LATE -BONS
 OPHTHALMIC
• BONE DEFORMITY
 DIPLOPIA

 ENOPTHALMOS

 EPIPHORIA

• NEUROLOGIC
 Injury to infra orbital nerve

 SUPERIOR ORBITAL FISSURE SYND

• Opthalmoplegia
• DIPLOPIA
• PTOSIS
 OPTIC NERVE

• BLINDNESS